Early-Life Adversity and the Age of Smoking and Drinking Initiation: Examining Older Adults’ Later-Life Mental and Self-Rated Health

The aim of this study is to examine whether early-life adversity (ELA) modifies associations between initiation age of smoking and drinking and later-life physical and mental health. Data came from 6,566 adults in the 2018 Chinese Longitudinal Healthy Longevity Survey. Smoking and drinking initiation were classified as never, adolescent (<18), or adult (≥18). ELA included three childhood hardships (score 0–4). Outcomes were self-rated health (SRH), depressive symptoms, and anxiety severity. Ordinal logistic regression estimated associations and ELA interactions, adjusting for demographic, socioeconomic, and lifestyle factors. Adult smoking and both adolescent and adult drinking were associated with poorer SRH. ELA strengthened the association between adolescent smoking and SRH and heightened the anxiety risk associated with adult drinking. ELA alone did not predict depression, but was associated with higher anxiety. ELA strengthens the long-term health impacts of early smoking and drinking. Interventions addressing childhood hardship and preventing adolescent substance use may promote healthier aging.