Background
Methods
Study setting and participants
Survey methods and variable definitions
Category | Definitions |
---|---|
Abuse | |
Emotional | At least one of the following responses: |
1. Often or very often a parent or other adult in the household swore at you, insulted you, or put you down. | |
2. Sometimes, often, or very often they acted in a way that made you think that you might be physically hurt. | |
Physical | At least one of the following responses: |
1. Sometimes, often, or very often you were pushed, grabbed, slapped, or had something thrown at you. | |
2. Sometimes, often, or very often hit so hard that you had marks or were injured. | |
Sexual | At least one affirmative (yes) response about an adult or a person at least 5 years older: |
1. Ever touched or fondled you in a sexual way. | |
2. Had you touch their body in a sexual way. | |
3. Attempted oral, anal, or vaginal intercourse with you. | |
4. Actually had oral, anal, or vaginal intercourse with you. | |
Neglect | |
Emotional | 5 Childhood Trauma Questionnaire (CTQ) questions (Bernstein, et al., 1994) had possible responses of “never true’, “rarely true”, “sometimes true”, “often true”, or “very often true”. Responses were reverse scored on a Likert scale ranging from 5 to 1, respectively. |
1. There is someone in my family who helped me feel important or special. | |
2. I felt loved. | |
3. People in my family looked out for each other. | |
4. People in my family felt close to each other. | |
5. My family was a source of strength and support. | |
A total cumulative score of 15 and higher (moderate to extreme on the CTQ clinical scale) defined childhood emotional neglect (Bernstein, et al., 1994). | |
Physical | 5 Childhood Trauma Questionnaire (CTQ) questions (Bernstein, et al., 1994) had possible responses of “never true’, “rarely true”, “sometimes true”, “often true”, or “very often true”. Responses were scored on a Likert scale ranging from 1 to 5, respectively with items 2 and 5 reverse scored (5 to 1, respectively). : |
1. You did not get enough to eat. | |
2. You knew there was someone to take care of you and protect you. | |
3. Your parents were too drunk or high to take care of the family. | |
4. You had to wear dirty clothes. | |
5. There was someone to take you to the doctor if you needed it. | |
A total cumulative score of 10 or higher (moderate to extreme on the CTQ clinical scale) defined childhood physical neglect (Bernstein, et al., 1994). | |
Household dysfunction | |
Witnessing domestic violence | At least one affirmative (yes) response to the following about your mother or stepmother: |
1. Sometimes, often, or very often was pushed, grabbed, slapped, or had something thrown at her. | |
2. Sometimes, often, or very often was kicked, bitten, hit with a fist, or hit with something hard. | |
3. Was ever repeatedly hit over at least a few minutes. | |
4. Was ever threatened or hurt by a knife or gun. | |
Household substance abuse | At least one affirmative (yes) response about living with anyone (before age 18) who: |
1. Was a problem drinker or alcoholic. | |
2. Used street drugs. | |
Household mental illness | At least one affirmative (yes) response about a household member who: |
1. Was depressed or mentally ill. | |
2. Attempted suicide. | |
Parental separation or divorce | Parents were ever separated or divorced. |
Incarcerated household member | A household member went to prison. |
Statistical analysis
Results
Descriptive characteristics
Characteristics | Females (n = 3,895) | Males (n = 3,315) | Chi-square test | |||
---|---|---|---|---|---|---|
n % | n % | Value p-value (df) | ||||
Age group (years)
| ||||||
18-34 | 440 | 11.3 | 234 | 7.1 | 52.7 (3) | <0.0001 |
35-54 | 1516 | 38.9 | 1213 | 36.6 | ||
55-74 | 1563 | 40.1 | 1481 | 44.7 | ||
75+ | 376 | 9.7 | 387 | 11.7 | ||
Mean age (SD)
| 54.8 (15.4) | 57.3 (14.4) | ||||
Race
| ||||||
White | 2874 | 73.8 | 2517 | 75.9 | 19.3 (5) | 0.0017 |
Black | 158 | 4.1 | 132 | 4.0 | ||
Hispanic | 428 | 11.0 | 340 | 10.3 | ||
Asian | 353 | 9.1 | 226 | 6.8 | ||
