Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2016 Jun 1.
Published in final edited form as: Psychol Addict Behav. 2014 Oct 27;29(2):338–346. doi: 10.1037/adb0000033

The relationship between childhood physical and emotional abuse and smoking cessation among U.S. women and men

Philip H Smith 1, Megan L Saddleson 2, Gregory G Homish 3, Sherry A McKee 4, Lynn T Kozlowski 5, Gary A Giovino 6
PMCID: PMC4486346  NIHMSID: NIHMS672720  PMID: 25347015

Abstract

Childhood maltreatment is associated with increased likelihood of smoking. The purpose of the current investigation was to compare quitting motives, quit attempts, and quit success between U.S. adult smokers with or without childhood maltreatment (physical or emotional abuse), and those with or without serious psychological distress (SPD). We also examined whether SPD mediated associations between childhood maltreatment and all outcomes. We analyzed data from a two-wave cohort telephone survey of a national U.S. sample of current cigarette smokers (n = 751). We used generalized path modeling to examine associations between maltreatment/SPD and concerns about smoking, motivation to quit, quit attempts, and smoking cessation [among the overall sample and selecting for those who made at least one quit attempt between waves (n = 368)]. Among women, maltreatment and SPD were associated with lower likelihood of quitting as well as making a successful quit attempt. SPD mediated the association between maltreatment and likelihood of successfully quitting. Women with maltreatment also had stronger concerns about smoking and motivation to quit than those without maltreatment, although there were no differences in actual quit attempts made. Neither childhood maltreatment nor SPD was associated with smoking outcomes among men. Findings suggest that female smokers with a history of childhood maltreatment are motivated to quit smoking; however, they may have more difficulty quitting smoking due to SPD.

Keywords: cigarette smoking, cessation, quit, child abuse, childhood adversity, gender

Cigarette smoking remains the leading cause of preventable death in the United States, resulting in approximately 480,000 deaths each year (U.S. Department of Health and Human Services, 2014). Individuals who have experienced adverse childhood experiences, which include physical and emotional maltreatment, are at a greater likelihood of smoking cigarettes than those without a history of adversity (Anda et al., 1999; DeWit, MacDonald, & Offord, 1999; Dube, Felitti, Dong, Giles, & Anda, 2003; Felitti et al., 1998; Ford et al., 2011; Mingione, Heffner, Blom, & Anthenelli, 2011; Nichols & Harlow, 2004; Vander Weg, 2011). As indicated by Anda and colleagues (1999), using retrospective cohort survey data from the Adverse Childhood Experiences (ACE) study (Felitti et al., 1998), the odds of having ever smoked were about 3-fold greater in individuals who experienced five or more adverse childhood experiences, compared with those who had experienced fewer. Those who experienced five or more adverse childhood experiences also had more than five times higher odds of starting smoking at an early age and engaging in heavy smoking.

Within the broad classification of childhood adversity, childhood maltreatment has been specifically studied as a risk factor for smoking in adolescence and young adulthood (Jun et al., 2008; Moran, Vuchinich, & Hall, 2004; Rodgers et al., 2004; Topitzes, Mersky, & Reynolds, 2010). In a prospective study of low-income, minority children in the U.S., Topitzes et al. (2009) found childhood maltreatment (defined as emotional/physical/sexual abuse or neglect) to be associated with a 10.5 percentage point difference in the prevalence of daily smoking during young-adulthood (18.0% vs. 28.5% for no maltreatment vs. maltreatment, respectively). However, previous studies of childhood maltreatment and smoking, as well as those examining childhood adversity more broadly, have yet to examine smoking cessation outcomes. Smith and colleagues (2013) found that smokers who reported childhood maltreatment reported greater levels of nicotine withdrawal during quit attempts than smokers who did not experience maltreatment, although it is unclear if this finding translated to lower likelihood of successfully quitting (Smith, Homish, Saddleson, Kozlowski, & Giovino, 2013). Other factors related to quitting are also relatively unstudied among smokers with a history of childhood maltreatment. For example, it is unclear whether maltreatment is related to quitting motives, concerns about the negative effects of smoking, or quit attempts.

Regardless of quitting motives and likelihood of making a quit attempt, one might expect those with a history of maltreatment (and adversity more generally) to have more difficulty quitting tobacco, due to the neurobiological effects of early stressors (Anda et al., 2006; Glaser, 2000; Mullen, Martin, Anderson, Romans, & Herbison, 1996). Evidence suggests that early childhood stress is associated with impaired functioning in several brain systems that are also implicated in nicotine dependence (i.e., dopaminergic, serotonergic, noradrenergic, and the hypothalamic-pituitary-adrenal axis) (Benowitz, 1996; Bremner, 2003; Glaser, 2000; Laviolette & van der Kooy, 2004; Mendelson, Sholar, Goletiani, Siegel, & Mello, 2005; Picciotto & Corrigall, 2002; Pruessner, Champagne, Meaney, & Dagher, 2004). Further, childhood maltreatment (and adversity more generally) has been linked to a number of psychiatric disorders during adulthood (Afifi, Henriksen, Asmundson, & Sareen, 2012; Anda et al., 1999; Anda et al., 2006; Pilowsky, Keyes, & Hasin, 2009; Shaw, Lewis, Loeb, Rosado, & Rodriguez, 2001), and it is well established that those with psychiatric disorders are less likely to quit smoking (Smith, Mazure, & McKee, 2014). Therefore, adult smokers with childhood maltreatment may have more difficulty quitting smoking, and psychological distress may be an important proximal variable mediating this process.

