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To the Editor: Dr Anda and colleagues¹ found a strong association between adverse childhood experiences and several aspects of smoking. They conclude that nicotine is used "as a pharmacological tool to alleviate the long-term emotional and psycho-biological wounds of adverse childhood experiences." However, self-medication may be only part of the explanation for the study's results. Quality of parenting and self-esteem may moderate this relationship.

Persons with adverse childhood experiences are more likely to have had parents whose main priorities did not include teaching them about the dangers of smoking, discouraging smoking initiation, and encouraging them to quit if they started. Also, since adverse childhood experiences can lead to low self-esteem, antismoking advice emphasizing health dangers may not be an effective incentive to quit.² Furthermore, low self-esteem has been found to limit confidence in behavioral control and thus to discourage such persons to attempt to quit smoking.³

The extent to which . . . [Full Text of this Article]

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RELATED ARTICLE

Adverse Childhood Experiences and Smoking During Adolescence and Adulthood
Robert F. Anda, Janet B. Croft, Vincent J. Felitti, Dale Nordenberg, Wayne H. Giles, David F. Williamson, and Gary A. Giovino
JAMA. 1999;282(17):1652-1658.
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