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Shevorykin A, Hyland BM, Robles D, Ji M, Vantucci D, Bensch L, Thorner H, Marion M, Liskiewicz A, Carl E, Ostroff JS, Sheffer CE. Tobacco use, trauma exposure and PTSD: a systematic review. Health Psychol Rev 2024:1-32. [PMID: 38711288 DOI: 10.1080/17437199.2024.2330896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/11/2024] [Indexed: 05/08/2024]
Abstract
Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets.
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Affiliation(s)
- Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bridget M Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Daniel Robles
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, Canada
| | - Mengjia Ji
- Department of Psychology, The City College of New York (CUNY), New York, NY, USA
| | - Darian Vantucci
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lindsey Bensch
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hannah Thorner
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Matthew Marion
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Amylynn Liskiewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Tran DD, Davis JP, Tucker JS, Bricker JB, Lee DS, Fitzke RE, Pedersen ER. Cigarette Smoking and Depression Among U.S. Veterans: Longitudinal Associations With Posttraumatic Stress Disorder. Nicotine Tob Res 2023; 25:1496-1504. [PMID: 37094359 PMCID: PMC10347971 DOI: 10.1093/ntr/ntad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 03/09/2023] [Accepted: 04/21/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Cigarette smoking and depression are associated with morbidity and mortality. Among veterans, approximately 22% are current smokers and 11%-15% have been diagnosed with depression. Although prior research suggests a strong association between smoking and depression among veterans, little research has examined trajectories of smoking and depressive symptoms and their correlates over time in this population. AIMS AND METHODS Using parallel process growth curve modeling, we examined the longitudinal relationship between smoking and depression and tested whether posttraumatic stress disorder (PTSD) symptoms predict smoking and depression trajectories over 18 months (February 2020-August 2021). Veterans were recruited for an online, longitudinal study and responded to surveys across five-time points (baseline N = 1230; retention = 79.3%-83.3% across waves). RESULTS Associations indicated that more frequent smoking at baseline was associated with steeper increases in depression symptom severity, and greater depression severity at baseline was associated with a less steep decrease in smoking frequency over time. PTSD was associated with less smoking at time 1 but more frequent smoking at times 3-5 as well as greater depression across all time points. CONCLUSIONS Findings provide support that the growth trajectories of smoking and depression are linked, and PTSD symptoms are associated with these trajectories among veterans. Addressing these factors simultaneously in veteran treatment centers or through tobacco cessation efforts may be beneficial. IMPLICATIONS This study offers strong evidence that the growth trajectories of smoking and depression are linked, and PTSD symptoms affect these trajectories among veterans, who represent a largely understudied population despite high rates of substance use and mental health problems. Results of this study strengthen the case for a more integrated treatment approach in which both smoking and mental health concerns are simultaneously addressed, which may yield more beneficial physical health and clinical outcomes for post-9/11 veterans.
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Affiliation(s)
- Denise D Tran
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CAUSA
| | | | - Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
- Department of Psychology, University of Washington, Seattle, WA USA
| | - Daniel S Lee
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Reagan E Fitzke
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
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Tran DD, Davis JP, Ring C, Wang J, Fitzke RE, Leventhal AM, Pedersen ER. Associations between depression, stress, and e-cigarette use among OEF/OIF veterans. MILITARY PSYCHOLOGY 2023; 35:245-251. [PMID: 37133546 PMCID: PMC10156999 DOI: 10.1080/08995605.2022.2114278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/12/2022] [Indexed: 10/15/2022]
Abstract
The COVID-19 pandemic has had profound mental and behavioral health implications for the general U.S. population. However, little is known regarding outcomes for U.S. veterans, who represent a population with high rates of depression, stress, and e-cigarette use. One month prior to the pandemic-related closures (February 2020), 1230 OEF/OIF veterans (ages 18-40) completed an online baseline survey. Six months later, participants completed a follow-up survey (83% retention rate). Hierarchical negative binomial regressions were used to examine the relationship between baseline depression and past 30-day e-cigarette use at follow-up and whether baseline stress moderated this relationship. Veterans who screened positive for depression or who endorsed higher stress levels reported greater e-cigarette use at follow-up. Stress also moderated the relationship between depression and e-cigarette use, such that regardless of stress levels, a positive depression screen was associated with greater rates of later e-cigarette use. However, for those with a negative depression screen, higher stress levels were associated with greater e-cigarette use relative to lower stress levels. Veterans with pre-pandemic depression and stress may be at highest risk for e-cigarette use. Ongoing assessment and treatment for depression and promoting stress management skills for veterans in e-cigarette use prevention and intervention programs may be valuable.
