The relationship between childhood physical and emotional abuse and smoking cessation among U.S. women and men

Differential prevalence of Adverse Childhood Experiences (ACEs) by gender and substance used in individuals with cannabis, cocaine, opioid, and tobacco use disorders

Background: Adverse childhood experiences (ACEs) show a graded association with the development of substance use disorders (SUDs) and engagement in risky substance use behaviors. Women are overrepresented among individuals with more severe childhood adversity (≥4 types of ACEs) and may be at particular risk for aberrant substance use.Objectives: To assess the prevalence of ACEs among men and women with cannabis, opioid, cocaine, and tobacco use disorders.Methods: Non-treatment-seeking individuals participating in clinical addiction research at a single site completed the ACE questionnaire and provided a detailed substance use history. Data were analyzed using proportional odds models and logistic regression.Results: Most participants (424/565; 75%) reported at least one ACE, and more than one-quarter (156/565; 27%) reported severe childhood adversity. Relative to men (n = 283), women (n = 282) reported more ACEs (OR = 1.49; p = .01) and more experiences of emotional/physical abuse (OR = 1.52; p = .02), sexual abuse (OR = 4.08; p = .04), and neglect (OR = 2.30; p < .01). Participants in the cocaine (OR = 1.87; n = .01) and opioid (OR = 2.21; p = .01) use disorder, but not cannabis use disorder (OR = 1.46; p = .08), studies reported more severe adversity relative to the tobacco group. Relative to tobacco users, emotional/physical abuse (OR = 1.92; p = .02) and neglect (OR = 2.46; p = .01) scores were higher in cocaine users and household dysfunction scores were higher in opioid users (OR = 2.67; p = .01).Conclusion: The prevalence of ACEs differs with respect to both participant gender and primary substance used. Novel SUD treatment strategies that incorporate ACEs may be uniquely beneficial in specific subpopulations of people with SUDs.

Gender and past year serious psychological distress are associated with past year AUD: Time-varying results from the National Survey on Drug Use and Health (NSDUH; 2008-2017)

BACKGROUND

Rates of alcohol use disorder (AUD) have increased in women in the last decade. Women may be more likely to engage in alcohol use to regulate stress and negative affect compared to men. Findings from our group found that life event stress was more strongly associated with new AUD in women vs. men. Our aim was to extend these findings to psychological distress, a potentially related construct to stress, using a second nationally representative dataset.

METHODS

Using data from the National Survey on Drug Use and Health (NSDUH; 2008-2017, total n = 562,072), we examined time-varying associations between gender and past year serious psychological distress (SPD; Kessler-6 distress scale: scores > 13 yes, <13 no) with past year vs. absent DSM-IV AUD.

RESULTS

A significant (p < 0.0001) gender by SPD interaction for past year vs. absent AUD demonstrated that past year SPD was associated with increased odds of past year AUD in men (OR = 3.33, 95% CI = 3.15, 3.52) and even greater odds of past year AUD in women (OR = 4.39, 95% CI = 4.14, 4.66). The gender by SPD by time interaction was not significant (p = 0.06).

CONCLUSIONS

Results highlight that while men with past year SPD were 3 times more likely to have a past year AUD, women with past year SPD were nearly 4.5 times more likely to have a past year AUD. Psychological distress is clearly an important factor in AUD in both men and women, but results suggest that other factors may be driving the increase in rates of AUD in women.

A Comparison of the Smoking Outcomes of Self-reported and Agency-Notified Child Abuse in a Population-Based Birth Cohort at 30-Year-Old Follow-up

INTRODUCTION

Retrospective studies show a strong association between self-reported child abuse and subsequent tobacco use. Prospective studies using reports to statutory agencies are less common with limited information on people in their 30s. In addition, there have been no comparisons of the effect of self- and agency-reported abuse on smoking. We therefore assessed the effect on the prevalence and persistence of smoking at the 30-year-old follow-up of prospective agency notifications of child abuse compared to retrospective self-reports of maltreatment in the same birth cohort.

METHODS

There were 2443 young adults with data on smoking and child abuse at 30-year-old follow-up. Information on self-reported abuse was collected using the Child Trauma Questionnaire (CTQ) and linked to notifications of child maltreatment to statutory agencies.

RESULTS

The prevalence of self- and agency-reported maltreatment was 600 (24.7%) and 142 (5.8%), respectively. At follow-up, 565 participants smoked (23.1%) but only 91 (3.8%) smoked 20 or more cigarettes a day. Of the 206 participants who smoked at 14 years, 101 were still smoking at follow-up. On adjusted analyses, both self- and agency-reported maltreatment showed a significant association with the prevalence and persistence of smoking from 14 years old. However, associations were weaker for some of the agency-notified child maltreatment subtypes possibly because of lower numbers.

CONCLUSIONS

Child maltreatment is associated with both an increased prevalence and persistence of smoking at 30-year-old follow-up irrespective of reporting source. This is despite self- and agency-reported maltreatment possibly representing different populations. Smoking cessation programs should therefore target both groups.

IMPLICATIONS

Retrospective studies show an association between self-reported child abuse and subsequent tobacco use. Prospective studies of reports to statutory agencies are less common with limited information on people in their 30s. In addition, there have been no comparisons of self- and agency-reported abuse on smoking outcomes even though they may represent different populations. We therefore compared the effect of both on smoking outcomes at 30-year-old follow-up of 2443 adults from the same birth cohort. On adjusted analyses, both self- and agency-reported maltreatment showed significant associations with the prevalence and persistence of smoking. Smoking prevention and cessation programs should therefore target both groups.

History of child maltreatment and excessive dietary and screen time behaviors in young adults: Results from a nationally representative study

Child maltreatment is common and has been associated with substance use addictions, yet few studies have examined associations with potentially addictive dietary and screen time behaviors. The goal of this study was to assess associations between retrospectively self-reported child maltreatment (sexual abuse, physical abuse, emotional abuse, and neglect) and excessive self-reported dietary (sugar sweetened beverage and fast food consumption) and screen time behaviors (television/video watching and leisure time computer use) in early adulthood, overall and by sex and race/ethnicity. Associations were examined using data from 10,813 participants 24-32 years old from the National Longitudinal Study of Adolescent to Adult Health. We used predicted marginal proportions accounting for the complex sample design to obtain prevalence ratios (PRs) and adjusted for demographic characteristics and physical activity. In females, exposure to poly-maltreatment (2+ types of child maltreatment) was associated with excessive sugar sweetened beverage consumption, television/video watching, and leisure time computer use; in males, exposure to poly-maltreatment was associated with excessive sugar sweetened beverage consumption, television/video watching, and fast food consumption. Some associations were particularly strong in racial/ethnic minorities, especially Latina females (poly-maltreatment-sugar sweetened beverage association: aPR = 6.14, 95% CI:2.12, 17.75; poly-maltreatment-computer use association: aPR = 3.08, 95% CI:1.44, 6.58). These findings show that child maltreatment is associated with excessive dietary and screen time behaviors into adulthood, and these associations are present in racial/ethnic groups at high risk of cardiometabolic disease. Extension of an addiction paradigm to include dietary and screen time behaviors may inform health risks and disease prevention efforts in child maltreatment survivors.

Child Maltreatment and Persistent Smoking From Adolescence Into Adulthood: A Birth Cohort Study

OBJECTIVE

A prospective record-linkage analysis to examine whether notified and/or substantiated child maltreatment is associated with the prevalence and persistence of smoking in early adulthood.

METHODS

The sample consisted of 3758 participants enrolled in a population-based birth cohort study in Brisbane, Australia, who were followed up at both 14 and 21 years of age. Suspected experience of child maltreatment was measured by linkage with state child protection agency data. The two main outcomes were the prevalence and persistence of smoking at 21-year follow-up, as well as the 12-month prevalence of nicotine use disorder for participants who completed the Composite International Diagnostic Interview-Auto version.

RESULTS

Of the 3758 young people at the 21-year follow-up, 7.5% (n = 282) had a history of notified maltreatment by the age of 16 years. Of these, 167 cases were substantiated. There were 1362 (35.3%) smokers at 21-year follow-up, although only 220 (5.9%) smoked more than 20 cigarettes daily. Of the 602 participants who smoked at 14 years, 289 were still smoking 7 years later. On adjusted analyses, participants who had experienced any form of notified and/or substantiated maltreatment were approximately twice as likely to be smokers at 21 years old and persistent smokers from 14 years of age. Any form of maltreatment, except sexual abuse, was also associated with an increase in the 12-month prevalence of nicotine use disorders.

CONCLUSIONS

Child maltreatment is associated with both an increased onset and persistence of smoking from adolescence into young adulthood. This may have implications for smoking cessation programs and early interventions for individuals who have experienced maltreatment.

