Correlates of sexual abuse and smoking among French adults

Abstract

Objective

The goal of this study was to examine the association between sexual abuse (SA) and initiation, cessation, and current cigarette smoking among a large representative adult population in France.

Method

A random sample size of 12,256 adults (18–75 years of age) was interviewed by telephone concerning demographic variables, health practices and beliefs, and health status—for which SA and tobacco questions were included. Bivariate and multivariate analyses were conducted.

Results

Nearly 46% of SA survivors were current smokers compared to 34% of non-abused persons (p < .001). Survivors of SA consumed more cigarettes per day than non-abused individuals (14.5 vs. 12.4, p < .01). Survival analysis showed an increased risk of smoking initiation for respondents abused before 18 (adjusted relative hazard = 1.55; p < .0001) with referent to the non-abused group. SA was not found to be a significant predictor of current smoking status among those who began smoking after the first incident of SA. Respondents who were not sexually abused were 1.8 times (95% CI, 1.12–2.99) more likely to quit smoking than people who began smoking after they were sexually abused.

Conclusions

The early identification and treatment of sexually abused persons is critical to decrease smoking among adolescents and adults because of the association of SA with both smoking initiation and decreased cessation rates. It may be more difficult to detect an association between SA and current smoking due to the high rates of smoking and lower rates of quitting among the general French population.

Résumé

Objectif

Le but de cette étude a été d’examiner l’association entre agression sexuelle (AS) et le début, l’arrêt et la poursuite du tabagisme dans une population importante et représentative en France.

Méthode

Un échantillon pris au hasard de 12256 adultes (entre 18 et75 ans) a été interrogé par téléphone sur des variables démograhiques, leurs croyances et et leurs attitudes à l’égard de la santé, leur état de santé - dans lequel des questions sur AS et tabac étaient incluses. Des analyses bivariées et multivariées ont été réalisées.

Résultats

Presque 46% des “rescapés” d’AS étaient des fumeurs habituels contre 34% des personnes non agressées (p < .001). Les rescapés d’AS consommaient davantage de cigarettes par jour que les peronnes non-agressées (14,5 vs. 12,4, p < 0,01). L’analyse de survie a montré un risque accru de début de tabagisme chez les “enquêtés” agressés avant l’âge de 18 ans (risque relatif ajusté = 1,55; p < 0,0001) par rapport au groupe non-agressé. On n’a pas constaté qu’une AS était un facteur prédictif significatif de poursuite du tabagisme chez ceux qui ont commencé à fumer aprés la première AS. Les “enquétés” qui n’avaient pas été agressés sexuellement étaient 1,8 fois (95% CI, 1,12–2,99) plus susceptibles de stopper leur tabagisme que les gens qui avaient commencé à fumer aprés avoir été sexuellement agressés.

Conclusions

L’identification précoce et le traitement des personnes agressées sexuellement est crucial pour diminuer le tabagisme chez les adolescents et les adultes à cause de l’association d’une AS avec à la fois le début du tabagisme et les taux abaissés de son arrêt. Il peut être plus difficile de détecter une association entre AS et poursuite du tabagisme en raison des taux élevés de tabagisme et les taux plus bas de son arrêt dans la population française générale.

Resumen

Objetivo

El objetivo de este estudio fue examinar la asociación entre abuso sexual (AS) y el inicio, cese y actual consumo de cigarrillos en una muestra respresentativa de adultos en Francia.

Método

Una muestra aleatorizada de 12.256 adultos (18 a 75 años) fue entrevistada por teléfono en relación a las variables demográficas, creencias y prácticas sobre la salud y status de salud, incluyendo preguntas sobre abuso sexual y consumo de tabaco. Se llevaron a cabo análisis bivariados y multivariados.

Resultados

Cerca del 46% de las víctimas de abuso sexual fueron fumadores actuales comparados con un 34% de las personas no abusadas (p < .001). Las víctimas de abuso sexual consumieron más cigarrillos al día que los individuos no abusados (14.5 vs. 12.4, p < .01). Los análisis mostraron un aumento en el riesgo de inicio del consumo entre los abusados antes de los 18 años (probabilidad relativa ajustada = 1.55; p < .0001) que en el grupo de no abusados. No se observó que el abuso sexual sea predictor significativo del status de fumador actual entre aquellos que empezaron a fumar después del primer incidente de abuso sexual. Los sujetos que no fueron sexualmente abusados fueron 1.8 veces (IC 95%, 1.12–2.99) más proclives a dejar de fumar que los sujetos que empezaron a fumar después de que fueran abusados.

