Stimulant treatment of ADHD and cigarette smoking: a meta-analysis.
BACKGROUND AND OBJECTIVE
Individuals with attention-deficit/hyperactivity disorder (ADHD) have a significantly higher risk of cigarette smoking. The nature of the relationship between smoking and psychostimulant medications commonly used to treat ADHD is controversial. Our objective was to examine the relationship between stimulant treatment of ADHD and cigarette smoking by using meta-analysis, and to identify study and sample characteristics that moderate this relationship.


METHODS
Literature searches on PubMed and PsycInfo databases identified published studies for inclusion. Included studies compared cigarette smoking outcomes for stimulant-treated and untreated ADHD individuals. Seventeen studies met inclusion criteria, and 14 (total n = 2360) contained sufficient statistical information for inclusion in the meta-analysis. Two authors extracted odds ratios or frequencies of smokers in the treatment or nontreatment groups, and coded study characteristics including sample source, percentage of male participants, follow-up length, treatment consistency, type of smoking measure, prospective study, and controlling for comorbidities.


RESULTS
Meta-analysis revealed a significant association between stimulant treatment and lower smoking rates. Meta-regression indicated that effect sizes were larger for studies that used clinical samples, included more women, measured smoking in adolescence rather than adulthood, conceptualized stimulant treatment as consistent over time, and accounted for comorbid conduct disorder.


CONCLUSIONS
Nearly all studies were naturalistic, precluding causal inferences. Available data were insufficient to examine additional influences of patient demographics, treatment effectiveness, or other comorbidities. Consistent stimulant treatment of ADHD may reduce smoking risk; the effect was larger in samples with more severe psychopathology. Implications for further research, treatment of ADHD, and smoking prevention are discussed.
['Schoenfelder|Erin N|EN|', 'Faraone|Stephen V|SV|', 'Kollins|Scott H|SH|']
D000293:Adolescent D000328:Adult D001289:Attention Deficit Disorder with Hyperactivity D000697:Central Nervous System Stimulants D002648:Child D003430:Cross-Sectional Studies D005260:Female D006801:Humans D008137:Longitudinal Studies D008297:Male D012306:Risk D012907:Smoking D000074606:Smoking Prevention D013223:Statistics as Topic D014029:Tobacco Use Disorder D014481:United States D055815:Young Adult
ADHD cigarette smoking meta-analysis psychostimulant medication