Adverse childhood experiences and adult smoking, Nebraska, 2011.
BACKGROUND
Smoking is a public health risk; the prevalence of smoking among adults in Nebraska is 18.4%. Studies indicate that maltreatment of children alters their brain development, possibly increasing risk for tobacco use. Previous studies have documented associations between childhood maltreatment and adult health behaviors, demonstrating the influence of adverse experiences on tobacco use. We examined prevalence and associations between adverse childhood experiences and smoking among Nebraskans.


METHODS
We analyzed 2011 Nebraska Behavioral Risk Factor Surveillance System (Adverse Childhood Experience module) data, defining adverse childhood experience exposures as physical, sexual, and verbal abuse (ie, direct exposures), and household dysfunction associated with mental illness, substance abuse, divorce, domestic violence, and living with persons with incarceration histories (ie, environmental exposures). We estimated prevalence of exposures, taking into account the complex survey design. We used logistic regression with predicted margins to estimate adjusted relative risk for smoking by direct or environmental exposure.


RESULTS
Approximately 51% of Nebraskans experienced 1 or more adverse childhood events; 7% experienced 5 or more. Prevalence of environmental exposures (42%) was significantly higher than that of direct exposures (31%). Prevalence of individual exposures ranged from 6% (incarceration of a household member) to 25% (verbal abuse). Adjusted relative risks of smoking for direct and environmental exposures were 1.5 and 1.8, respectively.


CONCLUSIONS
We present a new method of evaluating adverse childhood experience data. Prevalence of adverse childhood experiences is high among Nebraskans, and these exposures are associated with smoking. State-specific strategies to monitor adverse events among children and provide interventions might help to decrease the smoking rate in this population.
Epidemic Intelligence Service Officer assigned to Nebraska Department of Health and Human Services, 301 Centennial Mall South, Lincoln, NE 68509, USA. kyeoman@cdc.gov
Kristin
K
Yeoman
Thomas
T
Safranek
Bryan
B
Buss
Betsy L
BL
Cadwell
David
D
Mannino
D000328:Adult; D040343:Behavioral Risk Factor Surveillance System; D002648:Child; D002649:Child Abuse; D017579:Domestic Violence; D005191:Family Characteristics; D006306:Health Surveys; D006801:Humans; D008016:Life Change Events; D001523:Mental Disorders; D009329:Nebraska / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D019966:Substance-Related Disorders; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000209:etiology*