Ecological Momentary Assessment of Antecedents and Consequences of Smoking in Adults with Attention-Deficit/Hyperactivity Disorder

Abstract

The current study assessed antecedents and consequences of ad lib cigarette smoking in smokers diagnosed with attention-deficit/hyperactivity disorder (ADHD) using ecological momentary assessment (EMA). Adult smokers with ADHD (n = 17) completed 870 smoking and 622 nonsmoking electronic diary entries over a 7-day observation period of their naturalistic smoking behavior. Data collection occurred from 2011 to 2012. Generalized estimating equations indicated that ADHD smokers were more likely to smoke when urge to smoke, negative affect, boredom, stress, worry, and restlessness were elevated. In addition, participants were more likely to smoke in situations that elicited higher levels of nervousness and frustration. ADHD symptoms, in general, did not differ between smoking and nonsmoking contexts, though hyperactive–impulsive ADHD symptoms were elevated prior to smoking in frustrating situations. Additional situational antecedent variables were associated with smoking, including being in the presence of others smoking, being in a bar or restaurant, while outside, and while consuming caffeinated or alcoholic beverages. Participants also reported a significant improvement in urge to smoke, negative affect, stress, hunger, and ADHD symptoms after smoking a cigarette. Findings suggest certain contextual factors that may maintain ad lib cigarette smoking in smokers with ADHD and identify potential treatment targets in smoking cessation interventions for this at-risk group. Clinical implications and future research directions are discussed. Funding for this study was provided by the National Institute on Drug Abuse.

Keywords :

• attention-deficit/hyperactivity disorder
• nicotine dependence
• cigarette smoking
• affect
• emotion dysregulation
• ecological momentary assessment

THE AUTHORS

John T. Mitchell, PhD, is an Assistant Professor of Psychiatry at Duke University School of Medicine and the Duke ADHD Program. His research interests include ADHD in adulthood, ADHD-smoking comorbidity, emotion dysregulation, and treatment development.

Michelle F. Dennis, BA, is an Associate in Research in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center.

Joseph S. English, MA, is a Clinical Research Coordinator in the Duke ADHD Program at Duke University Medical Center. Over the past 9 years, he has coordinated a variety of behavioral studies for Drs. Kollins and Mitchell, and has a particular interest in the treatment of ADHD with DBT/Mindfulness.

Paul A. Dennis, PhD, is a Research Scientist at the Durham Veterans Affairs Medical Center. His research concerns mental and physiological health trajectories of psychiatric populations.

Amy G. Brigthwood, M.T.S., is a Clinical Research Specialist in the Health Behavior Neuroscience Research Program at Duke University Medical Center.

Jean C. Beckham, PhD, is a Professor of Psychiatry at the Duke University School of Medicine. Her research interests primarily involve the assessment and treatment of trauma exposure, particularly as it occurs for men and women in military service and has published over 150 papers in peer-reviewed journals.

Scott H. Kollins, PhD, is a Professor of Psychiatry and Director of the Duke ADHD Program at the Duke University School of Medicine. He has worked with adults, adolescents, and children with ADHD for over 15 years and has published over 100 papers in the areas of ADHD and psychopharmacology.