The Developmental Timing of Child Maltreatment and Adolescent Cigarette Smoking Trajectories

Background: Adolescent cigarette smoking is a grave public health concern. Adolescent smoking is likely to persist into adulthood and may neurologically predispose youth to other substance use disorders. Child maltreatment, including physical abuse, sexual abuse, emotional abuse, and neglect, is a known risk factor for cigarette smoking. However, research has yet to examine how maltreatment may relate to trajectories of adolescent cigarette smoking over time. The current study contributes to the existing literature by 1) modeling developmental trajectories of adolescent cigarette smoking in a sample of youth who are at risk of maltreatment and 2) identifying how maltreatment timing and type are associated with distinct cigarette smoking trajectories.

Methods: This study was conducted using a high risk sample (n = 903) drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Cigarette smoking was measured using adolescent self-report of cigarette smoking frequency (0 = 0 days, 1 = 1 to 3 days, 2 = 4 to 20 days, 3 = > 20 days) in the past year at ages 12, 16, and 18. The type, timing, and chronicity of maltreatment experiences were measured using alleged maltreatment reports made to Child Protective Services. Using the modified maltreatment classification system, four types of non-mutually exclusive maltreatment categories were created: physical abuse, sexual abuse, emotional abuse, and neglect. The timing of maltreatment was classified into Infancy/Toddlerhood (ages 0–2), Preschool (ages 3–5), School Age (ages 6–11), and Adolescence (ages 12–18). Chronic maltreatment was defined as maltreatment at two or more development stages. Control variables included gender, race, and age 10 internalizing and externalizing symptoms. Latent class growth analysis was performed to examine heterogeneity in adolescent cigarette smoking trajectories. Next, multinomial logistic regression was conducted to examine the type, timing, and chronicity of maltreatment as predictors of membership in the identified classes.

Results: Three distinct classes of cigarette smoking trajectories were identified: 1) Stable low (9%); 2) Gradual increase (30%); and 3) Sharp increase (9%). Adolescents who experienced early childhood physical abuse were 2.48 times more likely to be in the sharp increase class compared with the stable low class. Similarly, physical abuse during adolescence was associated with 3.21 times higher odds of membership in this class. Adolescents who were neglected during early childhood were 1.77 times more likely to be in the gradual increase class than in the stable low class. Neglect during adolescence was also associated with approximately two times higher odds of membership in this class.

Discussion: The findings from this study provide empirical evidence for the existence of heterogeneity in the development trajectories of adolescent substance youth among populations at high-risk for maltreatment. Our findings suggest that intervention efforts should specifically target youth with experiences of physical abuse and neglect, as these experiences were found to significantly predict cigarette use in adolescence. Furthermore, early childhood and adolescence seem to be particularly vulnerable periods for maltreatment. Around these developmental stages, additional prevention efforts should be instituted; these efforts may include parental education around appropriate supervision and disciplinary practices, among other services.