Personality differences associated with smoking experimentation among adolescents with and without comorbid symptoms of ADHD

Prevalence of cigarette smoking and its related factors among Iranian male workers

Background: Smoking is considered as the second leading risk factor of early death and disability throughout the world. Smoking is the second leading risk factor of early death and disability in the world. The workplace is an important setting for the implementation of cigarette smoking prevention and control interventions. This study aimed to determine the prevalence of cigarette smoking and related factors by focusing on ADHD and risk-taking behaviors among a sample of Iranian workers.

Methods: This cross-sectional study was conducted on 2434 male workers of Kaveh Industrial City in Saveh. Random cluster sampling was used in the selection of workers. All workers completed five sets of anonymous and validated questionnaires. ADHD was measured by Conner’s Adult ADHD Rating Scales. Data analysis was done using chi-square, independent t-test and logistic regression model in STATA 10. Also, P-value <0.05 was considered statistically significant.

Results: The mean age of the workers was 32.80±7.05 years. The prevalence of cigarette smoking in the lifetime, last year, last month, and daily or almost daily in the last month were 26.2%, 20.6% , 18.5%, and 13.1% respectively. After adjustment, age (OR=1.08), sensation seeking (OR=1.57), hookah smoking (OR=4.21), alcohol use (OR=2.51), sexual risk behaviors (OR=2.25), religiosity (OR=0.95) and self-esteem (OR=2.02) were associated with cigarette smoking.

Conclusion: Our results showed that 13.1 % of workers were regular smokers (daily or almost daily). Specific programs in workplaces, including interventions to enhance self-steam and reduce anxiety, can be effective in lowering cigarette smoking prevalence. Also, comprehensive interventions to reduce or prevent different risk-taking behaviors can be considered as elements of preventive action plans.

UPPS-P impulsive personality traits and adolescent cigarette smoking: A meta-analysis

BACKGROUND

Adolescence is a critical developmental period in the trajectory of nicotine dependence, highlighting the need for a greater understanding of the modifiable risk factors. An extensive body of research has found that trait impulsivity is associated with higher levels of adolescent smoking; however, findings have been mixed. The present study aimed to synthesise existing literature to determine the strength and nature of the relationship between the UPPS-P impulsive traits and both adolescent cigarette consumption and nicotine dependence.

METHODS

Fifty-one studies were meta-analysed using a random effects model to determine the association between each UPPS-P impulsive trait and both adolescent cigarette consumption and nicotine dependence. Age, gender, ethnicity and sample type were examined as potential moderators.

RESULTS

Cigarette consumption was positively associated with each UPPS-P impulsive trait (r's ranging from 0.17-0.20). There were an insufficient number of studies to meta-analyse the association between nicotine dependence and the UPPS-P impulsive traits. There were no significant moderation effects of age, gender, ethnicity or sample type.

CONCLUSIONS

Findings suggest that each UPPS-P impulsive trait shares similar associations with adolescent cigarette consumption. Additional studies are needed to determine the relationship between adolescent nicotine dependence and impulsivity. As most adult smokers initiate during adolescence, targeting these impulsive traits via novel prevention and intervention strategies may assist in reducing the prevalence of smoking.

Temperament and character traits in patients with tinnitus: a prospective case series with comparisons

OBJECTIVE

To describe the personality traits of temperament and character in patients with tinnitus and to identify differences in these traits associated with the severity of tinnitus.

STUDY DESIGN

Case series with comparisons.

SETTING

Tertiary referral centre.

PARTICIPANTS

From January to December 2014, one hundred and thirty-four adult patients with chronic subjective tinnitus completed psychoacoustic measurements of tinnitus and the Temperament and Character Inventory (TCI).

MEASUREMENTS

Personality traits were assessed by the TCI. The TCI assesses seven dimensions of personality traits and four temperaments 'novelty seeking, harm avoidance, reward dependence, persistence', as well as three characters 'self-directedness, cooperativeness, self-transcendence'.

