Cancer Causes & Control

, Volume 21, Issue 11, pp 1817–1828 | Cite as

The mediating effect of childhood abuse in sexual orientation disparities in tobacco and alcohol use during adolescence: results from the Nurses’ Health Study II

  • Hee-Jin Jun
  • S. Bryn Austin
  • Sarah A. Wylie
  • Heather L. Corliss
  • Benita Jackson
  • Donna Spiegelman
  • Mathew J. Pazaris
  • Rosalind J. Wright
Original paper



To examine the mediating effect of childhood abuse on sexual orientation disparities in tobacco and alcohol use during adolescence.


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.


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%.


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.


Alcohol Bisexual Child abuse Lesbian Sexual orientation Tobacco 



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.


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Hee-Jin Jun
    • 1
  • S. Bryn Austin
    • 1
    • 2
    • 3
  • Sarah A. Wylie
    • 2
  • Heather L. Corliss
    • 2
  • Benita Jackson
    • 4
  • Donna Spiegelman
    • 1
    • 5
    • 6
  • Mathew J. Pazaris
    • 5
  • Rosalind J. Wright
    • 1
    • 7
  1. 1.Channing LaboratoryBrigham & Women’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Division of Adolescent and Young Adult MedicineChildren’s HospitalBostonUSA
  3. 3.Department of SocietyHuman Development, and Health, Harvard School of Public HealthBostonUSA
  4. 4.Department of PsychologySmith CollegeNorthamptonUSA
  5. 5.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  6. 6.Department of BiostatisticsHarvard School of Public HealthBostonUSA
  7. 7.Department of Environmental HealthHarvard School of Public HealthBostonUSA

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