The effect of smoking initiation in adolescence on the subsequent smoking trajectories of people who smoke, and the role of adverse childhood experiences: results from the 1958 British cohort study

Objective: To examine the association between smoking initiation in adolescence and subsequent different smoking trajectories of people who smoke, and to examine the combined effect of adverse childhood experiences (ACEs) and smoking initiation in adolescence on smoking trajectories of people who smoke. Design and sample: Data are from 8,757 individuals in Great Britain from the birth cohort National Child Development Study and who reported being smokers or former smokers by age 23. Measurements: Smoking initiation in adolescence was measured at 16y and smoking trajectories were derived from smoking variables from ages 23 to 55. We modelled the relationship between smoking initiation in adolescence with or without ACEs and smoking trajectories. Results: Individuals who initiated smoking in adolescence were more likely to quit later than quitting in twenties (RRR quitting in thirties = 3.43 [2.40; 4.89] p <0.001; RRR quitting in forties = 5.25 [3.38; 8.14] p <0.001; RRR quitting in fifties = 4.48 [2.95; 6.79] p <0.001), to relapse (RRR Relapse = 3.66 [2.82; 4.76] p <0.001) and to be persistent smokers (RRR persistent = 5.25 [3.81; 7.25] p <0.001) compared to those who had initiated smoking in young adulthood. These effects were particularly pronounced in case of ACEs. 2 Conclusion: Smoking prevention programs aimed at reducing smoking initiation should be promoted to adolescents to limit the burden of smoking, especially for people who have suffered adversity during childhood.