Date of Conferral



Doctor of Public Health (DrPH)


Public Health


Morton Wagenfeld


While research has indicated that impaired mental health partially mediates the relationship between adverse childhood experiences (ACEs) and alcohol and illicit drug use, little research has examined potential mediators in the relationship between ACEs and smoking, the number one cause of preventable mortality in the United States. Accordingly, this study examined the potential mediating effect of psychological distress on the relationship between ACES and smoking using data from Wave II of the ACE Study, a cross-sectional study completed between June and October of 1997 on a sample of adult health maintenance organization members (N = 7,211). The theoretical underpinnings for this study were grounded in the developmental psychopathological perspective which examines both environmental and biological influences as they interact to promote or impede social, emotional, and behavioral development. Mediation modeling employing both linear and logistic regression techniques indicated that, after adjusting by select covariates, psychological distress (as assessed using the SF-36 Mental Component Summary score) partially mediated the relationship between several of the ACEs examined and smoking in women. These same relationships were not found in men. This research contains several key findings with social change implications. First, additional research should be conducted to examine the causes, developmental paths, and critical points that link ACEs and psychological distress to smoking among women. Second, given the gender differences in the association between ACEs and smoking, gender-specific intervention programs that build resiliency, increase positive social support, and provide tools for developing alternative coping strategies may be important adjuncts to smoking cessation programs, particularly for women with a history of ACEs.