MAIN OUTCOME MEASURES

The values of the TCI parameters in the tinnitus patients were compared with reference data from a non-institutional adult population, and associations between TCI parameter values and tinnitus severity were evaluated.

RESULTS

In terms of temperament, tinnitus patients had higher scores for 'harm avoidance', whereas scores for 'novelty seeking', 'reward dependence' and 'persistence' were significantly lower than the reference. In terms of character, lower 'cooperativeness' and 'self-transcendence' were identified in the subjects with tinnitus. The 'novelty seeking' score was inversely related to tinnitus severity (r = -0.285, P = 0.001), while other temperament and character traits did not show significant correlations.

CONCLUSIONS

There may be a connection between tinnitus and personality traits, especially in the case of 'novelty seeking', which is relatively constant over a lifetime. The TCI questionnaire may be useful in facilitating the application of personality traits to tailored counselling for tinnitus.

Prevalence and smoking behavior characteristics of nonselected smokers with childhood and/or adult self-reported ADHD symptoms in a smoking-cessation program: a cross-sectional study

BACKGROUND

ADHD involves impairing core symptoms of inattention and hyperactivity/impulsivity in children (childhood ADHD = CH) that may persist in adulthood (adult ADHD = AD). Conflicting findings have been found regarding AD prevalences among adult smokers, and it is unclear whether AD is associated with a more severe smoking behavior in adulthood.

OBJECTIVE

The aim of this article is (a) to determine CH and AD prevalences in a nonselected sample of adult smokers, (b) to describe the characteristics of smokers with ADHD symptoms versus those without, and (c) to determine whether CH and/or AD symptoms are risk factors for more severe smoking in adulthood.

METHOD

Three hundred and seventy-three participants aged 18 years and over were prospectively recruited in a smoking-cessation unit. Participants were classified as "no ADHD symptoms," "CH symptoms," or "AD symptoms" according to their baseline score on the Wender Utah Rating Scale (WURS) alone (for CH symptoms) and WURS combined to the Adult Self Report Scale (ASRS) for AD symptoms. Other clinical variables were reported at first consultation.

RESULTS

(a) CH symptoms were reported in 15.3% (57/373) of the total sample, 42.1% (24/57) of whom also had persistent ADHD symptoms in adulthood (prevalence of AD was 24/373 = 6.4%). (b) In comparison with participants without ADHD symptoms, smokers with ADHD symptoms consume significantly more tobacco, but ADHD symptoms were no longer significantly associated with the daily number of smoked cigarettes after adjustment for sociodemographic variables. No significant association was found between the two groups and age at the first cigarette, age at onset daily smoking, and nicotine dependence. (c) Participants were categorized into three groups: Group 1 without ADHD symptoms lifetime (NH; n = 316), Group 2 with childhood history of ADHD symptoms (CH; n = 33), and Group 3 with Adult ADHD symptoms (AD; n = 24). The association with tobacco consumption (>20 cigarettes/day) was significant for CH only (p = .02). After adjustment for gender, age, professional status, and educational level, this association was not longer significant.

CONCLUSION

Childhood and adult ADHD symptoms are both highly prevalent among nonselected smokers but our study failed to show more severe smoking characteristics among these participants after adjustment with sociodemographic variables.

Contingency management improves smoking cessation treatment outcomes among highly impulsive adolescent smokers relative to cognitive behavioral therapy

BACKGROUND

Impulsive adolescents have difficulty quitting smoking. We examined if treatments that provide behavioral incentives for abstinence improve treatment outcomes among impulsive adolescent smokers, who have been shown to be highly sensitive to reward.

