Abstract:
Background: E-cigarette use has increased substantially among young people globally, raising public health concerns about nicotine dependence and health harms. Individuals with attention-deficit/hyperactivity disorder (ADHD) may be particularly vulnerable to e-cigarette use due to self-regulation difficulties, reward sensitivity, and possible use of nicotine to manage ADHD-related symptoms. This study aimed to systematically review and meta-analyse evidence on the association between ADHD and e-cigarette use.
Methods: Six databases (PsycINFO, EMBASE, PubMed, Scopus, Cochrane Library, and Web of Science) were searched on 2 June 2025 and updated on 9 December 2025. Studies were eligible if they reported quantitative data on ADHD diagnosis or symptoms in relation to e-cigarette-related outcomes. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools. Random-effects meta-analyses were conducted to estimate the pooled effect sizes.
Results: Twenty-one studies published between 2018 and 2025 were included in the qualitative synthesis. Across the narrative evidence, ADHD was consistently associated with greater likelihood of e-cigarette initiation and use, higher nicotine dependence severity, and poorer cessation-related outcomes. In the meta-analysis of unadjusted ORs (k = 4), ADHD was associated with higher odds of e-cigarette use across different assessment windows, including lifetime, past-year, and past-30-day use (pooled OR = 1.86, 95% CI: 1.48–2.32). In the meta-analysis of covariate-adjusted effect estimates (k = 4), the pooled association was attenuated and non-significant (pooled aOR = 1.32, 95% CI: 0.77–2.27). High between-study heterogeneity was observed in both analyses (I² = 88.1% and 85.2%, respectively).
Conclusion: ADHD was associated with elevated odds of e-cigarette use, which was attenuated after pooling covariate-adjusted estimates. ADHD may serve as a useful marker for identifying individuals potentially vulnerable to e-cigarette-related harms and for informing targeted support. Longitudinal studies are needed to clarify directionality and underlying mechanisms.
Biography:
Jiaxin Li is a PhD candidate at the National Centre for Youth Substance Use Research, School of Psychology, The University of Queensland. Her research focuses on e-cigarette use and mental health, with a particular interest in the relationship between attention-deficit/hyperactivity disorder (ADHD) and vaping-related vulnerability among young people. Her work aims to inform evidence-based prevention and cessation strategies for young people with neurodevelopmental and mental health-related risk factors.
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