CoChat
Sign Up
Cited by 1,256Smoking Behavior and CessationChild Abuse and TraumaSubstance Abuse Treatment and Outcomes

Adverse Childhood Experiences and Smoking During Adolescence and Adulthood

Anda, Robert F.·1999·JAMA
DOI 10.1001/jama.282.17.1652
Open this paper in CoChat — free account

Abstract

CONTEXT: In recent years, smoking among adolescents has increased and the decline of adult smoking has slowed to nearly a halt; new insights into tobacco dependency are needed to correct this situation. Long-term use of nicotine has been linked with self-medicating efforts to cope with negative emotional, 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 exposure to 8 categories of adverse childhood experiences (emotional, physical, and sexual abuse; a battered mother; parental separation or divorce; and growing up with a substance-abusing, mentally ill, or incarcerated household member), conducted from August to November 1995 and January to March 1996. SETTING: A primary care clinic for adult members of a large health maintenance 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 clinic visit. MAIN OUTCOME MEASURES: Smoking initiation by age 14 years or after age 18 years, and status as ever, current, or heavy smoker. RESULTS: At least 1 of 8 categories of adverse childhood experiences was reported by 63% of respondents. After adjusting for age, sex, race, and education, each category showed an increased risk for each smoking behavior, and these risks were comparable for each category of adverse childhood experiences. Compared with those reporting no adverse childhood experiences, persons reporting 5 or more categories had substantially higher risks of early smoking 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 relationship between smoking behavior and the number of adverse childhood experiences 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 experiences. Primary prevention of adverse childhood experiences and improved treatment of exposed children could reduce smoking among both adolescents and adults.

Integrity signals

Registry

Crossref · 10.1001/jama.282.17.1652

Cites

45 of 45 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Childhood maltreatment is a pleiotropic risk factor influencing multiple pathophysiological pathways and outcomes, including psychiatric disorders, health behaviors, and crime.

    “Third, childhood maltreatment is a pleiotropic risk factor influencing multiple pathophysiological pathways and outcomes [e.g., psychiatric disorders (31), health behaviors (19), and crime (12)].”

    From Childhood maltreatment predicts adult inflammation in a life-course study (2007) · cites this paper as [19]

  • The effect of stress often appears to be cumulative.

    “Given that the effect of stress often appears to be cumulative (2, 9, 19), we derived a cumulative exposure index for each child by counting the number of maltreatment experiences during the first decade of life (31);”

    From Childhood maltreatment predicts adult inflammation in a life-course study (2007) · cites this paper as [19]

  • ELA is linked to higher likelihood of smoking, alcohol and drug abuse, poor diet, and obesity.

    “Indeed, ELA is associated with a greater likelihood of smoking cigarettes,32,43,44 abusing alcohol and drugs,32,45–47 eating a poor diet,48 and being obese.32,49”

    From Early life adversity and health-risk behaviors: Proposed psychological and neural mechanisms (2018) · cites this paper as [44]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Anda, R. F.
Affiliations
Centers for Disease Control and Prevention (US)
Corresponding author
Anda, Robert F.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
1999-11-03
Volume
282
Issue
17
Pages
1652
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.282.17.1652
OpenAlex
W2140219025
Cited by
1,256
References
45
Citations by year
2026: 31 · 2025: 44 · 2024: 44 · 2023: 60 · 2022: 74 · 2021: 110 · 2020: 79 · 2019: 75 · 2018: 63 · 2017: 74 · 2016: 71 · 2015: 60 · 2014: 54 · 2013: 47 · 2012: 39
FWCI
8.89
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
Centers for Disease Control and Prevention (TS-44-10/11)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
adverse childhood experiences, smoking initiation, adolescent smoking, adult smoking, tobacco use, self-medication, emotional abuse, physical abuse, sexual abuse, parental separation, depression, ACE study, health maintenance organization members, heavy smoking, ever smoking, current smoking
MeSH terms
Adolescent, Adult, Mental Disorders, Child, Divorce, Family Characteristics, Female, Humans, Life Change Events, Male, Middle Aged, Regression Analysis, Retrospective Studies, Risk Factors, Smoking, Stress, Psychological, Domestic Violence, Substance-Related Disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review