Original article
Child Abuse and Smoking Among Young Women: The Importance of Severity, Accumulation, and Timing

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Abstract

Purpose

We examined the association between severity, accumulation, and timing of abuse in childhood and adolescence and smoking status among young women.

Methods

Retrospective self-reported childhood abuse was ascertained with the modified Conflict Tactics Scale from 91,286 Nurses Health Study II participants in 2001 (68,505 returned; 75.0% response rate). Childhood abuse was categorized by severity (mile/moderate/severe), type (physical/sexual), and timing (childhood/adolescence). Smoking status during adolescence was reported at baseline (1989). Logistic regression was used to predict smoking initiation by age 14 and smoking status between the ages of 15 and 19.

Results

A graded association between severity of abuse and early initiation of smoking (by age 14 years) was demonstrated (odds ratio [OR] = 1.9, 95% confidence interval [CI] = 1.7–2.1 for severe physical violence). Young women with both physical and sexual abuse were two times more likely to start smoking by age 14 than were those reporting no abuse (OR = 2.0, 95% CI = 1.8–2.3). Although abuse during childhood increased risk for adolescent smoking (OR = 1.7, 95% CI = 1.8–2.1) for those with childhood physical and sexual abuse, inclusion of adolescent physical and sexual abuse (OR = 2.2, 95% CI 2.1–2.4) diminished the impact of childhood abuse (OR = 1.1, 95% CI 1.1–1.2). The degree of familial emotional support was protective against smoking, and reduced the impact of abuse by 40% among those with high emotional support versus those without (p < .0001).

Conclusions

A strong and graded association was observed between both severity and accumulation of abuse and the risk of early initiation of smoking among girls. Smoking status during late adolescence was more strongly associated with adolescent abuse than childhood abuse. Early smoking onset is associated with both heightened risk for disease in adolescence but also increased morbidity and mortality in adulthood. Identifying and intervening in potentially modifiable risk factors for smoking onset in young women, such as early-life physical and sexual abuse, and building familial strengths, such as emotional support, may have significant public health implications.

Section snippets

Study population

The Nurses Health Study (NHS) II is an ongoing prospective study. A total of 116,608 female registered nurses between the ages of 25 and 42 years at the initiation of the study in 1989 completed a mailed questionnaire on their medical history and lifestyle. Follow-up questionnaires, mailed every 2 years to the entire cohort, updated information on the occurrence of diseases and health-related behaviors including smoking status. Detailed information on this study can be obtained online [13].

A

Results

Sample characteristics are shown in Table 1, Table 2. Notably, 4.8% of women reported having started smoking before they reached age 15, and 23.0% reported smoking between the ages of 15 and 19.

Discussion

Our findings support a consistent relation between several characteristics of childhood and adolescent abuse (timing, accumulation, and severity) and smoking behavior among adolescent girls. Exposure to physical and/or sexual abuse during childhood increased risk of smoking initiation prior to 14 years of age. A strong and graded association was found between severity of childhood physical abuse and risk for early smoking initiation. Moreover, smoking during ages 15 to 19 was more strongly

Conclusion

The developmental timing, cumulative type, and severity of abuse are important risk factors for smoking initiation during adolescence. Our finding that the children with a caring family member were less likely to start smoking in early childhood suggests that there are mechanisms to improve coping with social adversities. Future research to understand the processes by which children overcome social adversities is important to the development of effective interventions. Identifying and

Acknowledgments

During preparation of this manuscript, Dr. Jun and Dr. Wright were supported by a grant from the NIH/NHLBI (HL64108-04; Wright, PI).

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