The enduring effects of early life adversity on the dysregulation of the stress awakening response among dependent tobacco users.

Introduction: Adults with early life adversity (ELA) often exhibit stress system dysregulation and are prone to smoke for stress relief. This study, conducted as part of a larger project examining psychobiological stress responses in smokers, specifically focuses on the a priori research question of how ELA influences the cortisol awakening response (CAR) during acute tobacco withdrawal.

Methods: Using quasi-experimental design, adult daily (heavy) smokers were randomly assigned to either regular smoking (ad-lib) (N=37) or 24-hour withdrawal (N=55), and categorized into low or high ELA. CO levels verified smoking status, and CAR was assessed through salivary cortisol upon awakening and at 30 and 60 post-wakening. CAR was evaluated using mean cortisol levels, peak reactivity, and area under the curve with respect to increase (AUCi) and ground (AUCg) while controlling for possible covariates. Self-reported measures of mood, craving, and withdrawal were also analyzed.

Results: Smoking status X ELA interaction on peak cortisol and AUCi. High ELA ad-lib smokers (vs. high ELA withdrawal) had elevated peak and AUCi levels and were higher than low ELA ad-lib smokers with respect to peak (ps < 0.05). Withdrawal (vs. ad-lib smokers) had lower positive affect and higher negative affect, craving, and withdrawal (ps < 0.05). Adult smokers with a history of ELA exhibit heightened stress response dysregulation, as evidenced by altered CAR, compared to those without ELA or in smoking withdrawal.

Conclusions: These findings demonstrate that early life adversity significantly exacerbates stress system dysregulation among adult smokers, as evidenced by alterations in the cortisol awakening response. Identifying ELA experiences in smokers may inform the development of more targeted interventions for stress management and tobacco cessation.

Implications: Findings from this study suggest ELA not only leads to an earlier initiation of smoking but also worsens stress system dysregulation in adult smokers. These insights highlight the importance of developing early prevention strategies aimed at adolescents with ELA to prevent smoking initiation and reduce its impact on stress regulation. Additionally, the findings support the need for customized, trauma-informed smoking cessation programs for adults with ELA, emphasizing the necessity to address the distinct challenges related to stress regulation and nicotine withdrawal they face.