Adverse childhood experiences and smoking during adolescence and adulthood

Context In recent years, smoking among adolescents has increased and the de cline of adult smoking has slowed to nearly a halt; new insights into tobac co dependency are needed to correct this situation. Long-term use of nicoti ne has been linked with self-medicating efforts to cope with negative emoti onal, neurobiological, and social effects of adverse childhood experiences. Objective To assess the relationship between adverse childhood experiences and 5 smoking behaviors. Design The ACE Study, a retrospective cohort survey including smoking and e xposure to 8 categories of adverse childhood experiences (emotional, physic al, and sexual abuse; a battered mother; parental separation or divorce; an d growing up with a substance-abusing, mentally ill, or incarcerated househ old member), conducted from August to November 1995 and January to March 19 96. Setting A primary care clinic for adult members of a large health maintenan ce organization in San Diego, Calif. Participants A total of 9215 adults (4958 women and 4257 men with mean [SD] ages of 55.3 [15.7] and 58.1 [14.5] years, respectively) who responded to a survey questionnaire, which was mailed to all patients 1 week after a cli nic visit. Main Outcome Measures Smoking initiation by age 14 years or after age 18 ye ars, and status as ever, current, or heavy smoker. Results At least 1 of 8 categories of adverse childhood experiences was rep orted by 63% of respondents, After adjusting for age, sex, race, and educat ion, each category showed an increased risk for each smoking behavior, and these risks were comparable for each category of adverse childhood experien ces. Compared with those reporting no adverse childhood experiences, person s reporting 5 or more categories had substantially higher risks of early sm oking initiation (odds ratio [OR], 5.4; 95% confidence interval [CI], 4.1-7 .1), ever smoking (OR, 3.1; 95% CI, 2.6-3.8), current smoking (OR, 2.1; 95% CI, 1.6-2.7), and heavy smoking (OR, 2.8; 95% CI, 1.9-4.2), Each relations hip between smoking behavior and the number of adverse childhood experience s was strong and graded (P<.001). For any given number of adverse childhood experiences, recent problems with depressed affect were more common among smokers than among nonsmokers. Conclusions Smoking was strongly associated with adverse childhood experien ces. Primary prevention of adverse childhood experiences and improved treat ment of exposed children could reduce smoking among both adolescents and ad ults.