Adverse Childhood Experiences and Tobacco Use Patterns Among Adults in the United States: Exploring sex differences

Abstract

Objective Adverse childhood experiences (ACEs), which refer to childhood traumatic events, have been identified as risk factors for tobacco use in adulthood. However, studies are limited on the effect of sex on the association of ACEs with e-cigarettes and dual use of e-cigarettes and cigarettes. This study explored sex differences in the association of ACEs with e-cigarettes, cigarettes, and dual use of e-cigarettes and cigarettes among adults in the United States. Methods This was a cross-sectional analysis of data from adults aged ≥18 years in the 2020 Behavioral Risk Factor Surveillance System ( N = 62,768). ACEs, the independent variable, was a composite score assessed from 11 questions (with responses yes—1 or no/never—0) related to childhood emotional abuse, physical abuse, sexual abuse, and household dysfunction and categorized as 0 (reference), 1, 2, 3, or ≥4. The dependent variable, tobacco use patterns, included nonuse (reference), e-cigarette only, cigarette only, and dual use of e-cigarettes and cigarettes. Multinomial logistic regression was performed to test the interaction between sex and ACEs while controlling for potential confounders. Results Although we found no statistically significant interaction by sex, a greater number of ACEs were associated with higher odds of the different tobacco use patterns among females and males, with varying strengths of associations. Specifically, females who reported ≥4 ACEs compared with none had higher odds of e-cigarette (aOR [95% CI]: 3.58 [1.49–8.63]), cigarette (2.57 [1.72–3.83]) and dual use (3.25 [1.79–5.91]) relative to nonuse. Males with ≥4 ACEs had higher odds of cigarette (1.75 [1.15–2.65]) and dual use (7.64 [3.95–14.79]). Conclusion Our findings underscore the importance of developing appropriate, tailored trauma-informed intervention strategies for females and males. It is also important to consider ACEs in designing tobacco-specific preventive programs to curb initiation and promote cessation among U.S. adults.

Adverse Childhood Experiences and Electronic Cigarette Use among U.S. Young Adults

“…Specifically, as the number of ACEs increased, the odds of engaging in current e-cigarette use also increased. Another study that used 2020 BRFSS data and included a wide range of adults reported similar findings, and also noted that there were varying strengths of associations by participants' sex with female adults having higher odds of ecigarette use whereas male adults had higher odds of cigarette smoking and dual e-cigarette and cigarette use [32]. Additionally, an Australian study also suggested a dose-response association between the cumulative number of ACEs and lifetime or past-year e-cigarette use [40].…”

“…Other research has examined ACEs as predictors of e-cigarette use among a wide age range of adults living in one U.S. state, Florida, and found that a higher cumulative number of ACEs (i.e., ≥4) is associated with current e-cigarette use [31]. Another study assessed the potential effect of sex on the association of ACEs and current e-cigarette and cigarette smoking patterns among U.S. adults of all ages, and reported that there was no interaction by sex, but a higher cumulative number of ACEs (i.e., ≥4) was associated with use [32]. More research is needed to assess this association among a national sample of young adults living across the U.S.…”