The impact of early life stress on risk of tobacco smoking initiation by adolescents.

aimsOur study aimed to examine the association between early life stress and early initiation of alcohol and tobacco use.

designThis prospective cohort study of women and children belongs to the Ukrainian component of the European Longitudinal Study of Pregnancy and Childhood.

settingDniprodzerzhynsk, a city of some 250,000 inhabitants in south central Ukraine.

participantsAll 4398 women who visited antenatal clinics between December 25, 1992 and July 23, 1994, planned to continue their pregnancy, and were permanent residents of the city were invited to participate. Of the 4398 invitees, 2148 agreed and 1020 of the mother-child pairs were available for complete follow-up until the children were 16 years old. MEASUREMENTS: When study children reached ages 3 and 7, their mothers completed questionnaires about their children's exposure to and impact from a standard list of recent stressful life events. From the data on event prevalence and severity, we assigned each child to low, medium, or high early life stress. When the children became age 16, they completed questionnaires about their history of smoking and drinking.

findingsIn multivariate analysis that controlled for current level of family income, current family type, current school type, year of child's birth, lifetime smoking and current drinking by mother, and education of mother and father, girls with high stress at age 3 had 2.2 times (95% confidence interval: 1.23-4.08) higher odds than girls with low stress to start smoking early.

conclusionsOur study may be the first to use a longitudinal study design to examine early life stress as a risk factor for early smoking initiation in adolescence.