Native American | 13 | 0.3 | 14 | 0.4 | ||
Other | 69 | 1.8 | 86 | 2.6 | ||
Education
| ||||||
No high school diploma | 306 | 7.9 | 214 | 6.5 | 88.7 (3) | <0.0001 |
High school/GED | 653 | 16.8 | 402 | 12.1 | ||
Some college/technical | 1666 | 42.8 | 1280 | 38.6 | ||
College graduate | 1270 | 32.6 | 1419 | 42.8 | ||
Alcohol consumed in past month
| 2172 | 55.8 | 2158 | 65.1 | 65.0 (1) | <0.0001 |
History of parental smoking
| 2791 | 71.7 | 2434 | 73.4 | 2.8 (1) | 0.0940 |
Mean MCS score (SD)*
| 51.2 (9.5) | 53.2 (8.2) | ||||
Current smoker
| 294 | 7.6 | 281 | 8.5 | 2.1 (1) | 0.1470 |
ACE | Females (n = 3,895) | Males (n = 3,315) | Chi-square test | |
---|---|---|---|---|
% | % | Value (df) | p-value | |
Abuse
| ||||
Emotional | 11.7 | 8.2 | 23.8 (1) | <0.0001 |
Physical | 24.6 | 28.6 | 14.5 (1) | 0.0001 |
Sexual | 24.2 | 16.7 | 61.2 (1) | <0.0001 |
Neglect
| ||||
Emotional | 16.4 | 12.2 | 25.2 (1) | <0.0001 |
Physical | 8.6 | 10.5 | 7.7 (1) | 0.0054 |
Household dysfunction
| ||||
Witnessing domestic violence | 13.6 | 12.1 | 3.8 (1) | 0.0526 |
Parental separation or divorce | 25.3 | 22.4 | 8.6 (1) | 0.0034 |
Mental illness in household | 25.0 | 14.6 | 119.4 (1) | <0.0001 |
Household substance abuse | 29.9 | 25.5 | 17.4 (1) | <0.0001 |
Incarcerated household member | 6.9 | 4.8 | 14.6 (1) | 0.0001 |
Total number of ACEs
| ||||
0 | 32.1 | 34.7 | 50.2 (4) | <0.0001 |
1 | 24.1 | 26.9 | ||
2 | 14.7 | 16.1 | ||
3 | 10.4 | 9.3 | ||
4+ | 18.7 | 13.0 |
Relationship between ACEs and current adult smoking
ACE | Females AdjustedaOR (95% CI) | Males AdjustedaOR (95% CI) |
---|---|---|
Abuse
| ||
Emotional | ||
Yes | 1.4 (1.1-2.0)* | 1.2 (0.8-1.8) |
No | Referent | Referent |
Physical | ||
Yes | 1.4 (1.1-1.8)* | 1.3 (1.0-1.7) |
No | Referent | Referent |
Sexual | ||
Yes | 1.2 (0.9-1.6) | 0.9 (0.7-1.3) |
No | referent | Referent |
Neglect
| ||
Emotional | ||
Yes | 1.2 (0.9-1.7) | 1.2 (0.9-1.8) |
No | Referent | Referent |
Physical | ||
Yes | 1.5 (1.1-2.2)* | 1.1 (0.7-1.6) |
No | Referent | Referent |
Household dysfunction
| ||
Witnessing domestic violence | ||
Yes | 1.4 (1.0-1.9) | 0.9 (0.6-1.3) |
No | Referent | Referent |
Parental separation or divorce | ||
Yes | 1.4 (1.1-1.9)* | 1.1 (0.8-1.5) |
No | Referent | Referent |
Mental illness in the household | ||
Yes | 1.1 (0.8-1.4) | 1.1 (0.8-1.5) |
No | Referent | Referent |
Household substance abuse | ||
Yes | 1.0 (0.8-1.3) | 1.1 (0.8-1.4) |
No | referent | Referent |
Incarcerated household member | ||
Yes | 2.3 (1.6-3.2)* | 1.1 (0.7-1.8) |
No | Referent | Referent |
ACE score
| ||
0 | Referent | Referent |
1 | 0.7 (0.5-1.0) | 1.2 (0.8-1.7) |
2 | 1.3 (0.9-1.8) | 1.3 (0.9-2.0) |
3 | 1.3 (0.9-2.0) | 0.9 (0.6-1.5) |
4+ | 1.4 (1.0-2.0) | 1.2 (0.8-1.7) |
Relationship between ACEs and psychological distress
ACE | Females AdjustedaCoefficients (95% CI) | Males Adjustedacoefficients (95% CI) |
---|---|---|
Abuse
| ||
Emotional | −3.9 (−4.8- -3.0)* | −3.6 (−4.6- -2.6)* |
Physical | −2.6 (−3.3- -1.9)* | −2.1 (−2.7- -1.5)* |
Sexual | −1.8 (−2.5- -1.1)* | −0.9 (−1.6- -0.1)* |
Neglect
| ||
Emotional | −3.7 (−4.5- -2.9)* | −3.4 (−4.2- -2.5)* |
Physical | −2.8 (−3.8- -1.7)* | −1.9 (−2.7- -1.0)* |
Household dysfunction
| ||
Witnessing domestic violence | −2.4 (−3.2- -1.5)* | −0.9 (−1.7- -0.01)* |
Parental separation or divorce | −1.6 (−2.3- -0.9)* | −0.6 (−1.3-0.03) |
Mental illness in the household | −3.1 (−3.8- -2.5)* | −4.0 (−4.8- -3.3)* |
Household substance abuse | −1.7 (−2.4- -1.0)* | −1.7 (−2.3- -1.1)* |
Incarcerated household member | −0.9 (−2.1-0.2) | −0.9 (−2.2-0.4) |
ACE score
| −1.1 (−1.3- -0.9)* | −1.0 (−1.2- -0.8)* |
Relationship between psychological distress and current adult smoking
Mediating role of psychological distress on the relationship between ACEs and current adult smoking
Sobel Testa | % mediatedb | ||
---|---|---|---|
ACE
| Test Statistic (SE) | p-value | |
Abuse
| |||
Emotional | −3.36 (0.02) | 0.0008 | 22.0% |
Physical | −3.29 (0.02) | 0.0010 | 16.8% |
Neglect
| |||
Physical | −3.01 (0.02) | 0.0026 | 14.0% |
Household dysfunction
| |||
Parental sep/div | −2.88 (0.01) | 0.0040 | 10.2% |