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Affiliation(s)
- Denise D. Tran
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jordan P. Davis
- Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, University of Southern California, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | - Colin Ring
- Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, University of Southern California, Los Angeles, California
| | - Jennifer Wang
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Reagan E. Fitzke
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Adam M. Leventhal
- Institute for Addiction Science, University of Southern California, Los Angeles, California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Eric R. Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
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Salas J, Gebauer S, Gillis A, van den Berk-Clark C, Schneider FD, Schnurr PP, Friedman MJ, Norman SB, Tuerk PW, Cohen BE, Lustman PJ, Scherrer JF. Increased Smoking Cessation among Veterans with Large Decreases in Posttraumatic Stress Disorder Severity. Nicotine Tob Res 2021; 24:178-185. [PMID: 34477205 DOI: 10.1093/ntr/ntab179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Improvement in posttraumatic stress disorder (PTSD) is associated with better health behavior such as better medication adherence and greater use of nutrition and weight loss programs. However, it is not known if reducing PTSD severity is associated with smoking cessation, a poor health behavior common in patients with PTSD. METHODS Veterans Health Affairs (VHA) medical record data (2008 to 2015) were used to identify patients with PTSD diagnosed in specialty care. Clinically meaningful PTSD improvement, was defined as ≥20 point PTSD Checklist (PCL) decrease from the first PCL ≥ 50 and the last available PCL within 12 months and at least 8 weeks later. The association between clinically meaningful PTSD improvement and smoking cessation within 2-years after baseline among 449 smokers was estimated in Cox proportional hazard models. Entropy balancing controlled for confounding. RESULTS On average, patients were 39.4 (SD=12.9) years of age, 86.6% were male and 71.5% were white. We observed clinically meaningful PTSD improvement in 19.8% of participants. Overall, 19.4% quit smoking in year 1 and 16.6% in year 2. More patients with vs. without clinically meaningful PTSD improvement stopped smoking (n=36, cumulative incidence=40.5% vs. 111, cumulative incidence=30.8%; respectively). After controlling for confounding, patients with vs. without clinically meaningful PTSD improvement were more likely to stop smoking within 2-years (HR=1.57; 95%CI:1.04-2.36). CONCLUSIONS Patients with clinically meaningful PTSD improvement were significantly more likely to stop smoking. Further research should determine if targeted interventions are needed or whether improvement in PTSD symptoms is sufficient to enable smoking cessation. IMPLICATIONS Patients with PTSD are more likely to develop chronic health conditions such as heart disease and diabetes. Poor health behaviors, including smoking, partly explain the risk for chronic disease in this patient population. Our results demonstrate that clinically meaningful PTSD improvement is followed by greater likelihood of smoking cessation. Thus, PTSD treatment may enable healthier behaviors and reduce risk for smoking related disease.
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Affiliation(s)
- Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104, United States.,Harry S. Truman Veterans Administration Medical Center. Columbia, MO, United States
| | - Sarah Gebauer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104, United States.,Harry S. Truman Veterans Administration Medical Center. Columbia, MO, United States
| | - Auston Gillis
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104, United States
| | - Carissa van den Berk-Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104, United States
| | - F David Schneider
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Paula P Schnurr
- National Center for PTSD and Department of Psychiatry, Geisel School of Medicine at Dartmouth, United States
| | - Matthew J Friedman
- National Center for PTSD and Department of Psychiatry, Geisel School of Medicine at Dartmouth, United States
| | - Sonya B Norman
- National Center for PTSD and Department of Psychiatry, University of California San Diego, United States
| | - Peter W Tuerk
- Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville, VA. United States
| | - Beth E Cohen
- Department of Medicine, University of California San Francisco School of Medicine and San Francisco VAMC, United States
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis MO. and The Bell Street Clinic Opioid Addiction Treatment Programs, VA St. Louis Healthcare System, St. Louis, MO, United States
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104, United States.,Harry S. Truman Veterans Administration Medical Center. Columbia, MO, United States
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