METHODS

We ran secondary data analyses on 64 teen smokers (mean age=16.36 [1.44]; cigarettes/day=13.97 [6.61]; 53.1% female; 90.6% Caucasian) who completed a four-week smoking cessation trial to determine whether impulsive adolescents differentially benefit from receiving cognitive behavioral therapy (CBT), contingency management (CM), or the combination of the two (CM/CBT). Indices of treatment efficacy included self-report percent days abstinent and end of treatment biochemically-confirmed 7-day point prevalence abstinence (EOT abstinence). We assessed self-reported impulsivity using the Brief Barratt Impulsiveness Scale. We used univariate Generalized Linear Modeling to examine main effects and interactions of impulsivity and treatment condition as predictors of self-reported abstinence, and exact logistic regression to examine EOT abstinence.

RESULTS

CM/CBT and CM were comparably effective in promoting abstinence, so analyses were conducted comparing the efficacy of CBT to treatments with a CM component (i.e., CM and CM/CBT). CBT and deficient self-regulation predicted lower self-reported abstinence rates within the total analytic sample. Treatments containing CM were more effective than CBT in predicting 1) self-reported abstinence among behaviorally impulsive adolescents (% days abstinent: CM 77%; CM/CBT 81%; CBT 30%) and 2) EOT point prevalence abstinence among behaviorally impulsive adolescents and adolescents with significant deficits in self-regulation.

CONCLUSION

CM-based interventions may improve the low smoking cessation rates previously observed among impulsive adolescent smokers.

Predictors of middle school students' interest in participating in an incentive-based tobacco prevention and cessation program in connecticut

Behavioral incentives have been used to encourage smoking cessation in older adolescents, but the acceptability of incentives to promote a smoke-free lifestyle in younger adolescents is unknown. To inform the development of novel, effective, school-based interventions for youth, we assessed middle school students' interest in participating in an incentive-based tobacco abstinence program. We surveyed 988 students (grades 6–8) attending three Connecticut middle schools to determine whether interest in program participation varied as a function of (1) intrapersonal factors (i.e., demographic characteristics (sex, age, race), smoking history, and trait impulsivity) and/or (2) aspects of program design (i.e., prize type, value, and reward frequency). Primary analyses were conducted using multiple regression. A majority of students (61.8%) reported interest in program participation. Interest did not vary by gender, smoking risk status, or offering cash prizes. However, younger students, non-Caucasian students, behaviorally impulsive students, and students with higher levels of self-regulation were more likely to report interest. Inexpensive awards (e.g., video games) offered monthly motivated program interest. In sum, middle school students reported high levels of interest in an incentive-based program to encourage a tobacco-free lifestyle. These formative data can inform the design of effective, incentive-based smoking cessation and prevention programs in middle schools.

Smoking behavior characteristics of non-selected smokers with childhood attention-deficit/hyperactivity disorder (AD/HD) history: a systematic review and meta-analysis

It is unclear whether adult smokers with childhood attention-deficit/hyperactivity disorder history (CH) have more severe smoking behavior than non-CH smokers, while it is clearly suggested that CH adolescents have more severe smoking behavior than CH adolescents. The aim of the present comprehensive meta-analysis is to determine whether CH smokers have more severe smoking behavior characteristics than those without and the effect of age on the association between CH and smoking behavior. We included all case-control studies and first round data collection of observational studies addressing the difference in smoking behavior characteristics of CH smokers versus non-CH smokers, with validated scales or structured interviews, without any language or date restriction. Nine studies (including 365 smokers with CH and 1,708 smokers without) were included. Compared to non-CH smokers, CH smokers smoked significantly more cigarettes [standardized mean differences (SMD) = 0.15, 95 % CI 0.01-0.28, p = 0.04] and began to regularly smoke earlier (SMD = -0.28, 95 % CI -0.49; -0.07, p = 0.01) but were not significantly more nicotine dependent (SMD = 0.23, 95 % CI -0.04 to 0.48, p = 0.08). After removing the single adolescent study, the significant association between CH and number of daily smoked cigarettes disappeared, and subgroups analyses confirmed that the significant association between CH and number of daily smoked cigarettes disappeared as age increased. Our meta-analysis illustrates a clinically important link between CH and tobacco smoking in adolescence but not later in life. Further high-quality studies are needed to confirm this finding, as only two studies included participants with a mean age below 20 years.

