Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
Harry S. Truman Veterans Administration Medical Center, Research Service, Columbia, MO, USA.
Nicotine Tob Res. 2022 Feb 1;24(2):178-185. doi: 10.1093/ntr/ntab179.
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.
Veterans Health Affairs (VHA) medical record data (2008-2015) 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.
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 versus 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 versus without clinically meaningful PTSD improvement were more likely to stop smoking within 2 years (hazard ratio = 1.57; 95% confidence interval: 1.04-2.36).
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.
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.
创伤后应激障碍（PTSD）的改善与更好的健康行为相关，例如更好的药物依从性以及更多地使用营养和减肥计划。但是，目前尚不清楚减轻 PTSD 严重程度是否与戒烟有关，而戒烟是 PTSD 患者常见的不良健康行为。
使用退伍军人事务部（VA）医疗记录数据（2008-2015 年）来确定在专科护理中诊断出患有 PTSD 的患者。临床上有意义的 PTSD 改善定义为 PTSD 检查表（PCL）从首次≥50 分且最后一次可获得的 PCL 降低≥20 分，且在 12 个月内至少 8 周后至少有 1 次。在 449 名吸烟者中，在基线后 2 年内，使用 Cox 比例风险模型估算了临床意义上 PTSD 改善与戒烟之间的关联。在协变量平衡中，通过熵平衡控制混杂因素。
平均而言，患者年龄为 39.4（SD = 12.9）岁，86.6％为男性，71.5％为白人。我们观察到 19.8％的参与者出现了临床上有意义的 PTSD 改善。总体而言，19.4％的患者在第 1 年戒烟，16.6％的患者在第 2 年戒烟。与未出现临床上有意义的 PTSD 改善的患者相比，更多的患者停止了吸烟（n = 36，累积发生率= 40.5％比 n = 111，累积发生率= 30.8％）。在控制混杂因素后，与未出现临床上有意义的 PTSD 改善的患者相比，出现临床上有意义的 PTSD 改善的患者在 2 年内更有可能戒烟（危险比= 1.57；95％置信区间：1.04-2.36）。
临床上有意义的 PTSD 改善的患者更有可能戒烟。进一步的研究应确定是否需要有针对性的干预措施，或者 PTSD 症状的改善是否足以实现戒烟。
患有 PTSD 的患者更容易患上心脏病和糖尿病等慢性疾病。不良的健康行为，包括吸烟，在一定程度上解释了该患者人群中发生慢性疾病的风险。我们的研究结果表明，临床上有意义的 PTSD 改善后，戒烟的可能性更大。因此，PTSD 治疗可能会促进更健康的行为并降低与吸烟有关的疾病的风险。
