We would like to refute that idea as strongly as we can. The conclusions of the three reports that have addressed the risk differences between snus and cigarettes, the RCP (2007), SCENHIR (2008), and Levy et al. (2004), clearly suggest that the potential harm from snus is much lower than that from cigarette smoking. Declaration sellckchem of Interest None declared.
Attention-deficit/hyperactivity disorder (ADHD) is a strong risk factor for initiation of regular cigarette smoking (Lee, Humphreys, Flory, Liu, & Glass, 2011; Wilens et al., 2011), and smoking prevalence among adults with ADHD is approximately twice as high as in the general population (Lambert & Hartsough, 1998; McClave, McKnight-Eily, Davis, & Dube, 2010).

There is also some indication of poorer response to smoking cessation treatment among individuals with ADHD (Covey, Manubay, Jiang, Nortick, & Palumbo, 2008; Humfleet et al., 2005), although the available evidence to address the question of differential treatment efficacy is limited. Despite the high rates of smoking among individuals with ADHD and some indication that quitting may be more difficult, few studies have focused on identifying efficacious smoking cessation interventions to reduce the prevalence of smoking in this group. Identifying factors associated with treatment success can be translated into improved intervention effectiveness. Motivation to quit and self-efficacy in quitting are two factors that have been examined extensively in relation to smoking cessation outcomes and are specifically targeted by theory-based interventions to treat tobacco dependence, including cognitive-behavioral therapy and motivational interviewing.

There is fairly robust evidence that self-efficacy predicts successful smoking cessation, particularly when assessed close in time to the assessment of smoking cessation outcome (Gwaltney, Metrik, Kahler, & Shiffman, 2009). Similarly, it has been demonstrated that perceived difficulty in quitting smoking, a construct related to self-efficacy, predicts cessation success (Etter & Perneger, 2001; McCarthy, Piasecki, Jorenby, Lawrence, Shiffman, & Baker, 2010), as well as initiation of a quit attempt (Duffy, Scheumann, Fowler, Darling-Fisher, & Terrell, 2010). The evidence for a relationship between motivation Brefeldin_A and successful cessation is more mixed and appears to manifest primarily in motivation predicting quit attempts as opposed to sustained abstinence from tobacco (Borland et al., 2010; Smit, Fidler, & West, 2011; Zhou, Nonnemaker, Sherrill, Gilsenan, Coste, & West, 2009), although a number of studies have demonstrated associations between motivation and tobacco abstinence (e.g., Shmueli, Fletcher, Hall, Hall, & Prochaska, 2008).