Abstract

Background

Little is known about life-course factors that explain why some individuals continue smoking despite having smoking-related diseases.

Purpose

We examined (a) the extent to which early-life adversities are associated with the risk of recalcitrant smoking, (b) psychosocial factors that mediate the association, and (c) gender differences in the associations.

Methods

Data were from 4,932 respondents (53% women) who participated in the first and follow-up waves of the Midlife Development in the U.S. National Survey. Early-life adversities include low socioeconomic status (SES), abuse, and family instability. Potential mediators include education, financial strain, purpose in life, mood disorder, family problems/support, and marital status. We used sequential logistic regression models to estimate the effect of early-life adversities on the risk of each of the three stages on the path to recalcitrant smoking (ever-smoking, smoking-related illness, and recalcitrant smoking).

Results

For women, low SES (odds ratio [OR] = 1.29; 1.06–1.55) and family instability (OR = 1.73; 1.14–2.62) are associated with an elevated risk of recalcitrant smoking. Education significantly reduces the effect of childhood SES, yet the effect of family instability remains significant even after accounting for life-course mediators. For men, the effect of low SES on recalcitrant smoking is robust (OR = 1.48; 1.10–2.00) even after controlling for potential mediators. There are noteworthy life-course factors that independently affect recalcitrant smoking: for both genders, not living with a partner; for women, education; and for men, family problems.

Conclusions

The findings can help shape intervention programs that address the underlying factors of recalcitrant smoking.

中文翻译：

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早年逆境和中年顽固吸烟：对性别和人生道路的考察。

摘要

背景

对解释为什么有些人尽管患有与吸烟有关的疾病仍继续吸烟的生命历程因素知之甚少。

目的

我们检查了 (a) 早年逆境与顽固性吸烟风险的相关程度，(b) 调解这种关联的社会心理因素，以及 (c) 关联中的性别差异。

方法

数据来自 4,932 名受访者（53% 为女性），他们参与了美国国家调查中中年发展的第一波和后续波。早期生活中的逆境包括社会经济地位低下 (SES)、虐待和家庭不稳定。潜在的中介因素包括教育、经济压力、生活目标、情绪障碍、家庭问题/支持和婚姻状况。我们使用顺序逻辑回归模型来估计早期生活逆境对顽固吸烟路径（一直吸烟、吸烟相关疾病和顽固吸烟）三个阶段中每个阶段的风险的影响。

结果

对于女性而言，低 SES（优势比 [OR] = 1.29；1.06–1.55）和家庭不稳定（OR = 1.73；1.14–2.62）与顽固性吸烟风险升高有关。教育显着降低了儿童社会经济地位的影响，但即使考虑到生命历程中的中介因素，家庭不稳定的影响仍然显着。对于男性来说，即使在控制了潜在的调节因素之后，低 SES 对顽固性吸烟的影响也很明显（OR = 1.48；1.10–2.00）。有一些值得注意的生命历程因素会独立影响顽固性吸烟：无论男女，不与伴侣同住；对于妇女，教育；而对于男人来说，家庭问题。

结论

这些发现有助于制定干预计划，以解决顽固性吸烟的潜在因素。