Edwards Valerie J, Anda Robert F, Gu David, Dube Shanta R, Felitti Vincent J
Perm J. 2007 Spring;11(2):5-13. doi: 10.7812/TPP/06-110.
Little is known about why people continue to smoke after learning that they have diseases and conditions that contraindicate smoking. Using data from the Adverse Childhood Experiences (ACE) Study, we examined the relation between ACEs and smoking behavior when smoking-related illnesses or conditions are present, both with and without depression as a mediator.
Participants were more than 17,000 adult HMO members who retrospectively reported on eight categories of ACEs (emotional, physical, and sexual abuse; witnessing interparental violence; parental divorce; and growing up with a substance-abusing, mentally ill, or incarcerated household member). The number of maltreatment categories was summed to form an ordinal variable called the ACE Score. We measured current smoking, conditions that contraindicate smoking (heart disease, chronic lung disease, and diabetes), and symptoms of these illnesses (chronic bronchitis, chronic cough, and shortness of breath). Logistic regression models compared the ACE Score of smokers with smoking-related illnesses to participants who reported these illnesses but were not current smokers (n = 7483).
Significant dose-response relations between the ACE Score and smoking persistence were found (odds ratio = 1.69; confidence interval = 1.34-2.13 for participants with ≥4 ACEs). Depression was a significant independent predictor of smoking persistence as well as a mediator. Depression only slightly attenuated the relation between the ACE Score and persistent smoking, however.
Medical practitioners should consider the maltreatment history and depression status of their patients when a smoking-related diagnosis fails to elicit smoking cessation. Programs should be developed that better address the underlying motivations for continuing to smoke in the face of health problems that contraindicate smoking.
对于人们在得知自己患有与吸烟相悖的疾病和状况后仍继续吸烟的原因，我们知之甚少。利用儿童期不良经历（ACE）研究的数据，我们研究了在存在与吸烟相关的疾病或状况时，ACE与吸烟行为之间的关系，同时探讨了抑郁作为中介因素与否的情况。
参与者为超过17000名成年健康维护组织（HMO）成员，他们回顾性报告了八类ACE（情感虐待、身体虐待和性虐待；目睹父母间暴力；父母离异；以及与有药物滥用、精神疾病或被监禁家庭成员一起长大）。将虐待类别数量相加，形成一个名为ACE分数的有序变量。我们测量了当前吸烟情况、与吸烟相悖的状况（心脏病、慢性肺病和糖尿病）以及这些疾病的症状（慢性支气管炎、慢性咳嗽和呼吸急促）。逻辑回归模型将患有与吸烟相关疾病的吸烟者的ACE分数与报告有这些疾病但当前不吸烟的参与者（n = 7483）进行了比较。
发现ACE分数与吸烟持续性之间存在显著的剂量反应关系（对于有≥4次ACE的参与者，优势比 = 1.69；置信区间 = 1.34 - 2.13）。抑郁是吸烟持续性的一个显著独立预测因素，也是一个中介因素。然而，抑郁仅略微减弱了ACE分数与持续吸烟之间的关系。
当与吸烟相关的诊断未能促使患者戒烟时，医生应考虑患者的虐待史和抑郁状况。应制定相关项目，以更好地解决在面临与吸烟相悖的健康问题时继续吸烟的潜在动机。
