Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
Center for Chronic Disease Prevention and Control Prevention and Health Promotion Administration, Maryland Department of Health, Timonium, MD, USA.
Nicotine Tob Res. 2021 Aug 29;23(10):1716-1726. doi: 10.1093/ntr/ntab057.
Previous research has examined cigarette smoking in trauma exposed populations. However, the relationships between trauma exposure and use of other tobacco products (eg, cigars, e-cigarettes) and specific trauma exposure characteristics that may be associated with tobacco use are understudied.
Using the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36 151 adults), we conducted weighted bivariate analyses of tobacco use among participants with no trauma exposure, trauma exposure, and trauma exposure with post-traumatic stress disorder (trauma + PTSD), stratified by tobacco product use. We also performed weighted logistic regressions testing relationships between trauma exposure and tobacco use, controlling for behavioral health (BH) conditions (mood, anxiety, substance use, personality disorders) and sociodemographics.
Approximately 44% of participants had experienced trauma; 6% experienced trauma + PTSD. Trauma exposed participants had a higher prevalence of tobacco use (30%--46% vs. 22%) and poly-tobacco use (34%--35% vs. 28%) than unexposed participants. Cigarettes were the most used tobacco product; trauma + PTSD (19%), and trauma (15%) participants had a higher prevalence of e-cigarette use than unexposed participants (11%). Trauma exposure was associated with current tobacco use (AOR = 1.36 trauma + PTSD; 1.23 trauma) (but not former use), particularly among participants exposed to violence/abuse (AOR = 1.23). Personality and substance use disorders were strongly associated with current and former tobacco use.
Trauma exposure, PTSD, and experiences of violence/abuse are associated with current tobacco use. BH conditions may also play a role in current and former tobacco use. Recognizing and addressing trauma exposure and BH conditions among tobacco users may improve cessation rates in these populations.
This study contributes to research on tobacco use disparities in behavioral health populations by providing a comprehensive examination of tobacco use in trauma exposed individuals. Prior research has examined cigarette smoking, but not other tobacco product use in these populations. This study presents findings on multiple tobacco use behaviors (tobacco product, poly-tobacco use, cessation attempts) in trauma exposed populations and characteristics of trauma exposure (severity, type of traumatic event) associated with tobacco use. These findings underscore the importance of further examining the implications of trauma exposure for tobacco use and of screening and addressing trauma in cessation treatment.
先前的研究已经调查了创伤暴露人群中的吸烟情况。然而，创伤暴露与使用其他烟草制品（如雪茄、电子烟）之间的关系，以及可能与烟草使用相关的特定创伤暴露特征，仍研究不足。
利用 2012-2013 年全国酒精相关情况流行病学调查-III（N=36151 名成年人），我们对无创伤暴露、创伤暴露和创伤暴露后患有创伤后应激障碍（创伤+ PTSD）的参与者中，根据烟草制品使用情况，进行了烟草使用的加权双变量分析。我们还进行了加权逻辑回归测试，控制了行为健康（BH）状况（情绪、焦虑、物质使用、人格障碍）和社会人口统计学因素，以检验创伤暴露与烟草使用之间的关系。
约 44%的参与者经历过创伤；6%的参与者经历过创伤+ PTSD。创伤暴露的参与者烟草使用（30%-46%比 22%）和多烟草使用（34%-35%比 28%）的比例高于未暴露的参与者。香烟是使用最多的烟草制品；创伤+ PTSD（19%）和创伤（15%）参与者电子烟的使用比例高于未暴露的参与者（11%）。创伤暴露与当前的烟草使用有关（AOR=1.36创伤+ PTSD；1.23创伤）（但不包括以前的使用），尤其是在经历过暴力/虐待的参与者中（AOR=1.23）。人格和物质使用障碍与当前和以前的烟草使用密切相关。
创伤暴露、PTSD 和经历过暴力/虐待与当前的烟草使用有关。BH 状况也可能在当前和以前的烟草使用中发挥作用。在烟草使用者中识别和处理创伤暴露和 BH 状况可能会提高这些人群的戒烟率。
本研究通过全面研究创伤暴露个体的烟草使用情况，为行为健康人群中的烟草使用差异研究做出了贡献。先前的研究已经检查了吸烟情况，但没有研究这些人群中的其他烟草制品使用情况。本研究报告了创伤暴露人群中多种烟草使用行为（烟草制品、多烟草使用、戒烟尝试）和与烟草使用相关的创伤暴露特征（严重程度、创伤事件类型）的发现。这些发现强调了进一步研究创伤暴露对烟草使用的影响，以及在戒烟治疗中筛查和处理创伤的重要性。