There is also evidence that gender may play an important role in the association between childhood maltreatment and smoking. Hyman and colleagues (2006) studied gender differences in associations between childhood maltreatment and adult substance use, and found stronger associations among women for all examined effects. With specific regard to smoking cigarettes, previous evidence suggests that women are more likely to smoke to cope with stress and negative affect than men (McKee, Maciejewski, Falba, & Mazure, 2003; Westmaas & Langsam, 2005). Given these findings, as well as evidence that childhood maltreatment is associated with depressed affect and anxiety disorders (Afifi et al., 2012; Anda et al., 1999; Anda et al., 2006; Pilowsky et al., 2009; Sartor et al., 2007; Shaw et al., 2001), one might predict stronger associations between childhood maltreatment and smoking cessation outcomes among women.

Paradoxically, it may be the case that although those with childhood maltreatment and related psychological distress have more difficulty quitting smoking, these individuals may have greater motivation to quit smoking. Previous studies have found that those with high anxiety sensitivity and those with depression are more motivated to quit smoking than those without these conditions (Haukkala, Uutela, Vartiainen, Mcalister, & Knekt, 2000; Zvolensky et al., 2004). The suggested rationale has been that symptoms of these disorders may manifest as worry about the potential negative health effects of smoking, in turn increasing motivation to quit. Although this association has been established with regard to certain types of psychological distress, researchers have not examined associations between childhood maltreatment and quitting motives, and whether these associations are mediated by psychological distress.

The aims of this study were to examine whether adult cigarette smokers with childhood maltreatment (physical or emotional abuse), or serious psychological distress (SPD): 1) had greater concerns about the negative effects of smoking, 2) had stronger motivation to quit smoking, 3) were more likely to make a quit attempt, 4) were less likely to stop using tobacco, and 5) were less likely to be successful in their quit attempts. We also examined whether SPD mediated associations between maltreatment and these five cessation outcomes. We examined gender differences in all associations.

Method

Procedures

We analyzed data from a national telephone survey of U.S. smokers aged 25 or older, sampled using equal probability random-digit dialing (Haibach, Homish, & Giovino, 2013). In households with multiple eligible members, an individual was randomly selected for survey administration. A sample of n = 1,000 current smokers and n = 256 former smokers (abstinent for ≤ 5 years) completed the survey between May 2004 and March 2005 (46% response rate). Current smokers were then contacted for a follow-up interview 12–14 months after baseline. This current study was based on the n = 751 baseline cigarette smokers who completed both waves of data collection (75.1% follow-up rate). The procedures of this study were approved by the University at Buffalo Social and Behavioral Sciences and the Roswell Park Cancer Institute Institutional Review Boards.

Sample

The baseline sample of current smokers had a mean age of 44.7 (SD = 12.9; range = 25 to 105), and a median education level of 13–15 years. The sample consisted of 43.8% males, and 74.5% were White, non-Hispanic. Those lost to attrition were younger, were more likely to be of minority race/ethnicity, and had lower education than those who completed the follow-up survey (Haibach et al., 2013).

Measures

Childhood maltreatment

Childhood physical abuse and emotional abuse were measured at wave 1 using items from the Adverse Childhood Experiences Study (Anda et al., 1999), which were adapted from the Conflict Tactics Scale (CTS) (Straus, Gelles, & Smith, 1990). Two items captured the frequency of each form of abuse, measured from 0 to 4 (0 = “never,” 1 = “once or twice,” 2 = “sometimes,” 3 = “often” 4 = “very often”). For physical abuse the questions read, “While you were growing up, how often did a parent, step-parent, or adult living in your home…” 1) “…actually push, grab, shove, or throw something at you?” 2) “…hit you so hard that you had marks or were injured?” For emotional abuse the questions read, “While you were growing up how often did a parent, step-parent, or adult living in your home…” 1) “swear at you, insult you, or put you down?” 2) “…threaten to hit you or throw something at you, but didn’t do it?” We created binary variables for physical and emotional abuse based on Anda et al. (1999). A response of “sometimes” or more for the frequency of either physical abuse item was considered indicative of physical abuse. For emotional abuse, we used a frequency response of “sometimes” or more for the item “threaten to hit you or throw something at you, but didn’t do it?” or a response of “often” or more for the item “swear at you, insult you, or put you down?” to be indicative of abuse. Using this coding scheme, we found substantial overlap between childhood emotional and physical abuse. For example, over 90% of those classified with emotional abuse were also classified with physical abuse. To account for this overlap, and to maintain adequate power for analyses, we combined emotional and physical abuse into a single binary variable. The variable was coded 1 for those who reported either physical or emotional abuse, and was coded 0 for those who reported neither physical nor emotional abuse.

Serious Psychological distress

Serious psychological distress (SPD) was measured at wave 1 using Kessler’s K6 screening tool for non-specific psychological distress (Kessler et al., 2003; Kessler, Chiu, Demler, & Walters, 2005). For this measure, respondents reported how frequently they experienced each of six symptoms during the month out of the past year when they were at their worst emotionally. Responses ranged from 1 to 5 (“none of the time” to “all of the time”). Examples of items included: “how often did you feel hopeless” and “how often did you feel restless or fidgety.” The six items of this scale were first summed to generate a range of scores. Consistent with previous research (Hagman, Delnevo, Hrywna, & Williams, 2008; Kessler et al., 2003; Kessler et al., 2005), we used a cut-off of 13 or higher to represent SPD. Cronbach’s alpha for these 6 items was 0.86. It is important to note that this measure does not capture specific diagnoses; rather, the measure has been validated as a screening tool for non-specific DSM-IV psychiatric disorders. A study of the Australian National Survey of Mental Health and Well-being found that 80% of those with a score of 13 or higher had an ICD-10 diagnosis of a depressive or anxiety disorder (Lawrence, Mitrou, & Zubrick, 2011), suggesting that the measure is predominantly a marker of these disorders.