Long-term relationship between methylphenidate and tobacco consumption and nicotine craving in adults with ADHD in a prospective cohort study

Patients with Attention-Deficit/Hyperactivity disorder (ADHD) have higher smoking rates, a younger age of smoking onset, and increased difficulty to stop smoking as compared to controls. Methylphenidate induced acute effects of increased smoking in laboratory studies, but long-term effects are unknown. We studied the acute and long-term relationship between methylphenidate use and tobacco consumption and nicotine craving among ADHD patients naïve for methylphenidate (N=325). Patients filled out the Smoking Questionnaire (SQ) at baseline, and after two-weeks and three-months of methylphenidate use. The SQ involved questions on demographics, tobacco consumption, nicotine craving, life events, psychiatric diagnoses and use of medication. At baseline, smoking prevalence of ADHD patients was twice as high (50.2%) as the national norm (25.6%; p<.001). Tobacco consumption increased with 1.3 cigarettes per day after three-months of methylphenidate use. When translated into pack years, tobacco consumption increased by about 23 packs per year. Reports of increased nicotine craving after methylphenidate, increased with 20.3% after two weeks and 29.2% after three months. Light smokers (1-12 cigarettes/day) were especially at risk for increased tobacco consumption (p<.05). Thus although methylphenidate is the drug of choice in medical treatment for ADHD, tobacco consumption and nicotine craving increased acutely and stabilized at increased levels after three-months of methylphenidate use. Although the net effect of methylphenidate on smoking behavior and craving should be further investigated within a randomized, placebo-controlled design, the results suggest that active prevention of increased smoking is needed in patients prescribed methylphenidate.

Comparative Psychology as Unified Psychology: The Case of Curiosity and Other Novelty-Related Behavior

The comparative study of human and nonhuman animals covers the full range of psychological phenomenon, and so comparative psychology already exists as a form of general psychology. The potential of comparative psychology to bring together many aspects of the field of psychology is illustrated through a review of studies exploring curiosity in a variety of species. The issue of an organism's response to novelty was recognized as an important research subject in the era of Darwin. Since that time, considerable empirical and theoretical material on various aspects of behavior associated with new stimuli has been accumulated. This research additionally illustrates the utility of integrative levels theory, which enables a multilevel, comprehensive analysis of behavior. Comparative psychologists played important roles in the history of most of psychology's subdisciplines, and present-day comparative psychologists continue to contribute insights into a startlingly broad range of psychological phenomenon. Further, appreciation for the higher-level research program provided by comparative work provides a larger context that helps ground the study of human psychology.

An epidemiological study of ADHD symptoms among young persons and the relationship with cigarette smoking, alcohol consumption and illicit drug use

BACKGROUND

This study investigates the relationship between attention deficit hyperactivity disorder (ADHD) symptoms and cigarette smoking, alcohol use and illicit drug use.

METHOD

The participants were 10,987 pupils in the final three years of their compulsory education in Iceland (ages 14-16 years). The participants completed questionnaires in class relating to anxiety, depression and antiestablishment attitudes, ADHD symptoms, smoking, alcohol consumption and illicit drug use.

RESULTS

Of the total sample, 5.4% met screening criteria for ADHD. Smoking, alcohol and illicit drug use were significantly related to ADHD symptoms. In addition, the number of different illicit drugs consumed was significantly higher among the ADHD symptomatic than the nonsymptomatic participants, including the illicit use of sedatives. The main distinguishing illicit drug substances were lysergic acid diethylamide (odds ratio or OR = 8.0), cocaine (OR = 7.5), mushrooms (OR = 7.1) and amphetamines (OR = 6.5). Logistic multiple regressions showed that after controlling for gender and school grade, ADHD symptoms predicted smoking, alcohol use and illicit drug use independent of anxiety, depression and antiestablishment attitudes. In addition, poly-substance use was linearly and incrementally related to ADHD symptoms with a large effect size.

