童年逆境經驗對成年吸菸行為之影響

Abstract

背景： 近幾年兒童和青少年遭受不當對待的議題備受重視，其童年逆境經驗為影響未來身心健康狀況的重要因素。國內外文獻已指出童年逆境經驗對生理和心理的健康問題，也導致青少年在成年後從事高風險健康行為，如吸菸。過去研究已證實童年逆境經驗對吸菸行為的負面影響，但多著重於單一時間點的吸菸狀態，卻較少探討其對吸菸之長期變化模式的影響。另外，童年逆境與吸菸行為之間的性別差異，目前亦尚未有一致的定論。 目的： 本研究使用次級資料庫進行分析，探討性別差異下童年逆境經驗對成年期的累積吸菸量及吸菸量模式之影響，並進一步分析不同的童年逆境經驗事件對吸菸行為的關係。 方法： 本研究使用「台灣青少年成長歷程研究」（簡稱TYP），取其於2000年就讀國中一年級之J1樣本之資料，選取2000年至2017年之長期追蹤資料。本研究將使用潛在類別分析（Latent Class Analysis）和多元線性迴歸（Multiple Linear Regression）作為主要分析方法，並以Latent GOLD 6.0和SAS 9.4統計軟體進行統計分析。 結果： 根據潛在類別分析的結果，男性的吸菸量模式可以分成三種組別：「持續低量組」、「先降後升組」及「略升後降組」；女性的吸菸量模式則分成兩種組別：「持續低量組」及「先升後降組」。以「持續低量組」為參考組之結果顯示，相較於ACEs總數 ≤ 1者，女性在ACEs總數為2及3者，屬於「先升後降組」的可能性顯著較高，勝算比分別為5.47（信賴區間介於1.11至26.93）及6.28（信賴區間介於1.27至31.05）。然而加入控制變項後卻沒有相同的效果。以男性而言，ACEs總數的多寡與其成為「先降後升組」與「略升後降組」的可能性皆無統計顯著。進一步比較不同ACEs類別之影響，「忽視」與女性的吸菸量模式有關。具體來說，相較沒有遭受忽視的女性，有遭受過忽視者，其成為「先升後降組」的可能性為「持續低量組」的2.81倍。 就ACEs與累積吸菸量的關係來看，與ACEs總數 ≤ 1者相比，以女性而言，ACEs總數為2（β＝0.55；SE＝0.24）及3（β＝0.60；SE＝0.25）的累積吸菸量顯著較高；男性則即使經歷較多的ACEs皆不會顯著增加其累積吸菸量。比較不同ACEs類別之結果顯示，「忽視」與女性的累積吸菸量具有顯著正相關。在其他因素方面，重大生活事件、個人婚姻狀況及其他藥物使用情形為男性在吸菸量模式及累積吸菸量的危險因子；成年期憂鬱情形則為女性的影響因子。 結論： 本研究發現在吸菸量模式方面，男女性存在不同的吸菸模式。此外，女性在吸菸量模式與累積吸菸量方面均與ACEs有顯著關係，尤其在「忽視」面向上。根據此結果，建議應持續關注ACEs對吸菸行為造成的影響。此外，由於ACEs對男女性產生的影響有所差異，未來在制定相關介入措施時，應將性別差異與ACEs類型納入考量，以提升介入策略的成效。

Background: In recent years, the issue of mistreatment of children and adolescents has garnered significant attention, with adverse childhood experiences recognized as a key factor impacting future physical and mental health outcomes. Domestic and international literature has established associations between adverse childhood experiences and a range of health issues, both physiological and psychological. These adversities are also linked to increased engagement in high-risk health behaviors in adulthood, such as smoking. Previous studies have confirmed the negative impact of adverse childhood experiences on smoking behavior. However, most of this research has focused on smoking status at a single time point, with relatively limited attention to how ACEs may influence long-term patterns of smoking behavior. In addition, the evidence regarding sex-specific association between ACEs and smoking remains inconclusive. Aims: This study utilizes a secondary data analysis approach to examine the effects of childhood adversity on cumulative smoking quantity and smoking amount patterns in adulthood, with a particular focus on gender differences. It further investigates the effects of different types of ACEs on smoking behavior. Methods: The study draws on data from the Taiwan Youth Project (TYP), targeting the J1 cohort, which included first-year junior high students in 2000. Longitudinal data spanning from 2000 to 2017 will be analyzed. Statistical methods including latent class analysis and multiple linear regression will be employed using Latent GOLD 6.0 and SAS 9.4 software. Results: Based on the latent class analysis, three smoking amount patterns among males could be categorized for three groups: “consistently low group”, “decreasing-then-increasing group”, and “slightly increasing-then-decreasing group”. For females, two groups emerged: “consistently low group” and “increasing-then-decreasing group”. Using the “consistently low group” as the reference category, females with an ACEs total of 2 or 3 were significantly more likely to belong to the “increasing-then-decreasing group”, with odds ratios of 5.47 (95% CI = 1.11–26.93) and 6.28 (95% CI = 1.27–31.05), respectively. However, this effect was not observed after controlling for covariates. Among males, the number of ACEs was not significantly associated with membership in either the “decreasing-then-increasing” or “slightly increasing-then-decreasing” groups. When comparing different types of ACEs, “neglect” was found to be significantly associated with smoking amount patterns among females. Specifically, females who experienced neglect were 2.81 times more likely to belong to the “increasing-then-decreasing group” compared to those who did not experience neglect. Regarding the relationship between ACEs and cumulative smoking quantity, compared to those with ACEs ≤ 1, females with 2 (β = 0.55; SE = 0.24) and 3 ACEs (β = 0.60; SE = 0.25) had significantly higher cumulative smoking levels. Among males, a higher number of ACEs did not significantly predict cumulative smoking quantity. Further analysis showed that neglect was positively associated with cumulative smoking levels among females. Other factors, such as major life events, marital status, and other substance use, were identified as risk factors influencing both smoking amount patterns and cumulative smoking quantity among males. In contrast, depressive symptoms in adulthood were significant predictors for females. Conclusion: This study found that smoking patterns differed between males and females. In particular, among females, both smoking amount patterns and cumulative smoking quantity were significantly associated with adverse childhood experiences (ACEs), especially in the domain of neglect. Based on these findings, it is recommended that continued attention be given to the impact of ACEs on smoking behavior. Given the differential impact of ACEs by gender, future intervention strategies should take into account both gender differences and the specific types of ACEs in order to enhance the effectiveness of such interventions.