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Ann Epidemiol. 2016 Jul;26(7):488-492.e5. doi: 10.1016/j.annepidem.2016.06.003. Epub 2016 Jun 11.

Adverse childhood experiences and later life adult obesity and smoking in the United States.

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Department of Medicine, Stanford University School of Medicine, Stanford, CA. Electronic address:
Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley.
Division of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley.
Division of Maternal and Child Health, School of Public Health, University of California, Berkeley, Berkeley.
Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland.



Prior work demonstrates associations between physical abuse, household alcohol abuse, and household mental illness early in life with obesity and smoking. Studies, however, have not generally been in nationally representative samples and have not conducted analyses to account for bias in the exposure.


We used data from the 1979 U.S. National Longitudinal Survey of Youth to test associations between measures of adverse childhood experiences with obesity and smoking and used an instrumental variables approach to address potential measurement error of the exposure.


Models demonstrated associations between childhood physical abuse and obesity at age 40 years (odds ratio [OR] 1.23; 95% confidence interval [CI], 1.00-1.52) and ever smoking (OR 1.83; 95% CI, 1.56-2.16), as well as associations between household alcohol abuse (OR 1.53; 95% CI, 1.31-1.79) and household mental illness (OR 1.29; 95% CI, 1.04-1.60) with ever smoking. We find no evidence of association modification by gender, socioeconomic position, or race and/or ethnicity. Instrumental variables analysis using a sibling's report of adverse childhood experiences demonstrated a relationship between household alcohol abuse and smoking, with a population attributable fraction of 17% (95% CI, 2.0%-37%) for ever smoking and 6.7% (95% CI, 1.6%-12%) for currently smoking.


Findings suggest long-term impacts of childhood exposure to physical abuse, household alcohol abuse, and parental mental illness on obesity and smoking and that the association between household alcohol abuse and smoking is not solely due to measurement error.


Life course; Measurement; Obesity; Smoking

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