Nicotine withdrawal and dependence among smokers with a history of childhood abuse

Introduction: Previous studies have found that those with a history of childhood abuse are more likely to smoke cigarettes than those without a history of abuse. Mechanisms underlying this greater prevalence are unclear. We examined whether current smokers with a history of childhood abuse reported greater levels of nicotine dependence and more severe nicotine withdrawal symptoms. Methods: We analyzed data from a 2-wave, national, random-digit-dial survey of adult cigarette smokers (n = 751). We examined whether childhood physical, emotional, and sexual abuse were associated with greater levels of nicotine dependence. Among those who made a quit attempt (n = 368), we examined whether abuse was associated with more severe withdrawal symptoms recalled during the 14 months between surveys. For both dependence and withdrawal, we tested a mediation pathway through current serious mental illness (SMI). Results: All 3 types of childhood abuse were associated with more severe withdrawal symptoms. These associations were partially mediated by SMI. Sexual abuse and physical abuse were directly associated with dependence, whereas emotional abuse was indirectly associated with dependence through SMI. Conclusions: All 3 forms of childhood abuse were associated with both dependence and withdrawal. The greater prevalence of smoking found among those with a history of childhood abuse may be explained by heightened vulnerability to nicotine dependence and withdrawal and may be partially due to comorbid mental illness.