ADHD is associated with early initiation of cigarette smoking in children and adolescents

Sharon Milberger, Joseph Biederman, Stephen V. Faraone, Lisa Chen, Janice Jones

Research output: Contribution to journalArticlepeer-review

419 Scopus citations


Objective: The association between attention-deficit hyperactivity disorder (ADHD) and cigarette smoking in children and adolescents was evaluated. Method: Subjects were 6- to 17-year-old boys with DSM-III-R ADHD (n = 128) and non-ADHD comparison boys (n = 109) followed prospectively for 4 years into mid-adolescence. Information on cigarette smoking was obtained in a standardized manner blind to the proband's clinical status. Cox proportional hazard models were used to predict cigarette smoking at follow- up using baseline characteristics as predictors. Results: ADHD was a significant predictor of cigarette smoking at follow-up into mid-adolescence. Our findings also revealed that ADHD was associated with an early initiation of cigarette smoking. This was the case even after controlling for socioeconomic status, IQ, and psychiatric comorbidity. In addition, among children with ADHD, there was a significant positive association between cigarette smoking and conduct, major depressive, and anxiety disorders. Conclusions: ADHD, particularly the comorbid subtype, is a significant risk factor for early initiation of cigarette smoking in children and adolescents. Considering the prevalence and early childhood onset of ADHD, these findings highlight the importance of smoking prevention and cessation programs for children and adolescents with ADHD.

Original languageEnglish
Pages (from-to)37-44
Number of pages8
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number1
StatePublished - Jan 1997
Externally publishedYes


  • adolescents
  • attention-deficit hyperactivity disorder
  • children
  • cigarette smoking
  • comorbidity


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