Early Life Adversity and Cardiovascular Responses to Stress During Tobacco Ad Libitum Use and Withdrawal

Early life adversity (ELA) is associated with substance use initiation and maintenance, including tobacco use. However, its influence on cardiovascular responses to psychological stress among tobacco smokers remains unclear. This study explored this association among ad libitum and abstinent smokers.

Smokers were randomly assigned to an ad libitum (n=49) or 24-h withdrawal (n=69) group, and non-smokers (n=45) participated in the study. They completed two separate but identical sessions. Each session included speech preparation, speech delivery, and a mental arithmetic task. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were repeatedly measured during each session. Linear mixed-effects models were applied to analyze the relationship between ELA and cardiovascular responses across sessions and phases.

In the linear mixed-effects model for SBP, the overall group × ELA interaction was significant (P=0.006). The effect of having ≥1 ELA event on SBP changes in the withdrawal group was significantly greater than that in non-smokers (fixed effect = 3.89; 95% CI = 1.41 to 6.36; P=0.002). Similar findings were also observed for DBP and HR.

Results suggest that individuals with ELA exposure show heightened cardiovascular reactivity to acute stress during nicotine withdrawal, compared with those without ELA. They highlight the potential role of ELA in shaping stress-related physiological vulnerability during tobacco cessation efforts.