Violence and substance use in sexual minorities: Data from the Second Brazilian National Alcohol and Drugs Survey (II BNADS)

OBJECTIVE

To describe the prevalence of substance use and the associations between adverse early life experiences, sexual behaviour and violence in sexual minority (SM) individuals.

METHODS

The Brazilian National Alcohol and Drugs Survey is a probabilistic household survey performed in 2012, collecting data from 4067 Brazilians aged 14 years and older.

RESULTS

3.4% of the sample declared themselves as sexual minorities, 53.8% female, 66.5% single, mean age of 29.5 years (standard deviation 16.0 years). A high prevalence of alcohol dependence (15.2%) and binge drinking (22.2%) was identified in the SM group. Respondents were more likely to use crack cocaine and hallucinogens, to have been involved in child prostitution, child sexual abuse and to report suicidal ideation in the previous year. Respondents were also more likely to engage in unprotected sex compared to non-sexual minorities. Nearly one-third referred to having suffered homophobic discrimination in their lives. Respondents also reported higher rates of domestic violence (18.9%) and urban violence (18%) among the SM.

CONCLUSION

The findings reinforce that violence directed at individuals in the Brazilian SM community begins early in life and persists into adulthood when compared to non-sexual minorities. This population is also more exposed to substance use disorders.

Associations of Adverse Childhood Experiences to Smoking and Nicotine Dependence Among Adolescent Psychiatric Inpatients

Our aim was to examine whether ACEs associate to regular smoking and nicotine dependence (ND) among 508 psychiatric inpatients aged 13-17 years. Adolescents were interviewed using the Schedule for Affective Disorder and Schizophrenia for School-Age Children and the European Addiction Severity Index -instruments. ND was measured with the modified Fagerström Tolerance Questionnaire. In girls, all violent ACEs (domestic violence, physical abuse at home, sexual abuse) were related to regular smoking and some family-related ACEs (parental divorce and substance use problems) both to regular smoking and ND. After controlling for covariates, girls with parental substance use had an increased likelihood for being a regular smoker and having ND. Greater number of ACEs in girls indicated higher level of ND. Corresponding associations were not observed in boys. Our findings suggest that girls after experiencing ACEs are more prone to becoming smokers and developing ND already in adolescence compared to boys.

Associations between child maltreatment, cigarette smoking, and nicotine dependence in young adults with a history of regular smoking

PURPOSE

The purpose of this study was to evaluate whether childhood maltreatment is associated with smoking behaviors and lifetime nicotine dependence and if associations are moderated by sex. We examined these associations among individuals who ever reported being regular smokers.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health, we examined relationships between retrospectively self-reported child maltreatment (parent/caregiver-perpetrated emotional, physical, sexual abuse, and neglect; and non-parent/caregiver-perpetrated sexual abuse) and self-reported smoking behaviors among individuals with a history of regular smoking. Outcomes were any current smoking in early adulthood (mean age = 28 years), current smoking in adolescent study waves only, adulthood only, and adolescence and adulthood (n = 3581); and lifetime history of nicotine dependence (n = 3594) per the Fagerstrom scale.

RESULTS

Poly-maltreatment (aRR for 2+ vs. 0 exposures = 1.20, 95% CI: 1.08, 1.34) was associated with lifetime nicotine dependence; associations between nicotine dependence and neglect and non-parent/caregiver sexual abuse by force were only present in women. Neglect and non-parent/caregiver sexual abuse by nonphysical threat were associated with continued smoking, and an association between non-parent/caregiver sexual abuse by physical force and continued smoking was also noted in women only. Women who experienced poly-maltreatment were less likely to report current smoking in adolescence but not adulthood.

CONCLUSIONS

These data suggest in a nationally representative sample of ever regular smokers, child maltreatment is associated with outcomes that suggest an inability to quit smoking and some associations may vary by sex.

