Studies have been done to try to understand why people smoke. The following two summaries refer to studies that looked at smoking behavior. Both summaries appeared in the December 15, 1999, edition of Audio-Digest Foundation’s Journal Watch.
CHILDHOOD STRESS LEADS TO SMOKING
In order to gain insight into smoking behaviors, researchers examined the effect of social problems on patterns of smoking in adolescence and adulthood. Eight adverse childhood experiences were considered; they were:
- Being a victim of verbal abuse;
- Being a victim of physical abuse;
- Being a victim of sexual abuse;
- Having a battered mother;
- Living with a substance abuser;
- Living with someone who's mentally ill;
- Having parents who are separated or divorced; and
- Having an incarcerated household member.
Data were obtained from a retrospective cohort study of 9,200 adults enrolled in a large HMO in California. Findings appear in the November 3rd Journal of the American Medical Association.
About two thirds of the respondents had a parent who smoked. The adjusted prevalence of current smoking was 14%; at least one adverse childhood experience was reported by two thirds of the respondents. After adjusting for age, sex, and education, all eight adverse experiences were strongly associated with later smoking. The greater the extent of adverse experiences, the greater the likelihood that the respondents were early or current smokers. Respondents experiencing signs of depression over the past year were more likely to be smokers and to have had adverse experiences. The results were similar in an analysis stratified by history of parental smoking.
Children exposed to adverse experiences may have mood and other psychological disorders, and nicotine is known to improve affect. Smokers who've had adverse childhood experiences may have a strong underlying need to continue to smoke, so for them, successful smoking cessation techniques may mean counseling, nicotine replacement therapy, or antidepression medication.
CHILDHOOD ABUSE AND ADULT HEALTH STATUS
It's been reported that there's a link between childhood maltreatment and poorer adult physical and emotional health, although questions of study population and methodology have limited the applicability of these findings. Researchers in Seattle enrolled HMO patients to create a population-based picture of this association. Standardized questionnaires were administered to 1,900 women and were completed by 1,200. (The women were mostly white and their average age was 42.) Findings appear in October's American Journal of Medicine.
Forty percent of the women reported significant childhood maltreatment of any type, ranging from physical neglect to emotional abuse. Maltreatment was significantly associated with poor overall health, a greater number of distressing physical symptoms, more risky health behaviors, like alcohol abuse, and more physician-coded diagnoses. Most of the analyses were adjusted for marital status and education.
An editorialist notes several potential explanations for these findings, including sympathetic nervous system reactivity, alterations in cortisol and serotonin levels, and emotional dysregulation. More importantly though, the findings suggest types of patients whom primary care physicians should question about both current and past abuse. A measure of the importance such questioning holds for patients is the very high response rate (64%) for a study that required filling out a 22-page questionnaire.