The Development of Cigarette Smoking Behavior Among Juvenile Offenders in Adolescence and Early Adulthood: ADHD Symptomatology as a Risk Factor

Abstract

Background

Cigarette use is a public health issue and juvenile offenders are at risk for engagement in substance use. Attention deficit hyperactivity disorder (ADHD) has been linked to elevated risk for cigarette use and juvenile offenders are at elevated risk for mental health issues.

Objectives

To elucidate general patterns of development of cigarette use among juvenile offenders and examine the role that ADHD symptomatology plays for predicting development.

Methods

The Pathways to Desistance data (2000–2010) follow 1,354 juvenile offenders across 84 months following a recent conviction for a serious offense. Using group-based trajectory modeling, this research sought to elucidate heterogeneity in general developmental patterns of cigarette use across adolescence and early adulthood. This research then extended the method by using multinomial logistic regression to investigate the relevance of ADHD symptomatology and covariates for predicting trajectory group assignment.

Results

A five-group trajectory model was found to best fit the data. Groups elucidated were: Abstaining, Late Onset, Decelerating, Moderate Chronic, and High Chronic. When all covariates were controlled, increases in ADHD symptomatology presentation were associated with increased risk of assignment to the High Chronic cigarette smoking group. This group was characterized by early onset and chronic course of daily cigarette use.

Conclusions/importance: Juvenile offenders are at increased risk for participation in daily cigarette use and high and chronic levels of daily use during adolescence and early adulthood. ADHD symptomatology is a risk factor for early initiation and chronic daily cigarette-smoking behaviors.

Keywords:

• ADHD
• cigarettes
• group-based trajectory modeling
• juvenile offenders

Notes

1 The degree to which each behavioral prompt described each participant’s behavior was measured on an ordinal scale (1 = Not at all; 2 = Just a little; 3 = Pretty much; 4 = Very much). Only behaviors which parents rated as 3 or 4 were counted as behavioral issues in both the count and diagnosis measures. The behavior prompts are as follows: often interrupted or intruded on others; often talked excessively; was often easily distracted by extraneous stimuli; often fidgeted with hands or squirmed in seat; often did not seem to listen when spoken to directly; often blurted out answers before questions had been completed; often shifted from one incomplete activity to another; often failed to give close attention to details or made careless mistakes in schoolwork, work, or other activities; often left seat in classroom or in other situations in which remaining seated was expected; often did not follow through on instructions and failed to finish schoolwork, chores, or duties in the workplace; often had difficulty sustaining attention in tasks or play activities; often had difficulty awaiting turn; was often "on the go" or often acted as if "driven by a motor"; often lost things necessary for tasks or activities; often ran about or climbed excessively in situations in which it was inappropriate; often avoided, disliked, or was reluctant to engage in tasks that required sustained mental effort; often had difficulties organizing tasks and activities; was often forgetful in daily activities; often had difficulty playing or engaging in leisure activities quietly.

2 Only results pertaining to ADHD symptoms are described in tabular form, as ADHD diagnosis did not exert any significant effects on group membership.