Motivation to quit, concerns about smoking, and quit attempts

Motivation to quit smoking was based on a single item. At wave one, respondents were asked “how much do you want to quit smoking?” Responses ranged from 1 to 4 (“not at all” to “a lot”). We re-coded this variable to binary, with those who responded “not at all,” “a little,” or “somewhat” coded to 0, and those who responded “a lot” coded to one. This coding resulted in a variable that was split approximately at the median.

To assess concerns about smoking, we created a scale by averaging seven items from the wave 1 survey based on Curry et al. (1990); for example, “How concerned are you that your smoking is affecting your breathing and energy level?” Responses ranged from 0 to 2 (“not at all concerned” to “very concerned”). Cronbach’s alpha for these items was 0.81.

For quit attempts, during the Wave 2 interview, respondents were asked how many times they had attempted to quit since the previous interview (i.e., the past 12–14 months). We created a binary variable, coded based on whether respondents reported at least one quit attempt.

Quitting smoking

We examined the likelihood of quitting smoking with two variables. First, we examined overall cessation rates, based on a definition of 30-day abstinence from all tobacco (NAQC, 2009). We then examined quit attempt success, by modeling this same outcome but selecting for those who had made at least one quit attempt between their wave 1 interview and 30-days prior to the wave 2 interview (reported retrospectively at wave 2).

Covariates

We examined education (1 to 11, “never attended school” to “at least some graduate or professional school”) and race/ethnicity (white non-Hispanic, black non-Hispanic, Hispanic, other) as potential covariates, based on evidence for differences in smoking patterns and childhood abuse based on these variables (Barbeau, Krieger, & Soobader, 2004; Chaffin, Kelleher, & Hollenberg, 1996; Dube et al., 2005). We also considered binge drinking (5 or more drinks, at least once during the past month) and illicit drug use (any use in the past month) to account for associations between childhood abuse, cigarette smoking and other substance use (Chaffin et al., 1996; Grant, Hasin, Chou, Stinson, & Dawson, 2004).

Analyses

We conducted all analyses using Stata Version 13.0 (StataCorp, 2013). We first examined bivariate associations between study variables of interest using logistic and linear regression. We then analyzed associations between the two predictor variables of interest (childhood maltreatment and SPD) and cessation outcomes. In a third step, we conducted mediation analyses based on MacKinnon et al. (2004) and MacKinnon et al. (2007). All mediation modeling was conducted using generalized path modeling. We first tested the associations between childhood maltreatment and each outcome (overall quit rates, abstinence among those making one or more quit attempts, likelihood of making a quit attempt, quitting motives, and concerns about smoking), specifying a binomial distribution/logit link for smoking cessation and motivation to quit, and a guassian distribution/identity link for concerns about smoking. Second, we added a mediation pathway through SPD. We considered minimal evidence for mediation to be present if the predictor variable was associated with the mediator variable, and the mediator variable was associated with the outcome. The sociodemographic and substance use covariates had very little impact on the study findings, even when significantly associated with the outcome, and were consequently dropped from final analyses for purposes of simplification. All analyses were stratified by gender.

Results

Physical or emotional maltreatment was reported by 40.7% of women and 48.9% of men. SPD was found among 30.8% of women and 18.1% of men. Fifty-one percent of women and 46.3% of men reported at follow-up that they had made at least one quit attempt since the first interview. Of these respondents who made a quit attempt, 20.6% of women and 21.7% of men were characterized as successfully quitting based on 30-day abstinence from all tobacco. The quit rates for women and men in the overall sample were 10.3% and 9.9%, respectively. Bivariate associations between childhood abuse, SPD, and cessation variables are displayed in Tables 1 and 2, by gender. Childhood maltreatment and SPD were strongly associated in these bivariate analyses among both women and men, although associations between these two independent variables of interest and cessation outcomes were significant only among women.

Table 1.

Bivariate associations between childhood abuse and cessation outcomes among women (n = 442)

Serious psychological distress Concerns about smoking Motivation to quit smoking b At least 1 quit attempt between Wave 1 and 2 Tobacco cessation, overall sample Tobacco cessation, among attempters a
% p-value Mean (SD) p-value % p-value % p-value % p-value % p-value
Physical or emotional maltreatment
 No (n=262) 19.5 Ref. 1.20 (0.50) Ref. 42.3 Ref. 51.7 Ref. 12.98 Ref. 25.2 Ref.
 Yes (n=180) 38.0 <0.001 1.36 (0.50) <0.01 52.4 <0.05 50.3 0.766 6.11 <0.05 12.2 <0.05
Serious psychological distress --- ---
 No (n=306) 1.18 (0.50) Ref. 43.7 Ref. 49.4 Ref. 12.4 Ref. 25.2 Ref.
 Yes (n=136) 1.43 (0.47) <0.001 52.3 0.102 55.2 0.256 5.2 <0.05 9.5 <0.01
Open in a new tab

Note. Bivariate associations for binomial outcomes calculated using logistic regression; for continuous variables (quitting motives) calculated using linear regression. Significant values in bold.

a

There were n = 225 women who made at least one quit attempt between baseline and follow-up, n = 90 of whom reported either physical or emotional maltreatment.

b

This is the percentage of those who reported wanting to quit smoking “a lot” (as opposed to “not at all,” “a little,” or “somewhat”).

Table 2.

