Cook Jessica, Jakupcak Matthew, Rosenheck Robert, Fontana Alan, McFall Miles
Center for Tobacco Research and Intervention, University of Wisconsin, 1930 Monroe Street, Suite 200, Madison, WI 53711, USA.
Nicotine Tob Res. 2009 Oct;11(10):1189-95. doi: 10.1093/ntr/ntp123. Epub 2009 Jul 31.
Despite the strong association between smoking and posttraumatic stress disorder (PTSD), mechanisms influencing smoking in this population remain unclear. Previous smoking research has largely examined PTSD as a homogenous syndrome despite the fact that PTSD is composed of four distinct symptom clusters (i.e., reexperiencing, effortful avoidance, emotional numbing, and hyperarousal). Examination of the relationship between smoking and PTSD symptom clusters may increase understanding of mechanisms influencing comorbidity between smoking and PTSD. The goals of the present study were to (a) examine the influence of overall PTSD symptom severity on likelihood of smoking and smoking heaviness and (b) examine the influence of each PTSD symptom cluster on smoking.
Participants (N = 439) were Operation Iraqi Freedom/Operation Enduring Freedom combat veterans referred to VA mental health services.
Multinomial logistic regression was chosen to accommodate a three-level outcome, in which the likelihood of being a nonsmoker was compared with (a) light smoking (1-9 cigarettes/day), (b) moderate smoking (10-19 cigarettes/day), and (c) heavy smoking (> or =20 cigarettes/day). Results showed that veterans with higher levels of overall PTSD symptomatology were more likely to endorse heavy smoking (Wald = 4.56, p = .03, odds ratio [OR] = 1.65). Veterans endorsing high levels of emotional numbing were also more likely to endorse heavy smoking (Wald = 6.49, p = .01, OR = 1.81); all other PTSD symptom clusters were unrelated to smoking.
The association between emotional numbing and heavy daily smoking suggests that veterans with PTSD may smoke to overcome emotional blunting following trauma exposure.
尽管吸烟与创伤后应激障碍（PTSD）之间存在密切关联，但影响该人群吸烟行为的机制仍不清楚。以往的吸烟研究大多将PTSD视为一种同质综合征，尽管事实上PTSD由四个不同的症状群组成（即重新体验、努力回避、情感麻木和过度警觉）。研究吸烟与PTSD症状群之间的关系可能会增进对吸烟与PTSD共病影响机制的理解。本研究的目的是：（a）研究PTSD总体症状严重程度对吸烟可能性和吸烟量的影响；（b）研究每个PTSD症状群对吸烟的影响。
参与者（N = 439）为被转介至退伍军人事务部心理健康服务机构的伊拉克自由行动/持久自由行动的退伍军人。
选择多项逻辑回归来处理三级结果，即将不吸烟者的可能性与以下情况进行比较：（a）轻度吸烟（每天1 - 9支香烟），（b）中度吸烟（每天10 - 19支香烟），以及（c）重度吸烟（每天≥20支香烟）。结果显示，PTSD总体症状水平较高的退伍军人更有可能认可重度吸烟（Wald = 4.56，p = .03，优势比[OR] = 1.65）。认可高水平情感麻木的退伍军人也更有可能认可重度吸烟（Wald = 6.49，p = .01，OR = 1.81）；所有其他PTSD症状群与吸烟无关。
情感麻木与每日重度吸烟之间的关联表明，患有PTSD的退伍军人可能通过吸烟来克服创伤暴露后的情感迟钝。
