title: Association of attention-deficit/hyperactivity disorder and conduct disorder with early tobacco and alcohol use.
abstract: BACKGROUND
  The association of attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) with tobacco and alcohol use has not been assessed in a young adolescent sample representative of the U.S. population.
  
  
  METHODS
  Data are from the 2000-2004 National Health and Nutrition Examination Survey, a cross-sectional sample representative of the U.S. population. Participants were age 12-15 years (N=2517). Exposure variables included diagnosis of ADHD and CD, and counts of ADHD and CD symptoms based on caregiver responses to the Diagnostic Interview Schedule for Children. Primary outcomes were adolescent-report of any use of tobacco or alcohol and age of initiating use. Multivariate logistic regression and Cox proportional hazard models were conducted.
  
  
  RESULTS
  Adolescents with ADHD+CD diagnoses had a 3- to 5-fold increased likelihood of using tobacco and alcohol and initiated use at a younger age compared to those with neither disorder. Having ADHD alone was associated with an increased likelihood of tobacco use but not alcohol use. Hyperactive-impulsive symptom counts were not independently associated with any outcome, while every one symptom increase in inattention increased the likelihood of tobacco and alcohol use by 8-10%. Although participants with a diagnosis of CD alone (compared to those without ADHD or CD) did not have a higher likelihood of tobacco or alcohol use, for every one symptom increase in CD symptoms the odds of tobacco use increased by 31%.
  
  
  CONCLUSIONS
  ADHD and CD diagnoses and symptomatology are linked to higher risk for a range of tobacco and alcohol use outcomes among young adolescents in the U.S.
authors.affiliation: Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 7035, Cincinnati, OH 45229, USA. Electronic address: Bill.Brinkman@cchmc.org.
authors.forename: William B
authors.initials: WB
authors.lastname: Brinkman
authors.affiliation: Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 7035, Cincinnati, OH 45229, USA. Electronic address: Jeff.Epstein@cchmc.org.
authors.forename: Jeffery N
authors.initials: JN
authors.lastname: Epstein
authors.affiliation: University of Rochester School of Medicine and Dentistry, Saunders Research Bldg, Box 694, Rochester, NY 14642, USA. Electronic address: Peggy_Auinger@URMC.Rochester.edu.
authors.forename: Peggy
authors.initials: P
authors.lastname: Auinger
authors.affiliation: Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 7035, Cincinnati, OH 45229, USA. Electronic address: Leanne.Tamm@cchmc.org.
authors.forename: Leanne
authors.initials: L
authors.lastname: Tamm
authors.affiliation: Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 7035, Cincinnati, OH 45229, USA. Electronic address: Tanya.Froehlich@cchmc.org.
authors.forename: Tanya E
authors.initials: TE
authors.lastname: Froehlich
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D002648:Child; D019955:Conduct Disorder / Q000453:epidemiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D012959:Socioeconomic Factors; D064424:Tobacco Use / Q000453:epidemiology* / Q000523:psychology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Alcohol; Attention-deficit/hyperactivity disorder; Conduct disorder; Early onset substance use; Tobacco