CONCLUSIONS

The findings underscore the vulnerability of young persons with ADHD symptoms to smoking, alcohol and illicit drug use, possibly as a means of self-medication, and emphasize a need for early identification and treatment to reduce the risk of escalation.

Delay discounting by adolescents experimenting with cigarette smoking

AIMS

To evaluate delay discounting and self-reported impulsive behavior in a sample of adolescents experimenting with cigarette smoking compared with adolescents who had never smoked or were daily smokers.

DESIGN

A cross-sectional design was used to compare smoking-status groups.

SETTING

Columbus, Ohio, a city of approximately 780,000 people.

PARTICIPANTS

A sample of 141 male and female adolescents with a mean age of 15.37 (standard deviation = 1.09) years.

MEASUREMENTS

Primary measures included a computerized assessment of delay discounting, a self-report assessment of impulsivity [Barratt Impulsiveness Scale-adolescent (BIS-11-A)] and verifications of cigarette smoking status (breath carbon monoxide and urinary cotinine level).

FINDINGS

Smokers discounted more by delay and had higher impulsivity scores than non-smokers. Experimenters had scores intermediate to those of smokers and non-smokers on both measures. In some analyses the difference between experimenters and non-smokers was significant, with experimenters showing greater delay discounting, but in no case did experimenters differ significantly from the smokers.

CONCLUSIONS

Young people who experiment with cigarettes appear to be similar to those who smoke regularly in terms of tendency to discount future gains and report impulsive tendencies, and generally higher in these traits than non-smokers.

Co-occurrence of addictive behaviours: personality factors related to substance use, gambling and computer gaming

AIM

To investigate co-occurrence and shared personality characteristics of problematic computer gaming, problematic gambling and substance use.

METHODS

Cross-sectional survey data were collected from 2,553 German students aged 12-25 years. Self-report measures of substance use (alcohol, tobacco and cannabis), problematic gambling (South Oaks Gambling Screen - Revised for Adolescents, SOGS-RA), problematic computer gaming (Video Game Dependency Scale, KFN-CSAS-II), and of twelve different personality characteristics were obtained.

RESULTS

Analyses revealed positive correlations between tobacco, alcohol and cannabis use and a smaller positive correlation between problematic gambling and problematic computer gaming. Problematic computer gaming co-occurred only with cannabis use, whereas problematic gambling was associated with all three types of substance use. Multivariate multilevel analyses showed differential patterns of personality characteristics. High impulsivity was the only personality characteristic associated with all five addictive behaviours. Depression and extraversion were specific to substance users. Four personality characteristics were specifically associated with problematic computer gaming: irritability/aggression, social anxiety, ADHD, and low self-esteem.

CONCLUSIONS

Problematic gamblers seem to be more similar to substance users than problematic computer gamers. From a personality perspective, results correspond to the inclusion of gambling in the same DSM-V category as substance use and question a one-to-one proceeding for computer gaming.

Smoking and Cloninger's Temperament and Character Inventory

INTRODUCTION

Cloninger's neuropsychopharmacological theory identifies four temperament traits and three character traits that are largely heritable and are associated with addictions.

METHODS

We tested whether these personality traits were associated with smoking behavior and predicted smoking cessation and tobacco withdrawal symptoms. We conducted an Internet cohort study in 2005-2009. The Temperament and Character Inventory (TCI, 226 items, French version) was assessed in 2,993 people (1,593 current, 969 former, and 419 never-smokers). Subsets of participants indicated their smoking status after 30 days (n = 1,452, 48.5%) and answered the TCI again and reported tobacco withdrawal symptoms after 61 days (n = 644, 21.5%).

