ADHD Symptoms and Smoking Outcomes in a Randomized Controlled Trial of Varenicline for Adolescent and Young Adult Tobacco Cessation

Overview

Journal Drug Alcohol Depend

Publisher Elsevier

Specialty Psychiatry

Date 2023 Feb 12

PMID 36774808

Authors

ReJoyce Green

Nathaniel L Baker

Pamela L Ferguson

Daniel Hashemi

Kevin M Gray

Affiliations

Soon will be listed here.

Abstract

Background: Most adult daily smokers try their first cigarette during adolescence. Attention-Deficit Hyperactivity Disorder (ADHD) in adolescents is associated with increased risk for cigarette smoking. The impact of ADHD symptoms on smoking cessation among adolescents has been less well-studied. The present secondary data analysis from a clinical trial of varenicline examined ADHD symptoms as a moderator of smoking cessation in adolescents and young adults.

Methods: The double-blind, placebo-controlled trial included treatment-seeking daily cigarette smokers ages 14 - 21 (N = 157) randomized to receive a 12-week course of varenicline or placebo, added to weekly smoking cessation counseling. At pre-treatment assessment, participants were administered a self-report measure of ADHD symptoms, the ADHD - Rating Scale (ADHD-RS). High (≥5) versus low (<5) and continuous ADHD-RS symptom counts in both hyperactive/impulsive (HI) and inattention (IA) domains were examined as predictors of smoking outcomes.

Results: Participants with high IA symptoms at baseline were less likely to achieve 7-day point prevalence abstinence (PPA) at weekly visits (p = .001) during active treatment and end-of-treatment (p = .002) compared to those with low IA symptoms. In contrast, high HI symptoms did not predict differences in 7-day PPA or end-of-treatment abstinence versus low symptoms (p's ≥ .07). These findings were not modified by varenicline versus placebo treatment assignment.

Conclusions: ADHD IA symptoms were associated with poorer cessation outcomes among adolescent smokers. These findings warrant additional investigation into how ADHD symptoms may be accounted for in smoking cessation interventions for adolescents and young adults.

References

Doran N, Cook J, McChargue D, Spring B . Impulsivity and cigarette craving: differences across subtypes. Psychopharmacology (Berl). 2009; 207(3):365-73. PMC: 2776936. DOI: 10.1007/s00213-009-1661-x. View

Barrington-Trimis J, Braymiller J, Unger J, McConnell R, Stokes A, Leventhal A . Trends in the Age of Cigarette Smoking Initiation Among Young Adults in the US From 2002 to 2018. JAMA Netw Open. 2020; 3(10):e2019022. PMC: 7539122. DOI: 10.1001/jamanetworkopen.2020.19022. View

Nides M, Oncken C, Gonzales D, Rennard S, Watsky E, Anziano R . Smoking cessation with varenicline, a selective alpha4beta2 nicotinic receptor partial agonist: results from a 7-week, randomized, placebo- and bupropion-controlled trial with 1-year follow-up. Arch Intern Med. 2006; 166(15):1561-8. DOI: 10.1001/archinte.166.15.1561. View

Sobell L, Sobell M, Leo G, Cancilla A . Reliability of a timeline method: assessing normal drinkers' reports of recent drinking and a comparative evaluation across several populations. Br J Addict. 1988; 83(4):393-402. DOI: 10.1111/j.1360-0443.1988.tb00485.x. View

Bidwell L, Karoly H, Hutchison K, Bryan A . ADHD symptoms impact smoking outcomes and withdrawal in response to Varenicline treatment for smoking cessation. Drug Alcohol Depend. 2017; 179:18-24. PMC: 5599352. DOI: 10.1016/j.drugalcdep.2017.06.020. View

Mitchell J, Howard A, Belendiuk K, Kennedy T, Stehli A, Swanson J . Cigarette Smoking Progression Among Young Adults Diagnosed With ADHD in Childhood: A 16-year Longitudinal Study of Children With and Without ADHD. Nicotine Tob Res. 2018; 21(5):638-647. PMC: 6468128. DOI: 10.1093/ntr/nty045. View

Zou G . A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004; 159(7):702-6. DOI: 10.1093/aje/kwh090. View

Whalen C, Jamner L, Henker B, Delfino R, Lozano J . The ADHD spectrum and everyday life: experience sampling of adolescent moods, activities, smoking, and drinking. Child Dev. 2004; 73(1):209-27. DOI: 10.1111/1467-8624.00401. View

Burke M, Hays J, Ebbert J . Varenicline for smoking cessation: a narrative review of efficacy, adverse effects, use in at-risk populations, and adherence. Patient Prefer Adherence. 2016; 10:435-41. PMC: 4824380. DOI: 10.2147/PPA.S83469. View

10.

Gonzales D, Rennard S, Nides M, Oncken C, Azoulay S, Billing C . Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA. 2006; 296(1):47-55. DOI: 10.1001/jama.296.1.47. View

11.

Cornelius M, Loretan C, Wang T, Jamal A, Homa D . Tobacco Product Use Among Adults - United States, 2020. MMWR Morb Mortal Wkly Rep. 2022; 71(11):397-405. PMC: 8942309. DOI: 10.15585/mmwr.mm7111a1. View

12.

Kollins S, McClernon F, Fuemmeler B . Association between smoking and attention-deficit/hyperactivity disorder symptoms in a population-based sample of young adults. Arch Gen Psychiatry. 2005; 62(10):1142-7. DOI: 10.1001/archpsyc.62.10.1142. View

13.

Bitsko R, Claussen A, Lichstein J, Black L, Jones S, Danielson M . Mental Health Surveillance Among Children - United States, 2013-2019. MMWR Suppl. 2022; 71(2):1-42. PMC: 8890771. DOI: 10.15585/mmwr.su7102a1. View

14.

Caye A, Swanson J, Thapar A, Sibley M, Arseneault L, Hechtman L . Life Span Studies of ADHD-Conceptual Challenges and Predictors of Persistence and Outcome. Curr Psychiatry Rep. 2016; 18(12):111. PMC: 5919196. DOI: 10.1007/s11920-016-0750-x. View

15.

Zeger S, Liang K . Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986; 42(1):121-30. View

16.

Gray K, Carpenter M, Lewis A, Klintworth E, Upadhyaya H . Varenicline versus bupropion XL for smoking cessation in older adolescents: a randomized, double-blind pilot trial. Nicotine Tob Res. 2011; 14(2):234-9. PMC: 3265741. DOI: 10.1093/ntr/ntr130. View

17.

Faessel H, Ravva P, Williams K . Pharmacokinetics, safety, and tolerability of varenicline in healthy adolescent smokers: a multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Clin Ther. 2009; 31(1):177-89. DOI: 10.1016/j.clinthera.2009.01.003. View

18.

Gudjonsson G, Sigurdsson J, Sigfusdottir I, Young S . An epidemiological study of ADHD symptoms among young persons and the relationship with cigarette smoking, alcohol consumption and illicit drug use. J Child Psychol Psychiatry. 2011; 53(3):304-12. DOI: 10.1111/j.1469-7610.2011.02489.x. View

19.

Gentzke A, Wang T, Cornelius M, Park-Lee E, Ren C, Sawdey M . Tobacco Product Use and Associated Factors Among Middle and High School Students - National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ. 2022; 71(5):1-29. PMC: 8923300. DOI: 10.15585/mmwr.ss7105a1. View

20.

Pan W . Akaike's information criterion in generalized estimating equations. Biometrics. 2001; 57(1):120-5. DOI: 10.1111/j.0006-341x.2001.00120.x. View