Smoking does not accelerate leucocyte telomere attrition: a meta-analysis of 18 longitudinal cohorts

Smoking is associated with shorter leucocyte telomere length (LTL), a biomarker of increased morbidity and reduced longevity. This association is widely interpreted as evidence that smoking causes accelerated LTL attrition in adulthood, but the evidence for this is inconsistent. We analysed the association between smoking and LTL dynamics in 18 longitudinal cohorts. The dataset included data from 12 579 adults (4678 current smokers and 7901 non-smokers) over a mean follow-up interval of 8.6 years. Meta-analysis confirmed a cross-sectional difference in LTL between smokers and non-smokers, with mean LTL 84.61 bp shorter in smokers (95% CI: 22.62 to 146.61). However, LTL attrition was only 0.51 bp yr-1 faster in smokers than in non-smokers (95% CI: -2.09 to 1.08), a difference that equates to only 1.32% of the estimated age-related loss of 38.33 bp yr-1. Assuming a linear effect of smoking, 167 years of smoking would be required to generate the observed cross-sectional difference in LTL. Therefore, the difference in LTL between smokers and non-smokers is extremely unlikely to be explained by a linear, causal effect of smoking. Selective adoption, whereby individuals with short telomeres are more likely to start smoking, needs to be considered as a more plausible explanation for the observed pattern of telomere dynamics.

Sex differences in stress-related alcohol use

Rates of alcohol use disorder (AUD) have increased in women by 84% over the past ten years relative to a 35% increase in men. This substantive increase in female drinking is alarming given that women experience greater alcohol-related health consequences compared to men. Stress is strongly associated with all phases of alcohol addiction, including drinking initiation, maintenance, and relapse for both women and men, but plays an especially critical role for women. The purpose of the present narrative review is to highlight what is known about sex differences in the relationship between stress and drinking. The critical role stress reactivity and negative affect play in initiating and maintaining alcohol use in women is addressed, and the available evidence for sex differences in drinking for negative reinforcement as it relates to brain stress systems is presented. This review discusses the critical structures and neurotransmitters that may underlie sex differences in stress-related alcohol use (e.g., prefrontal cortex, amygdala, norepinephrine, corticotropin releasing factor, and dynorphin), the involvement of sex and stress in alcohol-induced neurodegeneration, and the role of ovarian hormones in stress-related drinking. Finally, the potential avenues for the development of sex-appropriate pharmacological and behavioral treatments for AUD are identified. Overall, women are generally more likely to drink to regulate negative affect and stress reactivity. Sex differences in the onset and maintenance of alcohol use begin to develop during adolescence, coinciding with exposure to early life stress. These factors continue to affect alcohol use into adulthood, when reduced responsivity to stress, increased affect-related psychiatric comorbidities and alcohol-induced neurodegeneration contribute to chronic and problematic alcohol use, particularly for women. However, current research is limited regarding the examination of sex in the initiation and maintenance of alcohol use. Probing brain stress systems and associated brain regions is an important future direction for developing sex-appropriate treatments to address the role of stress in AUD.

Demographic Moderators of the Relationship Between Adverse Childhood Experiences and Cigarette Smoking

Background: Research suggests that there is a dose-response relationship between Adverse Childhood Experiences (ACEs) and cigarette smoking, such that as ACE score increases, so do the odds of smoking behavior, but little is known about what factors moderate this relationship. Objectives: The goal of this study was to examine demographic characteristics as potential moderators of relationship between ACE score and cigarette smoking. Methods: A secondary data analysis was conducted using the 2013 California Behavioral Risk Factor Surveillance System data. The sample included 2,604 U.S. adults (54.8% female; Age: M = 53.3, SD = 8.10). We used multinomial logistic regression to test sex, race, income, and education as moderators of the relationship between ACE score and smoking. Results: ACEs were not significantly associated with smoking behavior. No interactions between ACE score and sex, race, education, or income significantly predicted smoking outcomes. Sex, race, education, and income were significantly and independently associated with smoking outcomes. Men, individuals with lower income and education, and certain ethnic/racial groups reported greater odds of smoking. Conclusions/Importance: Results suggest that there may not be a relationship between ACEs and smoking later in life. Additionally, the relationship between ACEs and smoking in adulthood may not depend on basic demographic features. Knowing which populations are more vulnerable to smoking can help clinicians better assess and tailor interventions to meet the needs of their patients by using culturally sensitive interventions and obtaining resources to help improve treatment access, motivation, and success.

Early childhood maltreatment experience and later sexual behavior in Brazilian adults undergoing treatment for substance dependence

Objective:

To investigate the prevalence of early childhood maltreatment and associations with later sexual behavior among adult substance users.

Methods:

A cross-sectional study enrolled 134 substance dependents who sought outpatient care in São Paulo, Brazil. Childhood trauma prevalence was assessed using the Childhood Trauma Questionnaire (CTQ). The Sexual Addiction Screening Test (SAST), drug of choice (DOC), and sexual behavior were also investigated.