RESULTS

Compared with never- and former smokers, daily smokers had higher scores of Harm Avoidance (HA) and lower scores of Persistence and Self-Directedness (SD). Daily smokers had higher scores of Novelty Seeking than never-smokers. In daily smokers, the level of tobacco dependence was associated with higher scores of HA and lower scores of SD. In the 60 daily smokers who had stopped smoking after 61 days, after adjustment for tobacco dependence level and baseline tobacco withdrawal ratings, SD predicted lower scores of depressed mood and anxiety at 61-day follow-up and HA predicted higher scores of depressed mood at 61-day follow-up. Personality ratings did not predict smoking cessation at follow-up in daily smokers or relapse in former smokers.

DISCUSSION

A consistent association was found between smoking and high HA and low SD. Knowledge about these associations may be useful to clinicians to tailor counseling.

Dimensions of impulsive behavior in adolescent smokers and nonsmokers

Robust associations have been identified between impulsive personality characteristics and cigarette smoking during adolescents, indicating that impulsive behavior may play an important role in the initiation of cigarette smoking. The present study extended this research by using laboratory behavioral assessments to explore relationships between three specific dimensions of impulsive behavior (impulsive decision-making, inattention, and disinhibition) and adolescent cigarette smoking. Participants were male and female adolescent smokers (n = 50) and nonsmokers (n = 50). Adolescent smokers were more impulsive on a measure of decision-making; however, there were significant smoking status by gender interaction effects for impulsive inattention and disinhibition. Male smokers were most impulsive on the measure of inattention, but male smokers were least impulsive on the measure of disinhibition. Correlations between biomarkers of smoking and impulsive inattention and disinhibition were found for females but not males. The current findings, coupled with previous findings (Reynolds et al., 2007), indicate there may be robust gender difference in associations between certain types of impulsive behavior and cigarette smoking during adolescence.

Tobacco smoking in individuals with attention-deficit hyperactivity disorder: epidemiology and pharmacological approaches to cessation

The co-occurrence of attention-deficit hyperactivity disorder (ADHD) and nicotine dependence is common. Individuals with ADHD are more likely to initiate smoking and become dependent on nicotine than their non-ADHD counterparts, and recent evidence suggests that they may have more difficulty quitting smoking. Little is known about how to best approach treating these co-morbidities to optimize clinical outcome. Clinicians treating individuals with either ADHD or nicotine dependence should be aware of their common co-occurrence and the need to address both in treatment. This review of ADHD and nicotine dependence provides an overview of relevant epidemiology, bidirectional interactions and implications for pharmacological and adjunctive psychosocial treatment. Incorporating the current evidence base and their clinical experience, the authors propose a stepwise approach to treating patients with co-morbid ADHD and nicotine dependence. Given the potential for ADHD symptoms to interfere with smoking cessation success, the first priority is to stabilize ADHD. The first-line pharmacological approach should be a long-acting psychostimulant. Upon ADHD stabilization, motivational techniques should be used to encourage readiness for a smoking cessation attempt. In the context of behavioural cessation interventions sensitive to the patient's needs and developmental stage, pharmacological intervention targeting smoking cessation may be initiated. The authors recommend varenicline as a first-line agent, given its superior effect size among available medication treatments. Symptoms of ADHD, as well as nicotine withdrawal and craving symptoms, should be monitored closely during the cessation attempt, and adjustments to therapy should be considered if warranted. The authors conclude that, while current treatments may potentially be effective for co-morbid ADHD and nicotine dependence, further research is needed to parse the complex associations between these disorders and prospectively study combined treatments.

Individual and family correlates for cigarette smoking among Taiwanese college students

OBJECTIVE

This college-based questionnaire survey aimed to explore the individual, family, and peer correlates for cigarette smoking among first-year college students.

METHOD

The sample included 2918 first-year college students (males, 45.5%) recruited from a national university in Taiwan (participation rate, 79.1%). The participants reported on questions about various substances, attitudes toward substances, personality characteristics, psychopathology, suicidal behaviors, parenting style, family function and use of substances, and peer substance use.

