Do Depression and Antisocial Behavior Moderate the Relationship Between ADHD and Smoking Progression?

Introduction This study examines whether depression, antisocial behavior, and gender moderate the relationship between ADHD symptoms and smoking among a sample of young adults (N=939). ADHD symptoms, depression symptoms, antisocial behavior, and gender have been consistently related to smoking, but rarely are their combined effects examined longitudinally. We hypothesized that depressive symptoms would exacerbate the ADHD-smoking association, particularly for females. We also hypothesized that antisocial behavior would exacerbate the ADHD-smoking association, particularly for males. Methods Participants for this study were recruited in either 9th or 10th grade, and followed for 7 years. Data for this study come from the baseline, 2, and 6-year data collection waves. Results ADHD symptoms were associated with both any smoking and higher rates of past month smoking. Depressive symptoms moderated the relationship between ADHD symptoms and any prior month smoking, such that ADHD symptoms were more strongly associated with smoking among adolescents with higher levels of depression. Among smokers, male gender and higher levels of depression and ADHD symptoms were each associated with more smoking days. Additionally, an interaction was observed showing that while ADHD symptoms were positively associated with smoking for males, this association was not significant for females. Furthermore, a significant interaction between ADHD symptoms and depression symptoms showed that ADHD symptoms were positively associated with past month smoking days at low and mean, but not high, levels of depression. Antisocial behavior did not moderate the link between ADHD symptoms and any smoking. Among smokers, however, gender interacted with antisocial behavior revealing a significant positive effect of antisocial behavior on past-month smoking vii days specific to female smokers. Antisocial behavior was also found to moderate the link between ADHD symptoms and past-month smoking days. While ADHD symptoms were significantly positively associated with past-month smoking among those reporting mean and high levels of antisocial behavior, there was no significant association for those with low antisocial behavior. An interaction between ADHD symptoms and gender showed that while ADHD symptoms were positively associated with smoking for females, this association was not significant for males. Conclusions In sum, this study suggests that the relationship between ADHD and smoking is not straightforward and can vary significantly in response to depression and antisocial behavior. Additionally, treating these variables dimensionally may help discriminate between profiles of adolescent smoking and identify those who may be at risk for smoking progression earlier in their smoking careers.