Bivariate associations between childhood abuse and cessation outcomes among men (n = 309)

Serious psychological distress Concerns about smoking Motivation to quit smoking b At least 1 quit attempt between Wave 1 and 2 Tobacco cessation, overall sample Tobacco cessation, among attempters a
% p-value Mean (SD) p-value % p-value % p-value % p-value % p-value
Physical or emotional maltreatment
 No (n=158) 12.0 Ref. 1.16 (0.51) Ref. 49.7 Ref. 44.3 Ref. 8.9 Ref. 20.0 Ref.
 Yes (n=151) 24.5 <0.01 1.11 (0.55) 0.372 50.8 0.853 48.3 0.476 10.6 0.607 21.9 0.778
Serious psychological distress --- ---
 No (n=253) 1.06 (0.53) Ref. 49.1 Ref. 43.9 Ref. 9.9 Ref. 22.5 Ref.
 Yes (n=56) 1.18 (0.54) 0.143 55.3 0.599 57.1 0.072 8.9 0.827 15.6 0.399
Open in a new tab

Note. Bivariate associations for binomial outcomes calculated using logistic regression; for continuous variables (quitting motives) calculated using linear regression. Significant values in bold.

a

There were n = 143 respondents who made at least one quit attempt between baseline and follow-up, n = 73 of whom reported either physical or emotional abuse.

b

This is the percentage of those who reported wanting to quit smoking “a lot” (as opposed to “not at all,” “a little,” or “somewhat”).

Concerns about smoking, motivation to quit smoking, and quit attempts

Among women, childhood maltreatment and SPD were each individually associated with greater concerns over the negative effects of smoking (Figures 1A and 1B, p < 0.05). When maltreatment and SPD were included in the same model, each variable remained significantly associated with greater concerns about smoking (Figure 1C). There was also a significant mediation pathway whereby childhood maltreatment was associated with SPD, and SPD was associated with higher concerns about smoking (Figure 1B, p < 0.05). Among men, neither childhood maltreatment nor SPD were associated with concerns about smoking (data not shown; p > 0.05).

Figure 1.

Figure 1

Open in a new tab

Serious psychological distress (SPD) mediated the association between childhood maltreatment and concerns about smoking, among women (n = 442). Estimates calculated using generalized path modeling. OR = odds ratio; b = regression coefficient. * p < 0.05, ** p < 0.01, *** p < 0.001.

Among women, childhood maltreatment was also associated with greater likelihood of reporting they wanted to quit smoking “a lot” (OR = 1.50, 95% CI = 1.01, 2.23). This association was not significant among men. SPD was not significantly associated with wanting to quit “a lot” for either gender. Among both men and among women, the association between childhood maltreatment and quit attempts was non-significant (p > 0.05), as was the association between SPD and quit attempts (p > 0.05).

Overall quit rates

Among women, those with childhood maltreatment had 66% lower odds of quitting tobacco than those without maltreatment (OR = 0.44, 95% CI = 0.22, 0.89). Cessation was also less likely among those with SPD compared to those without (OR = 0.38, 95% CI = 0.17, 0.87). However, when both SPD and maltreatment were included in a model, mutually adjusting for each other, neither variable was significantly associated with cessation (p = 0.08, 0.07 for maltreatment and SPD, respectively). Among men, neither childhood maltreatment nor SPD was associated with cessation (p > 0.05).

Quit success among attempters

Among women who made a quit attempt, childhood maltreatment was associated with 58% lower odds of successfully quitting (OR = 0.42, 95% CI = 0.20, 0.88; Figure 2A), prior to adjusting for SPD. SPD was associated with 70% lower odds of successful cessation (OR = 0.30, 95% CI = 0.13, 0.51; Figure 2B), prior to adjusting for maltreatment. When both SPD and maltreatment were included in the same model, maltreatment was no longer significantly associated with lower odds of cessation (p > 0.05; Figure 2C). However, maltreatment was significantly associated with SPD (OR = 4.35, 95% CI = 2.41, 7.92), which was in turn significantly associated with lower odds of cessation (OR = 0.13, 0.51). The results supported a mediation model for female smokers, whereby maltreatment was associated with lower odds of cessation, through its relationship with SPD. Among women who attempted to quit smoking, neither maltreatment nor SPD were associated with significantly lower odds of successful tobacco cessation.

Figure 2.

Figure 2

Open in a new tab

Serious psychological distress (SPD) mediated the association between childhood maltreatment and tobacco abstinence, among women who made a quit attempt between baseline and follow-up (n = 225). Estimates calculated using generalized path modeling. OR = odds ratio. * p < 0.05, ** p < 0.01, *** p < 0.001.

Discussion

To our knowledge, this was the first investigation to examine quitting motives, quit attempts, and quit success among smokers with a history of childhood maltreatment. Our findings suggest that both childhood maltreatment (physical or emotional) and Serious Psychological Distress (SPD) were associated with cessation outcomes (greater motivation to quit and lower likelihood of quit success) among women but not men. Further, among women, the association between childhood maltreatment and cessation outcomes was mediated by SPD.

The results from the current investigation, although relatively novel, were consistent with our expectations. Psychiatric disorders are strongly related to smoking cessation outcomes (Grant et al., 2004; Lasser et al., 2000; Smith, Homish, Giovino, & Kozlowski, 2014; Smith, Mazure, et al., 2014), and the current investigation supports this conclusion. As noted in the introduction, childhood maltreatment is a robust risk factor for a number of adverse psychiatric outcomes (Kessler, Davis, & Kendler, 1997; McLaughlin et al., 2012; Young, Abelson, Curtis, & Nesse, 1997), which are captured generally with the summary measure of SPD utilized in this study (Kessler’s K6). In the current investigation, those with childhood maltreatment were approximately two-times more likely to have SPD than those without childhood maltreatment. Therefore, it makes intuitive sense that SPD would be significantly associated with lower odds of cessation, and that childhood maltreatment would be linked to lower likelihood of cessation through its relationship with SPD.

