Original article| Volume 23, ISSUE 2, e95-e102, March 2013

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The Influence of Childhood Physical Abuse on Adult Health Status in Sexual Minority Women: The Mediating Role of Smoking

Published:February 15, 2013DOI:



      Among women in the general population, childhood physical abuse (CPA) is associated with poor adult health status and engagement in health risk behaviors. Sexual minority women (SMW) are at elevated risk of CPA, have higher rates of smoking, and may be at higher risk for poorer general health. In this study, we examined the influences of CPA on health status in a diverse sample of SMW. We hypothesized that SMW with a history of CPA would report poorer health than those without such histories and that early onset of smoking—an important health risk behavior—would mediate the relationship between CPA and current health status.


      Structural equation modeling was used to evaluate the influence of CPA on early health risk behavior (i.e., age of smoking onset) and current perceived health status in a community based sample of 368 SMW.


      More than one fifth of the sample (21.5%) reported a history of CPA. One fourth of the sample was current smokers; the average age of smoking onset was 19 to 20 years old. The mean level of self-rated health status was between “fair” and “good.” When relationships were simultaneously estimated, the effect of CPA on health status was mediated by two sequential smoking factors: CPA was associated with earlier age of smoking onset, and age of smoking onset was associated with current smoker status. Being a current smoker had a negative effect on perceived health status.

      Implications for Practice and/or Policy

      These results suggest that tobacco use is an important pathway by which CPA influences current health status. Prevention and early intervention initiatives should focus on the reduction of CPA among SMW to eliminate the long-term health consequences of adverse childhood events among SMW.
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      Alicia K. Matthews, PhD, is Associate Professor, College of Nursing, University of Illinois at Chicago. Research interests include identification of sociocultural predictors of poor health, and the use of culturally targeted interventions to improve the physical health of underserved minority populations.


      Young Ik Cho, PhD, is Associate Professor, Zilber School of Public Health, University of Wisconsin-Milwaukee. Research interests are: substance abuse behaviors and treatment, substance abuse risk factors among minority populations, and evaluation of substance abuse intervention and treatment programs.


      Tonda L. Hughes, PhD, is Professor, Department Head, Health Systems Sciences, College of Nursing, University of Illinois at Chicago. Research expertise is in sexual minority women's health, alcohol use, and mental health.


      Timothy P. Johnson, PhD, is Professor and Director, Survey Research Laboratory, University of Illinois at Chicago, Chicago. Research interests include cultural disparities in survey measurement and health behaviors among disadvantaged populations.


      Lisa Alvy, MA, is a Doctoral student, Department of Psychology, University of Illinois at Chicago. Research interests include lesbian, gay, bisexual, and transgender (LGBT) health, body image and obesity, and sexual health and HIV prevention.