title: Internalizing problems: a potential pathway from childhood maltreatment to adolescent smoking.
abstract: OBJECTIVE
  This study examines the association between childhood maltreatment and adolescent smoking and the extent to which internalizing behavioral problems mediate this hypothesized link.
  
  
  METHODS
  Data from 522 youth at ages 12, 14, and 16 and from their caregivers were obtained as part of a prospective, longitudinal study of child abuse and neglect (LONGSCAN). Official Child Protective Services (CPS) reports of maltreatment and self-reported abusive experiences of children aged 12 were obtained for this study. Internalizing behavioral problems were reported by caregivers for the adolescents at age 14. Cigarette use was self-reported by adolescents at age 16.
  
  
  RESULTS
  A significantly higher proportion of maltreated youth (19%) reported having smoked in the last 30 days compared with nonmaltreated youth (7%). A history of childhood maltreatment predicted smoking at the age of 16. Maltreatment history was associated with internalizing problems at the age of 14, and internalizing problems were associated with smoking. Finally, internalizing behaviors partially mediated the link between childhood maltreatment by the age of 12 years and adolescent smoking at 16.
  
  
  CONCLUSIONS
  Internalizing problems are one mediating pathway by which adolescents with a history of childhood maltreatment may initiate smoking behavior during mid-adolescence. Given the elevated rate of smoking among maltreated adolescents, it is important to identify potential pathways to better guide prevention strategies. These finding suggest that youth with a history of maltreatment should be identified as a high-risk group, and that efforts to identify and address internalizing problems in this population may be an important area of intervention to reduce smoking among adolescents.
authors.affiliation: Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA. TerriLewis@uab.edu
authors.forename: Terri L
authors.initials: TL
authors.lastname: Lewis
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kotch
authors.forename: Tisha R A
authors.initials: TR
authors.lastname: Wiley
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Litrownik
authors.forename: Diana J
authors.initials: DJ
authors.lastname: English
authors.forename: Richard
authors.initials: R
authors.lastname: Thompson
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Zolotor
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Block
authors.forename: Howard
authors.initials: H
authors.lastname: Dubowitz
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D016009:Chi-Square Distribution; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D005260:Female; D006801:Humans; D007389:Internal-External Control; D007407:Interviews as Topic; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D000297:Psychology, Adolescent; D012307:Risk Factors; D012907:Smoking / Q000523:psychology*