Objective: The goal of this study was to examine the association between sexual abuse (SA) and initiation, cessation, and current cigarette smoking among a large representative adult population in France. Method: A random sample size of 12,256 adults (18-75 years of age) was interviewed by telephone concerning demographic variables, health practices and beliefs, and health status--for which SA and tobacco questions were included. Bivariate and multivariate analyses were conducted. Results: Nearly 46% of SA survivors were current smokers compared to 34% of non-abused persons ("p" less than 0.001). Survivors of SA consumed more cigarettes per day than non-abused individuals (14.5 vs. 12.4, "p" less than 0.01). Survival analysis showed an increased risk of smoking initiation for respondents abused before 18 (adjusted relative hazard = 1.55; "p" less than 0.0001) with referent to the non-abused group. SA was not found to be a significant predictor of current smoking status among those who began smoking after the first incident of SA. Respondents who were not sexually abused were 1.8 times (95% CI, 1.12-2.99) more likely to quit smoking than people who began smoking after they were sexually abused. Conclusions: The early identification and treatment of sexually abused persons is critical to decrease smoking among adolescents and adults because of the association of SA with both smoking initiation and decreased cessation rates. It may be more difficult to detect an association between SA and current smoking due to the high rates of smoking and lower rates of quitting among the general French population.