Childhood sexual abuse and two stages of cigarette smoking in African-American and European-American young women

Objective: The aim of the current study was to determine whether the higher rates of childhood sexual abuse (CSA) but lower rates of cigarette smoking in African-American vs. European-American women can be explained in part by a lower magnitude of association between CSA and smoking in African-American women. Methods: Data were drawn from a same-sex female twin study of substance use (n = 3521; 14.3% African-American). Cox proportional hazards regression analyses using CSA to predict smoking initiation and progression to regular smoking were conducted separately by race/ethnicity. Co-twin status on the smoking outcome was used to adjust for familial influences on smoking (which may overlap with family-level influences on CSA exposure). Results: After adjusting for co-twin status, CSA was associated with smoking initiation in European Americans (hazard ratio (HR) = 1.43, 95% confidence intervals (CI): 1.26-1.62) and with smoking initiation ≤. 16 in African Americans (HR = 1.70, CI: 1.26-2.29). CSA was associated with regular smoking onset ≤. 15 in European Americans (HR = 1.63, CI: 1.21-2.18), with no change in HR after adjusting for co-twin status. In the African-American subsample, the HR for CSA was reduced to non-significance after adjusting for co-twin status (from HR = 3.30, CI: 1.23-8.89 to HR = 1.16, CI: 0.71-1.92 for regular smoking ≤. 15). Conclusions: CSA is associated with moderate elevation in risk for initiating smoking among African-American and European-American women. By contrast, CSA is associated with elevated risk for (adolescent onset) regular smoking only in European-American women. Furthermore, there is significant overlap between risk conferred by CSA and familial influences on regular smoking in African-American but not European-American women.