RESULTS

There were 263 (9.0%; males, 70.6%) current smokers. Compared to nonsmokers, college smokers were more extraverted and neurotic, and showed less harm avoidance, and more novelty seeking in their personality. They had more hostile, somatic, depressive, paranoid, and psychotic symptoms in terms of psychopathology. Smokers were more likely to use other substances, and to have suicidal ideations, wishes, plans, and attempts. Smokers perceived lower family cohesion, less care from their fathers, and less overprotection from their mothers. They were more likely to have peers and family members who also smoked or used other substances. The most associated correlates were male sex, older age, other substance use, novelty seeking, suicidal ideation and attempts, sibling and peer substance use, a prosubstance attitude, and less maternal overprotection.

CONCLUSIONS

Our findings support the association of cigarette use in Taiwanese young adults with several individual, family, and peer factors identified in Western studies. Intervention in cigarette use should be multifaceted, by taking its correlates and the concurrent psychopathology, use of substances, and suicidality into consideration.

Learning disabilities and risk-taking behavior in adolescents: a comparison of those with and without comorbid attention-deficit/hyperactivity disorder

Risk-taking behavior includes alcohol and drug use, delinquency, acts of aggression, sexual activity, and so on. Many studies have explored the relationship between adolescents and risk-taking behavior; however, only a few studies have examined this link in adolescents with learning disabilities (LD) or attention-deficit/hyperactivity disorder (ADHD). The purpose of the present study was to address that limitation by comparing the risk-taking behavior of adolescents with LD (n=230), with comorbid LD/ADHD (n=92), and without LD or ADHD (n=322) on their substance use, engagement in major and minor delinquency, acts of aggression, sexual activity, and gambling activities. The study also investigated whether psychosocial variables (e.g., well-being) may act as mediating variables that help explain between-group differences. Results suggest that it is a combination of the LD and the secondary psychosocial characteristics that explains why adolescents with LD and comorbid LD/ADHD more frequently engage in some risk-taking behavior.

Bedingungsfaktoren eines frühen Erstkonsumalters von Tabak

Zusammenfassung. Bedingungsfaktoren eines frühzeitigen Beginns des Tabakkonsums, der als einer der besten Prädiktoren einer späteren Tabakabhängigkeit gilt, sollen überprüft und auf ihren Zusammenhang hin untersucht werden. In einer Längsschnittstudie an einer Geburtskohorte von 384 Risikokindern wurden das psychosoziale Risiko, das mütterliche Rauchen in der Schwangerschaft, der elterliche Tabak- und Alkoholkonsum sowie externale Verhaltensauffälligkeiten von Geburt bis zum Jugendalter erhoben. Mit 15 Jahren wurde das Alter beim ersten Tabakkonsum erfragt und mittels Überlebenszeitanalysen vorhergesagt. Jugendliche, die früh Zigaretten probierten, kamen eher aus Familien mit einer hohen psychosozialen Belastung, wobei dieser Einfluss über mehr externale Verhaltensauffälligkeiten vermittelt wurde. Ein starker täglicher Tabak- sowie ein riskanter Alkoholkonsum der Eltern erwiesen sich ebenfalls als Risikofaktoren für einen frühzeitigen Rauchbeginn der Kinder. Das elterliche Rauchen fungierte als Mediator für den Einfluss des mütterlichen Rauchens in der Schwangerschaft sowie der psychosozialen Belastung. Ein frühes Einstiegsalter in den Tabakkonsum kann als Folge genereller Risikofaktoren für die Entwicklung von Verhaltens- und Suchtproblemen interpretiert werden.

Smoking, psychosocial factors, psychopathologic behavior, and other related conditions in hospitalized youth suicide attempters

BACKGROUND

Comorbidity of suicidal behavior with various risk factors has been reported. This study examines the combined effect and the interactions of the most prominent risk factors in hospitalized suicide attempters.