Nevertheless, despite its high prevalence in the population, childhood maltreatment (and other types of childhood adversity) has received little attention as a potentially important factor related to smoking cessation. In most cases childhood maltreatment is temporally distal relative to cessation attempts, while more proximal factors such as psychiatric co-morbidity may be more obvious targets. This rational is supported by results from the current investigation – associations between childhood maltreatment and lower odds of cessation were no longer significant after adjusting for mediation by psychological distress. It is then important to question whether childhood maltreatment is an important variable related to cessation in its own right, beyond more proximal factors. There are multiple points to consider regarding this question. For one, distal risk factors such as childhood maltreatment are highly important from a prevention perspective. Second, from a clinical perspective, there is evidence to suggest individuals with childhood maltreatment may be vulnerable to particular types of psychological distress. This hypothesis is supported by a growing body of literature demonstrating early maltreatment and other types of adversity may lead to a heightened stress response. This phenomenon, often labeled “stress-sensitization,” has been documented as a risk factor for onset of major depression, anxiety disorders, and alcohol use disorders (McLaughlin et al., 2010; Young-Wolff, Kendler, & Prescott, 2012). Although associations between childhood maltreatment, stress-sensitization, and smoking cessation have yet to be studied, similar mechanisms may be of importance. This speculation is further bolstered by previous evidence that stress can be a salient factor in the perpetuation of smoking (McKee et al., 2011; Nakajima & al’Absi, 2012). A third important point is that our study was underpowered to detect small effect sizes as well as interactions between childhood maltreatment and SPD. Therefore it remains unclear whether small but significant associations between childhood maltreatment and cessation would have remained after controlling for SPD, or whether childhood maltreatment and SPD interacted synergistically to predict lower odds of cessation.

Our finding that maltreatment was associated with greater levels of motivation to quit smoking among female smokers is novel. Analyses related to concerns about smoking suggested women with maltreatment also have greater concerns about the negative effects of smoking than those without maltreatment. This finding was also true for women with SPD. Zvolensky and colleagues (2004) speculated that associations between psychological distress (anxiety sensitivity in their study) and quitting motives can be explained by greater levels of anxiety over risks related to smoking. Our findings support this mechanism. It is important to note, though, that neither childhood maltreatment nor SPD was associated with greater likelihood of making a quit attempt, and both variables were associated with lower likelihood of cessation. In other words, stronger quitting motives and concerns about the negative effects of smoking did not relate to greater likelihood of quitting behavior among those with maltreatment/SPD. At this point, it seems as though greater than average quitting motives and smoking-related concerns may be capitalized upon to improve smoking cessation interventions for those with childhood maltreatment and related SPD. It may be the case that interventions could focus on translating quitting motives to action. However, more research is needed to test this hypothesis.

Regarding gender differences, there is a growing body of evidence that associations between childhood maltreatment and adult substance use behaviors may be stronger among women than men (Hyman et al., 2006). There is also evidence that stress and negative affect may play a more prominent role in smoking for women than men (McKee et al., 2003; Westmaas & Langsam, 2005). If this stress or negative affect are related to childhood maltreatment, one might anticipate stronger associations between maltreatment and smoking among women. However, research has yet to fully explore the reasons why stress and negative affect are more strongly related to smoking among women than men, and therefore although findings from this study are consistent with our hypotheses, underlying mechanisms are unclear. In conjunction with previous research, this study supports the need for gender-sensitive treatments for smoking cessation, although more research is needed on the topic. Understanding individuals’ histories of childhood maltreatment, SPD, and stress response may all play an important role in gender-sensitive treatments.

There are important limitations of this study to note. Reports of childhood abuse were retrospective and thus subject to bias, although previous research has demonstrated the validity of retrospective childhood abuse measures (Hardt & Rutter, 2004). Although the K6 measure of SPD has been well-validated and widely used in population surveys (Kessler et al., 2003; Kessler et al., 2005; Lawrence et al., 2011), findings cannot be extrapolated to specific types of mental illness or SPD. Findings may vary by type of mental illness; thus, study of specific mental illness may be warranted. Only landlines were contacted, and those without landlines may have lower income (Blumberg & Luke, 2007); however, rates of childhood maltreatment found in this study were similar to those found among smokers through the Behavioral Risk Factor Surveillance System (36.3% emotional abuse and 22.3% physical abuse) (Ford et al., 2011), suggesting the sample was representative of adult smokers in the U.S. for these variables. Although the study was adequately powered to detect moderate and large effect sizes, analyses were underpowered to detect small, but potentially clinically relevant effect sizes. Therefore, non-significant findings should be interpreted with caution as to whether small but clinically relevant associations may have been identified with a larger sample.

Further research is needed to replicate and extend these findings. This study was of a community sample of adults, and it is unclear how findings may extend to clinical or younger samples. More rigorous measurement of tobacco cessation may also be important for verifying these conclusions. Despite the limitations of the current investigation and the need for further research on this topic, the results are first that we are aware of to document lower cessation rates among those with a history of childhood maltreatment, bolstering the broader literature on childhood maltreatment and smoking outcomes. Given the high prevalence of childhood maltreatment (41% of women and 49% of men in the current study), mental illness, and psychological distress among smokers (Lasser et al., 2000; Smith, Mazure, et al., 2014), these associations may be highly relevant for smoking prevention and cessation interventions. Although there is evidence of effective methods for helping those with mental illness quit smoking (Banham & Gilbody, 2010; Fiore, 2008; Ziedonis et al., 2008), non-treatment remains the norm (Prochaska, 2010). The incorporation of information about childhood maltreatment into cessation interventions has yet to be explored, although early literature suggests targeting stress/threat-response systems with behavioral or pharmacological interventions may be promising.

Acknowledgments

This study was supported by grants awarded to Dr. Gary Giovino from the Robert Wood Johnson Foundation Innovators Combatting Substance Abuse Program and the American Legacy Foundation. Funding was also provided by Grant Number P50 DA033945 from the National Institute on Drug Abuse (NIDA), the Food and Drug Administration (FDA), and the Office of Research on Women’s Health (ORWH), OD (PI: Sherry McKee), and the National Institute of Mental Health (T32 MH014235, PI: Heping Zhang). Further support was provided by NIDA and ORWH (K12 DA031050, PI: Carolyn Mazure).

