Adverse Childhood Experiences and Children's Exposure to Smoking in U.S Households

Background and Purpose: Adverse childhood experiences (ACEs) are associated with an increased risk of indulging in smoking behaviors in youth. Additionally, research has established a link between e-cigarette use and childhood maltreatment, which is categorized as ACEs. While studies have focused on the adverse effects of ACEs on smoking behaviors for youth and adults globally, research linking children’s ACE exposure and smoking behaviors in U.S. households is limited. Therefore, this study investigated the relationship between ACE exposure and smoking behaviors in U.S. children.

Methods: Data for this study were obtained from the 2023 National Survey of Children's Health (N=54,303; children aged 0 to 17). Cumulative ACEs served as independent variables, which were drawn from nine experiences: economic hardships, parental divorce, parental incarceration, parental death, household mental illness, substance use, discrimination, witnessing domestic violence, and experiencing violence (coded as ‘yes’ or ‘no’). These were categorized into several ACE scores: 0 ACEs, 1 ACE, and 2 or more ACEs. The dependent variable, children’s exposure to smoking, was assessed by asking parents to identify whether anyone in the household (1) vapes or uses an E-cigarette, (2) smokes inside the house, or (3) uses any cigarettes. This was dichotomously coded as “yes " or no. " Child’s sex, age, race/ethnicity, family structure, caregiver’s education, caregiver’s employment, household poverty threshold, and neighborhood safety were used as control variables. Cross-tabulations were used to estimate the weighted rates of household exposure to ACEs and smoking behaviors. Complex logistic regression analyses were conducted to assess the significant association between ACEs and children’s exposure to smoking behaviors in households. SPSS vs.29.0 was utilized to analyze the data (p<.05).

Results: An estimated 13.8% (n=7,509) of children were exposed to smoking behaviors in their households. The rates of exposure to smoking behaviors in households were higher for children with two or more ACEs (28.6%) and at least one ACE (17.2%) compared to those without ACEs (8.9%). In unadjusted regression analysis, children with at least one ACE (aOR = 2.12, 95% CI = 1.85–2.42, p<.001) and two or more ACEs (aOR = 4.07, 95% CI = 3.54–4.69, p<.001) were significantly associated with higher odds of being exposed to smoking behaviors in their households compared to those without ACEs. Similarly, after adjusting for other factors, children with at least one ACE (aOR = 2.12, 95% CI = 1.86–2.42, p<.001) and two or more ACEs (aOR = 4.02, 95% CI = 3.49–4.63, p<0.001) were more likely to be exposed to smoking behaviors in their households compared to those without ACEs.

Conclusion and Implications: This study has demonstrated that exposure to smoking is linked to a higher risk of ACEs in children. This study underscores the urgent need for implementing interventions aimed at preventing ACEs, such as providing psychoeducation and public protection policies to shield children from the harmful effects of smoking behaviors and to ensure quality health for at-risk children in U.S. households.