An estimated one in every 10 U.S. kids has ADHD. That’s short for attention-deficit/hyperactivity disorder. Those with multiple ADHD symptoms are more likely than others to vape, smoke or use other tobacco products, a new study finds.

ADHD can make it hard to pay attention or control one’s emotions. Affected people might be restless, forgetful or careless. If they’re also impulsive, they may speak or act before thinking.

Scientists had known that people with this condition are more likely than others to use tobacco, says Sean Esteban McCabe. He’s the new study’s lead author. An epidemiologist, or disease detective, he works at the University of Michigan in Ann Arbor. There, his work focuses on tobacco and other addictive substances.

Nicotine releases chemicals in the brain that may, for a short time, make it easier to focus, he notes. So people with ADHD might use tobacco to self-medicate, he worries.

Vaping, smoking and packing a nicotine pouch were the most common types of tobacco-use behaviors among high-school students last year. But all tobacco products pose big health risks for teens and tweens.

Teens with multiple ADHD symptoms faced a heightened risk of tobacco use, McCabe’s group found. That was true whether the teens had been diagnosed with ADHD or not.  

But just having ADHD doesn’t mean someone will use tobacco, the study team found. Teens diagnosed with ADHD but with no current symptoms had about the same low risk for using tobacco as kids with no diagnosis and no ADHD symptoms. That’s why, McCabe says, “these findings are a really big deal.”

Various studies have linked the nicotine in tobacco to anxiety and depression. It’s also been linked to heart and lung problems and impaired immunity. Some chemicals in tobacco can lead to cancer. And even experimenting with such products is dangerous because their nicotine is addictive. That means users can find it very hard to stop.

New study mines years of data

For the new study, McCabe’s team analyzed data from the Population Assessment of Tobacco and Health, or PATH Study. Some 13,000 U.S. students, aged 12 to 17, took part. They were chosen to be representative of all U.S. kids their age.

Starting in 2013, surveys asked if these kids had ever used tobacco products. They also asked if kids ever had an ADHD diagnosis. If they had, did they take medicine for it? (Common treatments include medicines, talk therapy or both.)

Over the next nine years, follow-up surveys asked about tobacco use and any ADHD symptoms.

The more symptoms a kid reported, the more likely they were to use tobacco, the data show. For example, teens with three or four ADHD symptoms, despite taking medicine for it, had a 60 percent greater risk of vaping than did teens with no diagnosis or ADHD symptoms.

The team shared this newfound link between tobacco and ADHD symptoms on February 11 in JAMA Network Open.

Says McCabe, “This study suggests that if their symptoms of ADHD are controlled through therapy … or if the symptoms naturally dissipate, [kids] remain at lower risk for tobacco and nicotine and associated adverse outcomes.”

Indeed, he notes, “As the father of someone with ADHD, I know how frustrating it can be to try so many different medications and various other treatments.” But finding the right combo, he says, “makes all the difference in the world. I want to encourage teens and parents to keep trying [to find what works].” In the end, he feels, “the price for not trying, or giving up, is too great.”

For McCabe, the takeaway is: Don’t ignore ADHD symptoms.

His team is now exploring if people with ADHD are more likely to become addicted to nicotine.

What to make of these data

The new study suggests kids and teens “should be assessed throughout their youth for the symptoms of ADHD,” says Shahrdad Lotfipour. He works at the University of California, Irvine. He did not take part in the new research. He does, however, study ways the brain and nervous system affect drug use. And nicotine is a drug. “Please do not self-medicate with nicotine/tobacco products,” he pleads.

All forms of tobacco are addictive. In fact, the ways some teens have been abusing e-cigarettes and nicotine pouches often puts more nicotine in their system than smoking would. Bonnie Halpern-Felsher explained this in a January 22 online briefing. She’s a psychologist at Stanford University in California.

Try to be aware if you have symptoms of ADHD, Shivani Gaiha advises kids. Check with a doctor, if you need to. Gaiha is an adolescent-health scientist in Massachusetts. She works at Boston Children’s Hospital and Harvard Medical School. And if you think a friend might have ADHD, she says, urge them to get help.

Anti-tobacco campaigns can make it less tempting to vape or smoke.

A November 2024 study by Gaiha, Halpern-Felsher and others, for instance, found middle- and high-school students considered nicotine more addictive after taking part in a five-session prevention program. Also, fewer kids who went through this program planned to vape afterward. And a March 14 study by other researchers found young people were less likely to take up e-cigarettes after exposure to an anti-vaping ad campaign.

Today, some 8 percent of U.S. middle- and high-school students use tobacco. That’s a little more than one in every 12 kids.

“Tobacco remains the leading cause of preventable death,” McCabe says. So preventing tobacco use “is a powerful game changer for anyone — including those with ADHD.”