Contributor Information

Philip H. Smith, Psychiatry, Yale University School of Medicine

Megan L. Saddleson, Community Health and Health Behavior, University at Buffalo, SUNY

Gregory G. Homish, Community Health and Health Behavior, University at Buffalo, SUNY

Sherry A. McKee, Psychiatry, Yale University School of Medicine

Lynn T. Kozlowski, Community Health and Health Behavior, University at Buffalo, SUNY

Gary A. Giovino, Community Health and Health Behavior, University at Buffalo, SUNY

References

  1. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Childhood maltreatment and substance use disorders among men and women in a nationally representative sample. Canadian journal of psychiatry Revue canadienne de psychiatrie. 2012;57(11):677. doi: 10.1177/070674371205701105. [DOI] [PubMed] [Google Scholar]
  2. Anda RF, Croft JB, Felitti VJ, Nordenberg D, Giles WH, Williamson DF, Giovino GA. Adverse childhood experiences and smoking during adolescence and adulthood. JAMA: The Journal of the American Medical Association. 1999;282(17):1652–1658. doi: 10.1001/jama.282.17.1652. [DOI] [PubMed] [Google Scholar]
  3. Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield CH, Perry BD, Giles WH. The enduring effects of abuse and related adverse experiences in childhood. European archives of psychiatry and clinical neuroscience. 2006;256(3):174–186. doi: 10.1007/s00406-005-0624-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Banham Lindsay, Gilbody Simon. Smoking cessation in severe mental illness: what works? Addiction. 2010;105(7):1176–1189. doi: 10.1111/j.1360-0443.2010.02946.x. [DOI] [PubMed] [Google Scholar]
  5. Barbeau Elizabeth M, Krieger Nancy, Soobader Mah-Jabeen. Working class matters: socioeconomic disadvantage, race/ethnicity, gender, and smoking in NHIS 2000. Journal Information. 2004;94(2) doi: 10.2105/ajph.94.2.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Benowitz Neal L. Pharmacology of nicotine: addiction and therapeutics. Annual Review of Pharmacology and Toxicology. 1996;36(1):597–613. doi: 10.1146/annurev.pa.36.040196.003121. [DOI] [PubMed] [Google Scholar]
  7. Blumberg SJ, Luke JV. Coverage bias in traditional telephone surveys of low-income and young adults. Public Opinion Quarterly. 2007;71(5):734–749. doi: 10.1093/poq/nfm047. [DOI] [Google Scholar]
  8. Bremner J Douglas. Long-term effects of childhood abuse on brain and neurobiology. Child and Adolescent Psychiatric Clinics of North America. 2003;12(2):271–292. doi: 10.1016/s1056-4993(02)00098-6. http://dx.doi.org/10.1016/S1056-4993(02)00098-6. [DOI] [PubMed] [Google Scholar]
  9. Chaffin Mark, Kelleher Kelly, Hollenberg Jan. Onset of physical abuse and neglect: Psychiatric, substance abuse, and social risk factors from prospective community data. Child Abuse and Neglect. 1996;20(3):191–203. doi: 10.1016/s0145-2134(95)00144-1. [DOI] [PubMed] [Google Scholar]
  10. DeWit DJ, MacDonald K, Offord DR. Childhood stress and symptoms of drug dependence in adolescence and early adulthood. American Journal of Orthopsychiatry. 1999;69(1):61–72. doi: 10.1037/h0080382. [DOI] [PubMed] [Google Scholar]
  11. Dube SR, Anda RF, Whitfield CL, Brown DW, Felitti VJ, Dong M, Giles WH. Long-term consequences of childhood sexual abuse by gender of victim. American Journal of Preventive Medicine. 2005;28(5):430–438. doi: 10.1016/j.amepre.2005.01.015. [DOI] [PubMed] [Google Scholar]
  12. Dube SR, Felitti VJ, Dong M, Giles WH, Anda RF. The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900. Preventive medicine. 2003;37(3):268–277. doi: 10.1016/s0091-7435(03)00123-3. [DOI] [PubMed] [Google Scholar]
  13. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine. 1998;14(4):245–258. doi: 10.1016/S0749-3797(98)00017-8. [DOI] [PubMed] [Google Scholar]
  14. Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating Tobacco Use and Dependence: 2008 Update. Rockville, MD: U.S. Department of Health and Human Services; 2008. [Google Scholar]
  15. Ford ES, Anda RF, Edwards VJ, Perry GS, Zhao G, Li C, Croft JB. Adverse childhood experiences and smoking status in five states. Preventive medicine. 2011;53(3):188–193. doi: 10.1016/j.ypmed.2011.06.015. [DOI] [PubMed] [Google Scholar]
  16. Glaser D. Child abuse and neglect and the brain—a review. Journal of child psychology and psychiatry. 2000;41(1):97–116. [PubMed] [Google Scholar]
  17. Grant BF, Hasin DS, Chou SP, Stinson FS, Dawson DA. Nicotine dependence and psychiatric disorders in the United States: Results from the national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry. 2004;61(11):1107–1115. doi: 10.1001/archpsyc.61.11.1107. [DOI] [PubMed] [Google Scholar]
  18. Hagman BT, Delnevo CD, Hrywna M, Williams JM. Tobacco use among those with serious psychological distress: results from the national survey of drug use and health, 2002. Addictive Behaviors. 2008;33(4):582–592. doi: 10.1016/j.addbeh.2007.11.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Haibach Jeffrey P, Homish Gregory G, Giovino Gary A. A longitudinal evaluation of fruit and vegetable consumption and cigarette smoking. Nicotine & Tobacco Research. 2013;15(2):355–363. doi: 10.1093/ntr/nts130. [DOI] [PubMed] [Google Scholar]
  20. Hardt J, Rutter M. Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. Journal of Child Psychology and Psychiatry. 2004;45(2):260–273. doi: 10.1111/j.1469-7610.2004.00218.x. [DOI] [PubMed] [Google Scholar]