Conclusiones

La identificación temprana y el tratamiento de las personas víctimas de abuso sexual es crítica para hacer disminuir el consumo de tabaco entre adolescentes y adultos ya que se observa una asociación entre el abuso sexual y el inicio del consumo y el descenso en las tasas de abandono. Puede ser más difícil detectar una asociación entre el abuso sexual y el consumo actual de cigarrillos debido a las altas tasas de consumo de tabaco y a las bajas tasas de abandono del consumo entre la población general de Francia.

Introduction

The pharmacological and neurobehavioral characteristics of nicotine in regulating affect have been well-established (Balfour & Fagerstrom, 1996; Carmody, 1989; Pomerleau & Pomerleau, 1984), and studies have shown that nicotine may be used by adolescents and adults to cope with psychosocial problems resulting from adverse events such as sexual victimization (Anda et al., 1999; Molnar, Buka, & Kessler, 2001).

Studies conducted in France, the US, and other countries have demonstrated that individuals with a history of SA exhibit a wide range of psychological and behavioral problems (Briere & Runtz, 1988; Darves-Bornoz, 1997; Darves-Bornoz, Lemperiere, Degiovanni, & Gaillard, 1995). Depression, aggression, low self-esteem, substance abuse problems, sexualized behavior, excessive internalizing or externalizing behavior problems, school-based attainment problems, and relationship difficulties have all been found to be associated with childhood SA (Berliner & Elliot, 1996; Browne & Finklehor, 1986; Fergusson, Horwood, & Lynskey, 1996; Garnefski & Arends, 1998; Garnefski & Diekstra, 1997; Harrison, Hoffman, & Edwall, 1989; Kendall-Tackett, Williams, & Finkelhor, 1993; Luster & Small, 1997).

Sexual victimization during childhood has been shown to be associated with cigarette smoking as well as other forms of substance abuse (DeFronzo & Pawlak, 1993; Dembo, Dertke, Borders, Washburn, & Schmeidler, 1988). A study (n = 5,513) by Simantov, Schoen, and Klein (2000) of adolescent smoking and alcohol consumption revealed that children who had experienced physical or SA were almost three times as likely to smoke cigarettes than their non-abused cohort. Women physicians (Doyle, Frank, Saltzman, McMahon, & Fielding, 1999) who were sexually abused as children were found to have a higher proportion of smokers (10.8%) than non-abused women (4.7%).

Springs and Friedrich (1992) found that persons who were abused began smoking 1.6 years earlier than their non-abused cohort. Anda et al. (1999) found that individuals who were sexually abused were four times more likely than non-abused persons to initiate smoking by the age of 14. Silverman, Raj, Mucci, and Hathaway (2001) reported that girls who experienced SA from a dating partner were more likely to be heavy smokers (i.e., more than 10 cigarettes per day).

A review of studies on childhood SA among women in France indicates that self-reported rates ranged from 3% to 11% (Aspard et le groupe ENVEFF, 2001a; Spira, Bajos, et le groupe ACSF, 1993). A nationally representative survey of 20,055 French adults (18–70 years old) reported that 4.4% of women (77% of whom were abused as children) and .5% of men had been sexually abused (Spira et al., 1993). In a review of French Department of Justice records from 1980 to 1986 of SA against minors, Deltaglia (1990) found that cases involving girls outnumbered those involving boys nearly 3–1.

Studies of SA in France have generally not examined its association with cigarette smoking (Aspard et le groupe ENVEFF, 2001b; Spira et al., 1993). A noteworthy exception is the study of rape among a nationally representative sample of 8,104 secondary school French students (Choquet, Darves-Bornoz, Ledoux, Manfredi, & Hassler, 1997). Choquet et al. (1997) found that rape was a significant predictor of smoking for each gender group in a bivariate analysis of daily smoking.

To our knowledge, the present study is the first to examine smoking initiation and cessation among SA survivors in France. The following analyses investigate the association between SA and cigarette smoking among a large representative adult population in France. Moreover, this work substantively extends research linking SA and cigarette smoking and advances the understanding of SA's effect on quitting. The results of these analyses may be valuable in understanding the sequelae of SA, and in developing programmatic strategies to identify and address tobacco consumption as a correlate of SA.