Research
has shown that children who are at high risk of being mistreated at home -- who
live in poverty or have parents who use drugs or have mental health problems --
are more likely to start smoking. Because abused and neglected children are
often unsupervised, these teens may have easy access to cigarettes and other
substances that they use to deal with anxiety and other trauma-related
symptoms.
A
recent study out of Ohio State University (OSU) shows that physical abuse of
children in high-risk homes, especially when they’re toddlers or teens,
dramatically increases the odds that their adolescent experimentation with
cigarettes will lead to a heavy smoking habit.
The
study examined data on children who were at high risk for abuse and neglect -- either
because they had been referred to a child protective service, lived in
conditions associated with the likelihood of maltreatment, or both.
“I
wanted to look at different types of maltreatment and whether they have an
impact on cigarette smoking,” said lead author Susan Yoon, assistant professor
of social work at OSU. “There’s also the impact of timing – it’s not just
maltreatment, yes or no. When did it happen, and does that matter with regard
to outcomes?”
Yoon
noted that substance abuse research doesn’t often take cigarette smoking into
consideration despite its significant damaging effects on health.
“Adolescent
cigarette smoking is a really serious social problem and public health concern.
Brain development is not complete until late adolescence or during young
adulthood, and cigarette smoking is associated with damage in brain
development,” Yoon said. “We also know that those who start smoking cigarettes
during adolescence are more likely to continue smoking into adulthood.”
Yoon
and colleagues used data from the Longitudinal Studies of Child Abuse and
Neglect, a consortium of studies across different regions of the U.S. targeting
children who were identified as maltreated or at risk for maltreatment. This
study used data on 903 adolescents who were assessed at age 12, 16 and 18.
According
to study authors, a breakdown of different types of abuse and neglect
experienced by the sample population during three different time periods (early
childhood, school age and adolescence) confirmed how vulnerable these children
were. Almost a quarter had been neglected during early childhood and their
school-age years, and 19 percent reported school-age physical abuse. Almost
half lived in poverty and 58 percent lived in households in which family
members smoked cigarettes.
Yoon
used their responses about smoking between the ages of 12 and 18 to identify
three patterns of cigarette use: stable low/no use (61 percent of respondents),
gradually increasing use (30 percent) and sharply increasing cigarette use (9
percent).
“It
was almost shocking how the pattern of cigarette use over time went up so
drastically in the sharply increasing use class,” Yoon said. “They were pretty
similar to the others at age 12 – almost 80 percent didn’t smoke. At age 16, we
saw that almost 60 percent had used cigarettes more than 20 days in the past
year and by 18, every single kid in this group reported heavy use of
cigarettes.”
A
statistical analysis showed that adolescents who experienced early childhood
physical abuse were 2.3 times more likely to be in the sharply increasing
cigarette use group compared with the stable no/low group. Physical abuse
during adolescence had an even stronger effect – this type of mistreatment at
that point in life was linked to 3.7 times higher odds for sharply increased
cigarette use.
Adolescents
who had been neglected during early childhood were 1.89 times more likely to be
in the gradually increasing cigarette use group than in the stable no/low use
group. Neglect can include a lack of appropriate supervision and failure to
meet a child’s needs -- ranging from food and clothing to medical needs and
education.
About
40 percent of these smokers had reported using cigarettes at age 16, and by age
18, more than 80 percent were smokers, and about 40 percent had smoked on more
than 20 days in the previous year.
The
analysis also measured the potential effects of sexual abuse and emotional
abuse on cigarette use, but neither was a predictor of an increase in smoking.
“The
different types of maltreatment predicted different patterns of cigarette use,
but the timing mattered as well. It was early childhood and adolescence that
appear to be really sensitive periods in which maltreatment influences these
outcomes,” Yoon said.
The
results suggest efforts to prevent smoking by teens at risk of maltreatment --
and especially children experiencing physical abuse and neglect -- should start
before age 12, she said.
“If
we intervene too late, it’s likely they’ve already started using cigarettes and
are in the process of using more cigarettes,” Yoon said. “We know from our
studies that these kids experiencing physical abuse and neglect are at much
higher risk of showing this poor pattern of cigarette use over time. We should
be targeting this high-risk group for cigarette use prevention and
intervention.”
The
study is published online in the journal Substance Use and Misuse.
The
work was funded by OSU Institute for Population Research through a grant from
the Eunice Kennedy Shriver National Institute of Child Health and Human
Development.