  21. Haukkala Ari, Uutela Antti, Vartiainen Erkki, Mcalister Alfred, Knekt Paul. Depression and smoking cessation: the role of motivation and self-efficacy. Addictive behaviors. 2000;25(2):311–316. doi: 10.1016/s0306-4603(98)00125-7. [DOI] [PubMed] [Google Scholar]
  22. Hyman Scott M, Garcia Miguel, Sinha Rajita. Gender Specific Associations Between Types of Childhood Maltreatment and the Onset, Escalation and Severity of Substance Use in Cocaine Dependent Adults. The American Journal of Drug and Alcohol Abuse. 2006;32(4):655–664. doi: 10.1080/10623320600919193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Jun Hee-Jin, Rich-Edwards Janet W, Boynton-Jarrett Renée, Austin S Bryn, Frazier A Lindsay, Wright Rosalind J. Child abuse and smoking among young women: the importance of severity, accumulation, and timing. Journal of Adolescent Health. 2008;43(1):55–63. doi: 10.1016/j.jadohealth.2007.12.003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, Zaslavski AM. Screening for serious mental illness in the general population. Archives of General Psychiatry. 2003;60(2):184–189. doi: 10.1001/archpsyc.60.2.184. [DOI] [PubMed] [Google Scholar]
  25. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry. 2005;62(6):617–627. doi: 10.1001/archpsyc.62.6.617. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Kessler RC, Davis CG, Kendler KS. Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychological medicine. 1997;27(05):1101–1119. doi: 10.1017/s0033291797005588. [DOI] [PubMed] [Google Scholar]
  27. Lasser Karen, Boyd J Wesley, Woolhandler Steffie, Himmelstein David U, McCormick Danny, Bor David H. Smoking and mental illness. JAMA: The Journal of the American Medical Association. 2000;284(20):2606–2610. doi: 10.1001/jama.284.20.2606. [DOI] [PubMed] [Google Scholar]
  28. Laviolette Steven R, van der Kooy Derek. The neurobiology of nicotine addiction: bridging the gap from molecules to behaviour. Nature Reviews Neuroscience. 2004;5(1):55–65. doi: 10.1038/nrn1298. [DOI] [PubMed] [Google Scholar]
  29. Lawrence D, Mitrou F, Zubrick SR. Non-specific psychological distress, smoking status and smoking cessation: United States National Health Interview Survey 2005. BMC Public Health. 2011;11(1):256. doi: 10.1186/1471-2458-11-256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. McKee SA, Maciejewski PK, Falba T, Mazure CM. Sex differences in the effects of stressful life events on changes in smoking status. Addiction. 2003;98(6):847–855. doi: 10.1046/j.1360-0443.2003.00408.x. [DOI] [PubMed] [Google Scholar]
  31. McKee SA, Sinha R, Weinberger AH, Sofuoglu M, Harrison ELR, Lavery M, Wanzer J. Stress decreases the ability to resist smoking and potentiates smoking intensity and reward. Journal of psychopharmacology. 2011;25(4):490–502. doi: 10.1177/0269881110376694. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. McLaughlin KA, Green JG, Gruber MJ, Sampson NA, Zaslavsky AM, Kessler RC. Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication II: associations with persistence of DSM-IV disorders. Archives of general psychiatry. 2010;67(2):124. doi: 10.1001/archgenpsychiatry.2009.187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. McLaughlin KA, Green JG, Gruber MJ, Sampson NA, Zaslavsky AM, Kessler RC. Childhood Adversities and First Onset of Psychiatric Disorders in a National Sample of US AdolescentsChildhood Adversities and Psychiatric Disorders. Archives of general psychiatry. 2012;69(11):1151–1160. doi: 10.1001/archgenpsychiatry.2011.2277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Mendelson Jack H, Sholar Michelle B, Goletiani Nathalie, Siegel Arthur J, Mello Nancy K. Effects of low-and high-nicotine cigarette smoking on mood states and the HPA axis in men. Neuropsychopharmacology. 2005;30(9):1751–1763. doi: 10.1038/sj.npp.1300753. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Mingione CJ, Heffner JL, Blom TJ, Anthenelli RM. Childhood adversity, serotonin transporter (5-HTTLPR) genotype, and risk for cigarette smoking and nicotine dependence in alcohol dependent adults. Drug and Alcohol Dependence. 2011 doi: 10.1016/j.drugalcdep.2011.11.013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Moran Patricia B, Vuchinich Sam, Hall Nancy K. Associations between types of maltreatment and substance use during adolescence. Child abuse & neglect. 2004;28(5):565–574. doi: 10.1016/j.chiabu.2003.12.002. [DOI] [PubMed] [Google Scholar]
  37. Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP. The long-term impact of the physical, emotional, and sexual abuse of children: a community study. Child abuse & neglect. 1996;20(1):7–21. doi: 10.1016/0145-2134(95)00112-3. [DOI] [PubMed] [Google Scholar]
  38. Nakajima Motohiro, al’Absi Mustafa. Predictors of risk for smoking relapse in men and women: A prospective examination. Psychology of Addictive Behaviors. 2012;26(3):633. doi: 10.1037/a0027280. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. An L, Betzner A, Luxenberg ML, Rainey J, Capesius T, Subialka E, editors. NAQC. Measuring Quit Rates. Quality Improvement Initiative. Phoenix, AZ: 2009. [Google Scholar]
