Abstract
Objective
To examine the mediating effect of childhood abuse on sexual orientation disparities in tobacco and alcohol use during adolescence.
Methods
We carried out analyses with data from over 62,000 women in the ongoing Nurses’ Health Study II cohort who provided information on sexual orientation, childhood abuse occurring by age 11, and tobacco and alcohol use in adolescence. We used multivariate regression analyses, controlling for confounders, to estimate the mediating effect of childhood abuse on the association between sexual orientation and tobacco and alcohol use in adolescence.
Results
Lesbian and bisexual orientation and childhood abuse were positively associated with greater risk of tobacco and alcohol use during adolescence. For lesbians, the estimated proportion of excess tobacco and alcohol use in adolescence relative to use among heterosexual women that was mediated by abuse in childhood ranged from 7 to 18%; for bisexual women, the estimated proportion of excess use mediated by abuse ranged from 6 to 13%.
Conclusions
Elevated childhood abuse in lesbian and bisexual women partially mediated excess tobacco and alcohol use in adolescence relative to heterosexual women. Interventions to prevent child abuse may reduce sexual orientation disparities in some of the leading causes of cancer in women.
Similar content being viewed by others
References
Permuth-Wey J, Sellers TA (2009) Epidemiology of ovarian cancer. Methods Mol Biol 472:413–437
Pelucchi C, Gallus S, Garavello W, Bosetti C, La Vecchia C (2008) Alcohol and tobacco use, and cancer risk for upper aerodigestive tract and liver. Eur J Cancer Prev 17(4):340–344
Coyle YM (2009) Lifestyle, genes, and cancer. Methods Mol Biol 472:25–56
Jordan SJ, Whiteman DC, Purdie DM, Green AC, Webb PM (2006) Does smoking increase risk of ovarian cancer? A systematic review. Gynecol Oncol 103(3):1122–1129
Dumitrescu RG, Shields PG (2005) The etiology of alcohol-induced breast cancer. Alcohol 35(3):213–225
Setiawan VW, Monroe KR, Goodman MT, Kolonel LN, Pike MC, Henderson BE (2008) Alcohol consumption and endometrial cancer risk: the multiethnic cohort. Int J Cancer 122(3):634–638
Freedman ND, Schatzkin A, Leitzmann MF, Hollenbeck AR, Abnet CC (2007) Alcohol and head and neck cancer risk in a prospective study. Br J Cancer 96(9):1469–1474
Giovannucci E (2001) An updated review of the epidemiological evidence that cigarette smoking increases risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev 10(7):725–731
MacKay AP, Duran C (2007) Adolescent health in the United States, 2007. National Center for Health Statistics, US Department of Health and Human Services, Hyattsville
Speizer FE, Colditz GA, Hunter DJ, Rosner B, Hennekens C (1999) Prospective study of smoking, antioxidant intake, and lung cancer in middle-aged women (USA). Cancer Causes Control 10(5):475–482
Okasha M, McCarron P, David Gunnell D, Smith GD (2003) Exposures in childhood, adolescence and early adulthood and breast cancer risk: a systematic review of the literature. Breast Cancer Res Treat 78:223–276
Colditz GA, Frazier AL (1996) Models of breast cancer show that risk is set by events of early life: prevention efforts must shift focus. Cancer Epidemiol Biomarkers Prev 4:567–571
Tang H, Greenwood GL, Cowling DW, Lloyd JC, Roeseler AG, Bal DG (2004) Cigarette smoking among lesbians, gays, and bisexuals: how serious a problem? Cancer Causes Control 15:797–803
Dilley JA, Maher JE, Boysun MJ, Pizacani BA, Mosbaek CH, Rohde K, et al. (2005) Response letter to: Tang H, Greenwood GL, Cowling DW, Lloyd JC, Roeseler AG, Bal DG. Cigarette smoking among lesbians, gays, and bisexuals: How serious a problem? Cancer Causes Control 16:1133–1134
Cochran SD, Keenan C, Schober C, Mays VM (2000) Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the US population. J Consult Clin Psychol 68(6):1062–1071
Diamant AL, Wold C, Spritzer K, Gelberg L (2000) Health behaviors, health status, and access to and use of health care: a population-based study of lesbian, bisexual, and heterosexual women. Arch Fam Med 9(10):1043–1051
Drabble L, Trocki K (2005) Alcohol consumption, alcohol-related problems, and other substance use among lesbian and bisexual women. J Lesbian Stud 9(3):19–30
