Discrepancies in the Validity of Self-Reported Cigarette Smoking in Adults With and Without ADHD

Abstract

Objective: Attention-deficit/hyperactivity disorder (ADHD) is associated with an increased smoking prevalence and impairments in executive function, which may negatively affect the validity of self-reported smoking rates. This study compares the utility of self-reported smoking with salivary cotinine in adult smokers and nonsmokers with and without ADHD. Methods: Participants (N = 82) were adult smokers and nonsmokers with and without ADHD (n = 35 ADHD and n = 47 controls) from an observational study. Odds ratios (ORs) for accuracy of self-reported smoking compared to salivary cotinine were calculated using diagnosis (ADHD vs. control), gender, age, education, employment, and number of cigarettes per day as predictors. Post-hoc analysis stratified sensitivity, specificity, and accuracy of self-reported smoking in individuals with ADHD and without ADHD. Results: The initial analysis identified education as a significant independent predictor of odds of accuracy, OR = 6.22, p = .013, after adjusting for diagnosis, gender, age, employment, and cigarettes per day. Post-hoc analysis revealed that sensitivity, specificity, and accuracy of self-reported smoking was 100% for individuals with ADHD who had more than high school education compared to those with high school or less, which was 83.3%, 45.5%, and 65.2%, respectively. Self-reported smoking of control participants with greater than a high school education had a sensitivity of 85.7%, a specificity of 91.7%, and an accuracy of 88.5%. Control participants with a high school or lower education had a sensitivity of 54.6%, a specificity of 90%, and an accuracy of 71.4% for their self-reported smoking. Conclusions: Individuals with ADHD and high school or lower education showed the lowest specificity and accuracy in their self-reported smoking, which may affect documented smoking prevalence rates. This is a secondary analysis of data collected as part of a clinical trial registered as NCT00915798 at www.clinicaltrials.gov.

Keywords:

• Cotinine
• education
• smoking prevalence
• executive function
• accuracy
• health disparities

Acknowledgments

The authors’ responsibilities were as follows: JGG and JG designed the research and wrote the manuscript; JGG, JG, and AS analyzed data; JGG, JG, SDA, MD, and AK edited the manuscript; JGG conducted the research and had primary responsibility for the final content of the manuscript; and all authors read and approved the final manuscript.

Disclosures

The authors report no relevant financial conflicts.

Additional information

Funding

The research was supported by the National Institutes of Health grants K01DA25131 from the National Institute on Drug Abuse and UL1TR001414 from the National Center for Advancing Translational Sciences.