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

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.