  40. Nichols HB, Harlow BL. Childhood abuse and risk of smoking onset. Journal of Epidemiology and Community Health. 2004;58(5):402–406. doi: 10.1136/jech.2003.008870. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Picciotto Marina R, Corrigall William A. Neuronal systems underlying behaviors related to nicotine addiction: neural circuits and molecular genetics. The Journal of neuroscience. 2002;22(9):3338–3341. doi: 10.1523/JNEUROSCI.22-09-03338.2002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Pilowsky DJ, Keyes KM, Hasin DS. Adverse childhood events and lifetime alcohol dependence. American journal of public health. 2009;99(2):258. doi: 10.2105/AJPH.2008.139006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Prochaska JJ. Failure to treat tobacco use in mental health and addiction treatment settings: A form of harm reduction? Drug and Alcohol Dependence. 2010;110(3):177–182. doi: 10.1016/j.drugalcdep.2010.03.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Pruessner JC, Champagne F, Meaney MJ, Dagher A. Dopamine release in response to a psychological stress in humans and its relationship to early life maternal care: a positron emission tomography study using [11C] raclopride. The Journal of neuroscience. 2004;24(11):2825–2831. doi: 10.1523/JNEUROSCI.3422-03.2004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Rodgers Carie S, Lang Ariel J, Laffaye Charlene, Satz Leslie E, Dresselhaus Timothy R, Stein Murray B. The impact of individual forms of childhood maltreatment on health behavior. Child abuse & neglect. 2004;28(5):575–586. doi: 10.1016/j.chiabu.2004.01.002. [DOI] [PubMed] [Google Scholar]
  46. Sartor CE, Lynskey MT, Bucholz KK, McCutcheon VV, Nelson EC, Waldron M, Heath AC. Childhood sexual abuse and the course of alcohol dependence development: Findings from a female twin sample. Drug and Alcohol Dependence. 2007;89(2–3):139. doi: 10.1016/j.drugalcdep.2006.12.022. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Shaw JA, Lewis JE, Loeb A, Rosado J, Rodriguez RA. A comparison of Hispanic and African-American sexually abused girls and their families. Child abuse & neglect. 2001 doi: 10.1016/s0145-2134(01)00272-1. [DOI] [PubMed] [Google Scholar]
  48. Smith PH, Homish GG, Giovino GA, Kozlowski LT. Cigarette smoking and mental illness: A study of Nicotine Withdrawal. American Journal of Public Health. 2014;104(2):e127–e133. doi: 10.2105/AJPH.2013.301502. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Smith PH, Homish GG, Saddleson ML, Kozlowski LT, Giovino GA. Nicotine withdrawal and dependence among smokers with a history of childhood abuse. Nicotine & Tobacco Research. 2013;15(12):2016–2021. doi: 10.1093/ntr/ntt092. [DOI] [PubMed] [Google Scholar]
  50. Smith PH, Mazure CM, McKee SA. Smoking and mental illness in the U.S. Population. Tobacco Control. 2014 doi: 10.1136/tobaccocontrol-2013-051466. Online ahead of print. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. StataCorp. Stata Statistical Software: Release 13.0. College Station, Tx: StataCorp LP; 2013. [Google Scholar]
  52. Straus MA, Gelles RJ, Smith C. Physical violence in American families: Risk factors and adaptations to violence in 8,145 families. New Brunswick, NJ: Transaction Pub; 1990. [Google Scholar]
  53. Topitzes James, Mersky Joshua P, Reynolds Arthur J. Child Maltreatment and Adult Cigarette Smoking: A Long-term Developmental Model. Journal of Pediatric Psychology. 2010;35(5):484–498. doi: 10.1093/jpepsy/jsp119. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. U.S. Department of Health and Human Services. The Health Consequences of Smoking - 50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: 2014. [Google Scholar]
  55. Vander Weg MW. Adverse Childhood Experiences and Cigarette Smoking: The 2009 Arkansas and Louisiana Behavioral Risk Factor Surveillance Systems. Nicotine & Tobacco Research. 2011;13(7):616–622. doi: 10.1093/ntr/ntr023. [DOI] [PubMed] [Google Scholar]
  56. Westmaas J Lee, Langsam Karen. Unaided smoking cessation and predictors of failure to quit in a community sample: Effects of gender. Addictive Behaviors. 2005;30(7):1405–1424. doi: 10.1016/j.addbeh.2005.03.001. [DOI] [PubMed] [Google Scholar]
  57. Young-Wolff Kelly C, Kendler Kenneth S, Prescott Carol A. Interactive effects of childhood maltreatment and recent stressful life events on alcohol consumption in adulthood. Journal of Studies on Alcohol and Drugs. 2012;73(4):559. doi: 10.15288/jsad.2012.73.559. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Young Elizabeth A, Abelson James L, Curtis George C, Nesse Randolph M. Childhood adversity and vulnerability to mood and anxiety disorders. 1997 [PubMed] [Google Scholar]
  59. Ziedonis Douglas, Hitsman Brian, Beckham Jean C, Zvolensky Michael, Adler Lawrence E, Audrain-McGovern Janet, Riley William T. Tobacco use and cessation in psychiatric disorders: National Institute of Mental Halth report. Nicotine & Tobacco Research. 2008;10(12):1691–1715. doi: 10.1080/14622200802443569. [DOI] [PubMed] [Google Scholar]
  60. Zvolensky Michael J, Baker Kristin M, Leen-Feldner Ellen, Bonn-Miller Marcel O, Feldner Matthew T, Brown Richard A. Anxiety sensitivity: association with intensity of retrospectively-rated smoking-related withdrawal symptoms and motivation to quit. Cognitive Behaviour Therapy. 2004;33(3):114–125. doi: 10.1080/16506070310016969. [DOI] [PubMed] [Google Scholar]

RESOURCES