Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) smoke cigarettes at a higher rate, initiate smoking at an earlier age, and have greater difficulty quitting compared to those without ADHD. It has been hypothesized that those with ADHD smoke in order to improve cognitive functioning (e.g., attention) and regulate negative affect. In addition, situational cues have been proposed to elicit smoking among ADHD smokers. However, there have been few empirical studies assessing these contextual factors of smoking among ADHD smokers. The work that has been done is generally limited by retrospective reporting methods to assess these factors. Ecological momentary assessment (EMA), which measures target behaviors in natural settings, may provide a more accurate and ecologically valid assessment of real-time functioning than retrospective self-report measures administered in laboratory settings. The overall goal of this study is to examine the impact of (a) smoking antecedents and (b) consequences of smoking on ADHD symptoms and mood among cigarette smokers with ADHD in the context of everyday life by utilizing EMA methods. ADHD smokers will complete multiple electronic diary entries on a handheld palm pilot over the course of 7 days at self-initiated (i.e., immediately prior to and following smoking) and experimenter prompted time points to report on smoking behavior and other relevant contextual variables. An analysis of antecedent conditions that are associated with smoking behavior and the consequences of smoking will be conducted. The primary hypotheses predict that ADHD smokers are more likely to smoke in the presence of elevated ADHD symptoms, negative affect, and in situations that require concentration or elicit negative affect. In addition, the act of smoking is predicted to result in a reduction in ADHD symptoms and negative affect. This study will lead to a better understanding of the high rates of smoking/nicotine dependence in those with ADHD. Results from this research will identify risk and protective factors associated with tobacco use among ADHD samples, and may inform the development of novel treatment and preventative efforts. These findings will also demonstrate the utility of a new research technology to improve behavioral assessment.

Public Health Relevance

Cigarette smoking is the leading preventable cause of death in the US and individuals with ADHD smoke at significantly higher rates than people without ADHD. This project will help to identify why people smoke in the service of developing a better understanding of the relationship between ADHD and smoking/nicotine dependence, which has the potential to inform prevention and treatment programs.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Small Research Grants (R03)
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Special Emphasis Panel (ZDA1-GXM-A (03))
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Lin, Yu
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Duke University
Schools of Medicine
United States
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Mitchell, John T; Schick, Robert S; Hallyburton, Matt et al. (2014) Combined ecological momentary assessment and global positioning system tracking to assess smoking behavior: a proof of concept study. J Dual Diagn 10:19-29
Mitchell, John T; Dennis, Michelle F; English, Joseph S et al. (2014) Ecological momentary assessment of antecedents and consequences of smoking in adults with attention-deficit/hyperactivity disorder. Subst Use Misuse 49:1446-56