Research suggests that there is a dose-response relationship between ACE score and cigarette smoking, such that as ACE score increases, so does smoking behavior, but little is known about what factors moderate this relationship. Therefore, the goal of this study was to examine demographic characteristics as potential moderators of relationship between Adverse Childhood Experiences (ACEs) and cigarette smoking. A secondary data analysis was conducted using the 2013 California Behavioral Risk Factor Surveillance System data. The sample included 2,604 U.S. adults (54.8% female; Age: M = 53.3, SD = 8.10; 83.6%; Caucasian, 6.4% Asian, 5.9% Black or African American, 3.1% American Indian or Alaska Native, and 0.6% other, and 0.2% Native Hawaiian or other Pacific Islander). We used multinomial logistic regression to test sex, race, socioeconomic status, and education as moderators of the relationship between ACE score and smoking. Sex, race, education, and income were significantly and independently associated with smoking outcomes. Men, individuals with lower income and education, and certain ethnic/racial groups reported greater odds of smoking. No interactions between ACE score and sex, race, education, or income significantly predicted smoking outcomes. ACEs were not significantly associated with smoking behavior. Results suggest that the relationship between ACEs and smoking later in life does not depend on basic demographic features. Knowing which populations are more vulnerable to smoking can help clinicians better assess and tailor interventions to meet the needs of their patients by using culturally sensitive interventions and obtaining resources to help improve treatment access, motivation, and success.

LLU Discipline





School of Behavioral Health

First Advisor

Holly E. R. Morrell

Second Advisor

Cameron Neece

Degree Name

Doctor of Psychology (PsyD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Adult Survivors of Child Adverse Events -- psychology; Behavioral Risk Factor Surveillance System; California -- epidemiology; Cigarette Smoking -- epidemiology; Cigarette Smoking -- psychology; Ethnic Groups; Female; Humans; Male; Middle Aged; Sex Factors; Socioenvironmental Therapy


Doctoral Project

Page Count

x; 63 p.

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives