Tobacco use among black women in the United States: A latent variable model of the long-term effect of childhood maltreatment

Objective: This study tests a model that describes the association between childhood maltreatment and adult cigarette smoking among a nationally representative cohort of black females in the United States. Methods: Data are from Waves I and III of the National Longitudinal Study of Adolescent Health (Add Health) 1994-2002, a nationally representative sample of adolescents followed from grades 7-12 into young adulthood. Black young adult females who were interviewed during the Wave III interview (N=1,741) were selected for subpopulation analyses. First, exploratory factor analysis was conducted to select reliable indicators for constructs (childhood maltreatment, tobacco use, religiosity) and scale items (emotional distress). Subsequently confirmatory factor analysis was conducted to confirm factor structures. Finally a structural equation model, which included hypothesized direct and indirect paths was tested. Results: The model showed good fit to the data, indicating potential for the model to represent population associations. Adult tobacco use was associated with adolescent tobacco use, lower adult religiosity, and higher adult emotional distress. While childhood maltreatment did not have a significant direct effect on adult tobacco use, the indirect long-term effect of childhood maltreatment via adult emotional distress was significant. Conclusion: Childhood maltreatment is associated with adult tobacco use via its effect on adult emotional distress. Religiosity (adolescent and adult) may be protective against tobacco use. To reduce tobacco use among black women in the United States, interventions may need to address the psychological impact of negative childhood experiences as well as to tap into existing sources of support such as religious affiliation/beliefs.