Results:

The sample was composed predominantly of single adult males (76.1%), with alcohol as the DOC (73.9%). Experiences of emotional neglect (88.1%), emotional abuse (80.6%), physical neglect (78.4%), physical abuse (64.2%), and sexual abuse (31.3%) were prevalent. Women were more likely to have been sexually abused (OR 2.9, 95%CI 1.15-7.61) and physically abused (OR 3.7, 95%CI 1.31-10.6) in childhood. Those who were sexually abused in adulthood were more likely to have suffered physical abuse in childhood (OR 6.9, 95%CI 1.45-11.8). The odds of having been sexually abused in childhood were higher among subjects who reported to have exchanged sexual favors for drugs (OR 5.7, 95%CI 1.35-9.64) and to have been sexually abused in adulthood (OR 6.1, 95%CI 5.2-12.36).

Conclusion:

Physical and sexual abuse in childhood are highly prevalent in substance-dependent adults, and are associated with sexual revictimization and high-risk sexual behavior in adulthood.

Predictors of reduced smoking quantity among recovering alcohol dependent men in a smoking cessation trial

INTRODUCTION

Adults with alcohol dependence (AD) have exceptionally high smoking rates and poor smoking cessation outcomes. Discovery of factors that predict reduced smoking among AD smokers may help improve treatment. This study examined baseline predictors of smoking quantity among AD smokers in a pharmacotherapy trial for smoking cessation.

METHODS

The sample includes male, AD smokers (N = 129) with 1-32 months of alcohol abstinence who participated in a 12-week trial of medication (topiramate vs. placebo) and adjunct counseling with 6 months of follow-up. Baseline measures of nicotine dependence, AD severity, psychopathology, motivation to quit smoking, and smoking-related cognitions were used to predict smoking quantity (cigarettes per day) at post-treatment and follow-up.

RESULTS

Overall, the sample had statistically significant reductions in smoking quantity. Greater nicotine dependence (Incidence rate ratios (IRRs) = 0.82-0.90), motivation to quit (IRRs = 0.65-0.85), and intrinsic reasons for quitting (IRRs = 0.96-0.98) predicted fewer cigarettes/day. Conversely, greater lifetime AD severity (IRR = 1.02), depression severity (IRRs = 1.05-1.07), impulsivity (IRRs = 1.01-1.03), weight-control expectancies (IRRs = 1.10-1.15), and childhood sexual abuse (IRRs = 1.03-1.07) predicted more cigarettes/day.

CONCLUSIONS

Smokers with AD can achieve large reductions in smoking quantity during treatment, and factors that predict smoking outcomes in the general population also predict greater smoking reductions in AD smokers. Treatment providers can use severity of nicotine dependence and AD, motivation to quit, smoking-related cognitions, and severity of depression to guide treatment and improve outcomes among AD smokers.

Why are there associations between telomere length and behaviour?

Individual differences in telomere length are associated with individual differences in behaviour in humans and birds. Within the human epidemiological literature this association is assumed to result from specific behaviour patterns causing changes in telomere dynamics. We argue that selective adoption-the hypothesis that individuals with short telomeres are more likely to adopt specific behaviours-is an alternative worthy of consideration. Selective adoption could occur either because telomere length directly affects behaviour or because behaviour and telomere length are both affected by a third variable, such as exposure to early-life adversity. We present differential predictions of the causation and selective adoption hypotheses and describe how these could be tested with longitudinal data on telomere length. Crucially, if behaviour is causal then it should be associated with differential rates of telomere attrition. Using smoking behaviour as an example, we show that the evidence that smoking accelerates the rate of telomere attrition within individuals is currently weak. We conclude that the selective adoption hypothesis for the association between behaviour and telomere length is both mechanistically plausible and, if anything, more compatible with existing empirical evidence than the hypothesis that behaviour is causal.This article is part of the theme issue 'Understanding diversity in telomere dynamics'.

Gender differences in the real-world effectiveness of smoking cessation medications: Findings from the 2010-2011 Tobacco Use Supplement to the Current Population Survey

BACKGROUND

Meta-analyses of clinical trial data have identified clinically relevant gender differences in the efficacy of smoking cessation pharmacotherapy. It is unclear whether these findings are generalizable to smokers quitting in real-world contexts.