Gilman SE, Cochran SD, Mays VM, Hughes M, Ostrow D, Kessler RC (2001) Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey. Am J Public Health 91(6):933–939
Pizacani BA, Rohde K, Bushore C, Stark MJ, Maher JE, Dilley JA et al (2009) Smoking-related knowledge, attitudes and behaviors in the lesbian, gay and bisexual community: A population-based study from the US Pacific Northwest. Prev Med 48(6):555–561
Case P, Austin SB, Hunter DJ, Manson JE, Malspeis S, Willett WC et al (2004) Sexual orientation, health risk factors, and physical functioning in the Nurses’ Health Study II. J Women’s Health 13(9):1033–1047
Brown JP, Tracy JK (2008) Lesbians and cancer: an overlooked health disparity. Cancer Causes Control 19(10):1009–1020
Bontempo DE, D’Augelli AR (2002) Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behavior. J Adolesc Health 30(5):364–374
Easton A, Jackson K, Mowery P, Comeau D, Sell R (2008) Adolescent same-sex and both-sex romantic attractions and relationships: implications for smoking. Am J Public Health 98(3):462–467
Russell ST, Driscoll AK, Truong N (2002) Adolescent same-sex romantic attractions and relationships: implications for substance use and abuse. Am J Public Health 92(2):198–202
Downs WR, Harrison L (1998) Childhood maltreatment and the risk of substance problems in later life. Health Soc Care Community 6(1):35–46
Simpson TL, Miller WR (2002) Concomitance between childhood sexual and physical abuse and substance use problems: a review. Clin Psychol Rev 22:27–77
Harrison PA, Fulkerson JA, Beebe TJ (1997) Multiple substance use among adolescent physical and sexual abuse victims. Child Abuse Negl 21(6):529–539
Schuck AM, Widom CS (2001) Childhood victimization and alcohol symptoms in females: causal inferences and hypothesized mediators. Child Abuse Negl 25:1069–1092
Orlando M, Ellickson PL, Jinnett K (2001) The temporal relationship between emotional distress and cigarette smoking during adolescence and young adulthood. J Consult Clin Psychol 69(6):959–970
Swendsen JD, Tennen H, Carney MA, Affleck G, Willard A, Hromi A (2000) Mood and alcohol consumption: an experience sampling test of the self-medication hypothesis. J Abnorm Psychol 109(2):198–204
Balsam KF, Rothblum ED, Beauchaine TP (2005) Victimization over the life span: a comparison of lesbian, gay, bisexual, and heterosexual siblings. J Consult Clin Psychol 73(3):477–487
Corliss HL, Cochran SD, Mays VM (2002) Reports of parental maltreatment during childhood in a United States population-based survey of homosexual, bisexual, and heterosexual adults. Child Abuse Negl 26(11):1165–1178
Matthews AK, Hughes TL, Johnson T, Razzano LA, Cassidy R (2002) Prediction of depressive distress in a community sample of women: the role of sexual orientation. Am J Public Health 92(7):1131–1139
Tjaden P, Thoennes N, Allison CJ (1999) Comparing violence over the life span in samples of same-sex and opposite-sex cohabitants. Violence Vict 14(4):413–425
Austin SB, Jun H-J, Jackson B, Spiegelman D, Rich-Edwards J, Corliss HL et al (2008) Disparities in child abuse victimization in lesbian, bisexual, and heterosexual women in the Nurses’ Health Study II. J Women’s Health 17(4):597–606
Wilsnack SC, Hughes TL, Johnson TP, Bostwick WB, Szalacha LA, Benson P et al (2008) Drinking and drinking-related problems among heterosexual and sexual minority women. J Stud Alcohol Drugs 69(1):129–139
Hughes TL, Johnson TP, Wilsnack SC, Szalacha LA (2007) Childhood risk factors for alcohol abuse and psychological distress among adult lesbians. Child Abuse Negl 31(7):769–789
Morris JF, Balsam KF (2003) Lesbian and bisexual women’s experiences of victimization: mental health, revictimization, and sexual identity development. J Lesbian Stud 7(4):67–85
Brigham and Women’s Hospital/Harvard Medical School (2010) Nurses’ Health Study, Brigham and Women’s Hospital/Harvard Medical School, Boston [cited 2010 Jan. 26, 2010], Available from: http://www.channing.harvard.edu/nhs/
Jun H-J, Rich-Edwards J, Boynton-Jarret R, Wright RW (2008) Intimate partner violence and cigarette smoking: association between smoking risk and psychological abuse with and without co-occurrence of physical and sexual abuse. Am J Public Health 98(3):527–535
