Adverse childhood experiences and smoking during adolescence and adulthood
Adverse childhood experiences and smoking during adolescence and adulthood
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DOI：
10.1001/jama.282.17.1652
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发表时间：
1999-11-03
影响因子：
120.7
通讯作者：
Giovino, GA
中科院分区：
文献类型：
--
作者：
Anda, RF;Croft, JB;Giovino, GA
近年来，青少年吸烟人数有所增加，而成人吸烟人数的下降速度已放缓至几乎停止；需要对烟草依赖有新的见解来纠正这种情况。长期使用尼古丁与自我治疗努力有关，以应对不良童年经历的负面情绪、神经生物学和社会影响。目的 评估不良童年经历与 5 种吸烟行为之间的关系。设计 ACE 研究，这是一项回顾性队列调查，包括吸烟和暴露于 8 类不良童年经历（情感、身体和性虐待；受虐待的母亲；父母分居或离婚；以及在药物滥用、精神病或监禁的环境下长大）家庭成员），于 1995 年 8 月至 11 月和 1996 年 1 月至 3 月进行。设置 加利福尼亚州圣地亚哥一家大型健康维护组织成年成员的初级保健诊所。 参与者 共有 9215 名成年人（4958 名女性和 4257 名男性，平均 [SD] 年龄分别为 55.3 [15.7] 和 58.1 [14.5] 岁）回答了调查问卷，调查问卷邮寄至就诊后 1 周对所有患者进行调查。主要结果指标 14 岁或 18 岁后开始吸烟，以及吸烟者的状态，包括吸烟者、当前吸烟者或重度吸烟者。结果 63% 的受访者报告了 8 类不良童年经历中的至少 1 类。在调整年龄、性别、种族和教育程度后，每个类别都显示出每种吸烟行为的风险增加，并且这些风险对于每种不良童年经历类别而言是可比的。与报告没有不良童年经历的人相比，报告 5 种或更多类别的人早期吸烟（比值比 [OR]，5.4；95% 置信区间 [CI]，4.1-7.1）、曾经吸烟（OR，3.1；95% CI，2.6-3.8）、当前吸烟（OR，2.1；95% CI，1.6-2.7）和大量吸烟（OR， 2.8；95% CI，1.9-4.2），吸烟行为与不良童年经历数量之间的关系均很强且分级（P
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