We also predicted that thorough depression and anxiety disorders and cigarette smoking would mediate a substantial portion of this association. The mechanism of the association between childhood abuse and respiratory disease in adulthood is not known, but several possible explanations have been put forth including neurobiological mechanisms whereby early trauma leads to increased vulnerability (Goodwin, Wamboldt, & Pine, 2003), shared risk factors for both child abuse and physical disease (Anda et al., 2008), and common physiologic mechanisms (e.g., immune-related pathways; Cohen, Canino, Bird, & Celedon, 2008; Goodwin & Stein, 2004). Improved understanding of the nature of these links could lead to improved effectiveness of prevention efforts. Specifically, several cross-sectional studies among children (Cohen et al.

, 2008) and adults (Goodwin & Stein, 2004; Goodwin, Wamboldt, et al., 2003; Scott et al., 2008) and at least one longitudinal study among young persons (Goodwin, Fergusson, & Horwood, 2005) and one among adults in an Health Maintenance Organization (Anda et al., 2008) have shown links between childhood abuse and asthma/respiratory disease. One alternative explanation for the association between childhood abuse and respiratory disease in adults is the role of behavioral or lifestyle factors associated with childhood abuse, which may lead or contribute to the development of poor respiratory health outcomes in adulthood. Several health risk behaviors, which are often associated with both childhood abuse and respiratory illness, may mediate a relationship between the two.

For instance, there are well-documented associations between (a) childhood abuse and major depression and anxiety disorders (Al-Modallal, Peden, & Anderson, 2008; Danese et al., 2008; Downs & Rindels, 2004; Fletcher, 2009); (b) childhood abuse and adult smoking (Anda et al., 1999; Spratt et al., 2009); Cilengitide (c) depression/anxiety disorders and smoking (Anda et al., 1999; Breslau, Novak, & Kessler, 2004; Fergusson & Lynskey, 1997); and (d) smoking and respiratory disease. Childhood abuse may increase the risk of onset of depression/anxiety disorders and smoking thereby increasing the risk of later respiratory disease via various biologic pathways.