METHODS

Using Tobacco Use Supplement to the Current Population Survey (TUS-CPS) 2010-2011 cross-sectional data, we generated propensity score matched samples of smokers who quit either unassisted by medication, using only varenicline, or using only transdermal nicotine patch (TNP). We used generalized estimating equations to estimate gender differences in the comparative effectiveness of these cessation options for achieving 30-days of abstinence, adjusting for potential confounders.

RESULTS

When stratified by gender, TNP was significantly more effective than unassisted quit attempts for men (OR=1.37; 95%CI=1.02,1.83; p=0.03), but not for women (OR=0.96; 95%CI=0.71,1.31; p=0.82). Varenicline was significantly more effective than unassisted quit attempts for women (OR=1.63; 95%CI=1.16, 2.31; p=0.005), but not men (OR=1.35; 95%CI=0.94,1.96; p=0.11). Varenicline was also more effective than TNP for women (OR=1.51; 95%CI=0.12,2.05; p=0.007) but not men (OR=0.92; 95%CI=0.65,1.31; p=0.64). A significant gender by medication interaction was found only for the comparison of varenicline to TNP (OR=1.64; 95%CI=1.04,2.61; p=0.04).

CONCLUSIONS

Findings for varenicline vs. TNP were consistent with clinical trial data, showing greater differences in effectiveness for women compared to men. Results lend support to the generalizability of clinical trial findings, highlighting the importance of considering gender when offering treatment for smoking cessation.

Sex/gender differences in smoking cessation: A review

Data from treatment studies tends to show women are less likely to quit smoking than men, but these findings have been disputed, typically based on contradictory evidence from epidemiological investigations. The purpose of this review was to shed light on this conflict. We conducted a qualitative review in January 2016 to examine sources of variation in sex/gender differences for smoking cessation. We identified 214 sex/gender difference tests from 190 studies through Medline and studies were categorized into efficacy trials (k=37), effectiveness trials (k=77), prospective observational studies of cessation (k=40; current smokers transitioning to former smokers), prospective observational studies of relapse (k=6; former smokers transitioning to current smokers), cross-sectional investigations of former smoker prevalence (k=32), and community-based interventions (k=4). We also summarized evidence across time periods, countries, outcome assessments, study sample, and treatment. Evidence from efficacy and effectiveness trials, as well as prospective observational studies of relapse, demonstrated that women have more difficulty maintaining long-term abstinence than men. Findings from prospective observational studies and cross-sectional investigations were mixed and demonstrated that bio-psycho-social variation in samples across place and time may determine whether or not women or men are less likely to quit smoking. Based on these findings, we consider whether sex/gender differences in quitting meet criteria for a disparity and outline directions for further research.

The role of adverse childhood experiences in cardiovascular disease risk: a review with emphasis on plausible mechanisms

Childhood adversity, characterized by abuse, neglect, and household dysfunction, is a problem that exerts a significant impact on individuals, families, and society. Growing evidence suggests that adverse childhood experiences (ACEs) are associated with health decline in adulthood, including cardiovascular disease (CVD). In the current review, we first provide an overview of the association between ACEs and CVD risk, with updates on the latest epidemiological evidence. Second, we briefly review plausible pathways by which ACEs could influence CVD risk, including traditional risk factors and novel mechanisms. Finally, we highlight the potential implications of ACEs in clinical and public health. Information gleaned from this review should help physicians and researchers in better understanding potential long-term consequences of ACEs and considering adapting current strategies in treatment or intervention for patients with ACEs.

Childhood adversity interacts with adult stressful events to predict reduced likelihood of smoking cessation among women but not men

Research has documented important sex differences in associations between early stress, stress-sensitization, and psychiatric outcomes. The current study investigated whether sex differences in stress-sensitization extended to cigarette smoking cessation. Data were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions (waves 1 and 2), selecting for current daily and non-daily smokers at wave 1 (daily smokers: n=3,499 women, 3055 men; non-daily smokers: n=451 women, 501 men). Three-way interactions between sex, childhood adversity, and past year stressful life events were modeled in the prediction of smoking cessation. Among women, stressful life events were more strongly related to lower likelihood of smoking cessation for those with a history of childhood adversity than those without. This relationship was not found among men. The stress-sensitization model may be applicable to women with regards to smoking cessation, supporting further exploration of stress-sensitization as a prevention and clinical target for smoking cessation.