METHOD

Seventy-six successive hospitalized suicide attempters and 76 matched control subjects, 9 to 20 years old, were subjected to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I and Axis II diagnoses and were interviewed for the use of licit and illicit substances. Also, 18 control subjects with the same psychiatric disorders diagnosed in the attempters were examined. Logistic regression analysis was applied to determine the independent effect of the risk factors to suicide attempts.

RESULTS

The findings showed an 18-fold greater frequency of psychiatric disorders, a 14-fold greater frequency of other conditions that may be a focus of clinical attention (mainly relational problems), a 9.7-fold greater frequency of smoking, and a 4.7-fold greater frequency of psychosocial and environmental problems in the attempters than in the control subjects. The independent association of these factors with increased suicide risk persisted after adjusting for the effect of other factors.

CONCLUSIONS

Psychopathologic behavior, psychosocial factors, and smoking are independently associated with increased risk for serious suicide attempts.

Susceptibility to nicotine dependence: the Development and Assessment of Nicotine Dependence in Youth 2 study

OBJECTIVES

The purpose of this work was to identify characteristics that predict progression from the first inhalation of a cigarette to dependence. We studied a cohort of 1246 public school 6th-graders in 6 Massachusetts communities (mean age at baseline: 12.2 years).

METHODS

We conducted a 4-year prospective study using 11 interviews. We assessed 45 risk factors and measured diminished autonomy over tobacco with the Hooked on Nicotine Checklist and evaluated tobacco dependence according to the International Classification of Diseases, 10th Revision. Cox proportional-hazards models were used.

RESULTS

Among 217 youths who had inhaled from a cigarette, the loss of autonomy over tobacco was predicted by feeling relaxed the first time inhaling from a cigarette and depressed mood. Tobacco dependence was predicted by feeling relaxed, familiarity with Joe Camel, novelty seeking, and depressed mood.

CONCLUSIONS

Once exposure to nicotine had occurred, remarkably few risk factors for smoking consistently contributed to individual differences in susceptibility to the development of dependence or loss of autonomy. An experience of relaxation in response to the first dose of nicotine was the strongest predictor of both dependence and lost autonomy. This association was not explained by trait anxiety or any of the other measured psychosocial factors. These results are discussed in relation to the theory that the process of dependence is initiated by the first dose of nicotine.

Prenatal smoking exposure and dopaminergic genotypes interact to cause a severe ADHD subtype

BACKGROUND

In utero exposure to smoking and alcohol are common risk factors that have been associated with attention-deficit/hyperactivity disorder (ADHD) in human beings and animal models. Furthermore, molecular studies have focused on the association between ADHD and DNA polymorphisms in dopamine pathway-related genes. We examined the joint effects of genetic and prenatal substance exposures on DSM-IV and population-defined subtypes of ADHD.

METHODS

Logistic regression was used to assess the relationship between ADHD subtypes, DAT1 and DRD4 polymorphisms, and prenatal substance exposures in a birth-record sample of male and female twin pairs, aged 7-19 years.

RESULTS

Interactions between prenatal exposure to smoking and variations in the DAT1 and DRD4 loci were observed in children with either the DSM-IV or population-defined ADHD combined subtypes. The odds of a diagnosis of DSM-IV combined subtype was 2.9 times greater in twins who had inherited the DAT1 440 allele and who were exposed, than in unexposed twins without the risk allele. The OR was 2.6 in the population-defined subtype. Odds ratios for the DRD4 seven-repeat allele were 3.0 (2.8) in the population-defined (DSM-IV) combined ADHD subtypes. The OR for exposed children with both alleles was 9.0 (95% confidence interval=2.0-41.5) for the population-defined combined subtypes.

CONCLUSIONS

Results indicate that smoking during pregnancy is associated with specific subtypes of ADHD in genetically susceptible children.