The Impact of Sexual Assault on Cigarette Smoking Among Young Women

Background/purpose:  Cigarette smoking is addictive and the number one cause of preventable disease in the United States.  Most cigarette smokers began smoking before age 18.  People take up smoking for a number of reasons.  Teenagers are more likely to become smokers if their parents and their peers smoke.  Cigarette smoking is also inversely associated with socioeconomic status (SES).

Researchers have also found an association between adverse childhood experiences (ACEs) and cigarette smoking in adulthood.  This may be due to a tendency for people who have untreated trauma to self-medicate; cigarette smoking has been found to temporarily reduce feelings of anxiety.  But the association between ACEs and smoking may be due in part to associated factors, including parents’ smoking habits and socioeconomic background.

The current study examines one type of adverse childhood experience—sexual assault during adolescence—and its impact on smoking in young adulthood. The study also examines whether an association between adolescent sexual assault and smoking in young adulthood is due to factors such as parental smoking, SES, and other child and family characteristics that existed before the sexual assault occurred.

Method: Data and sample:  The data come from the nationally representative Panel Study of Income Dynamics, which includes interviews with girls and their caregivers during childhood and follow-up interviews with the girls once they reach age 18.  The sample consists of 1,082 young women who had not been sexually assaulted and 53 young women who reported a first sexual assault between the ages of 13 and 17.  [Forty-one young women who reported having been sexually assaulted at 12 or younger were excluded from the analysis.]  The final sample comprised 1,035 girls.

Measures: Young women age 18-20 were asked whether they had ever been raped or sexually assaulted, and if so, at what age it first occurred.  Smoking was a dichotomous variable:  whether the respondent currently smokes (yes/no).  Control variables were measured during interviews that took place before the girl was 13 years old and included socio-economic background (family income, mother’s education, family structure) and childhood characteristics (externalizing behavior, internalizing behavior, intellectual disabilities and the Positive Behavior Index).  

Analysis:  Logistic regression was conducted with controls for background factors. 

Results:  Survivors of adolescent sexual assault were about three times more likely to smoke cigarettes at age 18-20 than were young women who had never been sexually assaulted (46.2% vs. 16.0%).  This translates into an odds ratio (OR) of 4.5 (95% CI = 2.7, 7.5).  The adjusted OR dropped to 4.0 (95% CI = 2.3, 7.2) when background factors were controlled. 

Conclusion/implications: Cigarette smoking is far more prevalent among young women who were sexually assaulted during adolescence than among young women who were never sexually assaulted.  The association is only partly accounted for by background factors.  The results suggest that anti-smoking campaigns will be more successful if adolescents who experience sexual assault receive effective trauma treatment and no longer feel the need to self-medicate.