Straus M, Hamby S, Boney-McCoy S, Sugarman D (1996) The revised conflict tactics scales (CTS2). J Family Issues 17(3):283–316
Finkelhor D, Moore D, Hamby S, Straus M (1997) Sexually abused children in a national survey of parents: methodological issues. Child Abuse Negl 21(1):1–9
Moore D, Gallup G, Schussel R (1995) Disciplining children in America: a Gallup poll report. The Gallup Organization, Princeton
US Department of Health and Human Services (1994) Preventing tobacco use among young people: a report from the Surgeon General. Atlanta
Ackard D, Neumark-Sztainer D, Hannan P (2003) Dating violence among a nationally representative sample of adolescent girls and boys: associations with behavioral and mental health. J Gend Specif Med 6(3):39–48
Spiegelman D, Hertzmark E (2005) Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol 162(3):199–200
Lin DY, Fleming TR, De Gruttola V (1997) Estimating the proportion of treatment effect explained by a surrogate marker. Stat Med 16:1515–1527
Austin SB, Ziyadeh N, Fisher LB, Kahn JA, Colditz GA, Frazier AL (2004) Sexual orientation and tobacco use in a cohort study of US adolescent girls and boys. Arch Pediatr Adolesc Med 158(4):317–322
Ziyadeh NJ, Prokop LA, Fisher LB, Rosario M, Field AE, Camargo CA Jr et al (2007) Sexual orientation, gender, and alcohol use in a cohort study of US adolescent girls and boys. Drug Alcohol Depend 87(2–3):119–130
Corliss HL, Rosario M, Wypij D, Fisher LB, Austin SB (2008) Sexual orientation disparities in longitudinal alcohol use patterns among adolescents: findings from the growing up today study. Arch Pediatr Adolesc Med 162(11):1071–1078
Lee L, Gilpin EA, Pierce JP (1993) Changes in the patterns of initiation of cigarette smoking in the United States: 1950, 1965, and 1980. Cancer Epidemiol Biomarkers Prev 2:593–597
National Household Survey on Drug Abuse (1979) [database on the Internet] 1979 [cited May 22, 2009]. Available from: http://www.icpsr.umich.edu/cgi-bin/SDA/SAMHDA/hsda3
Jun H-J, Rich-Edwards J, Boynton-Jarrett R, Austin SB, Frazier AL, Wright RJ (2008) Child abuse and smoking among young women: the importance of severity, accumulation, and timing. J Adolesc Health 43(1):55–63
Acknowledgments
The authors would like to thank Janet Rich-Edwards, ScD, for her contributions to this paper and the tens of thousands of women across the country participating in NHSII. The work reported in this manuscript was supported by the Harvard Medical School Center of Excellence in Women’s Health, American Cancer Society grant RSGT-07-172-01-CPPB, NIH grants HL64108 and CA50385. NHSII is supported for other specific projects by the following NIH grants: CA67262, AG/CA14742, CA67883, CA65725, DK52866, HL64108, HL03804, DK59583, and HD40882. In addition, the Channing Laboratory has received modest additional resources at various times and for varying periods since January, 1, 1993, from the Alcoholic Beverage Medical Research Foundation, American Cancer Society, Amgen, California Prune Board, Centers for Disease Control and Prevention, Ellison Medical Foundation, Florida Citrus Growers, Glaucoma Medical Research Foundation, Hoffmann-LaRoche, Kellogg’s, Lederle, Massachusetts Department of Public Health, Mission Pharmacal, National Dairy Council, Rhone Poulenc Rorer, Robert Wood Johnson Foundation, Roche, Sandoz, US Department of Defense, US Department of Agriculture, Wallace Genetics Fund, Wyeth-Ayerst, and private contributions. S.B.A. and H.L.C. are supported by the Leadership Education in Adolescent Health project, Maternal and Child Health Bureau, HRSA grant T71-MC00009-17. H.L.C. is supported by K01DA023610.
Conflict of interest statement
The authors have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
Hee-Jin Jun and S. Bryn Austin are Joint First Authors.
Rights and permissions
About this article
Cite this article
Jun, HJ., Austin, S.B., Wylie, S.A. et al. The mediating effect of childhood abuse in sexual orientation disparities in tobacco and alcohol use during adolescence: results from the Nurses’ Health Study II. Cancer Causes Control 21, 1817–1828 (2010). https://doi.org/10.1007/s10552-010-9609-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-010-9609-3