To the Editor: Dr Anda and colleagues1 found a strong association between adverse childhood
experiences and several aspects of smoking. They conclude that nicotine is
used "as a pharmacological tool to alleviate the long-term emotional and psycho-biological
wounds of adverse childhood experiences." However, self-medication may be
only part of the explanation for the study's results. Quality of parenting
and self-esteem may moderate this relationship.
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