Hawes Mark R, Chakravarty Deepalika, Xia Fan, Max Wendy, Kushel Margot, Vijayaraghavan Maya
Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA.
UCSF Benioff Homelessness and Housing Initiative, University of California, San Francisco, San Francisco, CA, USA.
J Community Health. 2025 Apr;50(2):369-376. doi: 10.1007/s10900-024-01422-w. Epub 2024 Dec 16.
50% of permanent supportive housing (PSH) residents in the U.S. smoke cigarettes, and tobacco-related mortality is their number one cause of death. Over 30% of PSH residents have post-traumatic stress disorder (PTSD), and many perceive their built environment (e.g., housing) as inadequate for mental and physical health recovery. It is unknown whether built environment factors moderate the relationship between PTSD and tobacco use among PSH residents.
We used baseline data from 400 participants in a smoke-free home intervention in PSH sites in the San Francisco Bay Area between 2022 and 2024. We explored whether perceived housing quality and perceived neighborhood safety moderated the relationship between PTSD symptoms and cigarettes per day (CPD) using linear mixed models.
62.8% of the participants were male, 41.8% were Black, 30.5% screened positive for PTSD, 54.3% rated their housing as average/poor, and the mean neighborhood safety score was 3.4 (SD 0.9). Mean CPD was significantly higher in participants with PTSD compared to those without PTSD among participants who rated their housing as good/excellent (5.1; 95% CI: 2.7, 7.5) or their neighborhood as safer (7.8; 95% CI: 2.8, 12.8). Mean CPD was not significantly different between those with and without PTSD among participants who rated their housing as average/poor or their neighborhood as less safe.
Perceived housing quality and neighborhood safety moderated the association between PTSD symptoms and CPD. Findings have implications for developing trauma-informed, multi-level interventions for tobacco use that combine individually directed approaches with those that consider the built environment.
在美国，50%的永久性支持性住房（PSH）居民吸烟，与烟草相关的死亡率是他们的首要死因。超过30%的PSH居民患有创伤后应激障碍（PTSD），许多人认为他们的居住环境（如住房）不利于身心健康的恢复。目前尚不清楚居住环境因素是否会调节PSH居民中PTSD与烟草使用之间的关系。
我们使用了2022年至2024年期间在旧金山湾区PSH场所进行的无烟家庭干预中400名参与者的基线数据。我们使用线性混合模型探讨了感知住房质量和感知社区安全性是否调节了PTSD症状与每日吸烟量（CPD）之间的关系。
62.8%的参与者为男性，41.8%为黑人，30.5%的PTSD筛查呈阳性，54.3%的人将他们的住房评为中等/较差，社区安全平均得分为3.4（标准差0.9）。在将住房评为良好/优秀（5.1；95%置信区间：2.7，7.5）或认为社区更安全（7.8；95%置信区间：2.8，12.8）的参与者中，患有PTSD的参与者的平均CPD显著高于未患PTSD的参与者。在将住房评为中等/较差或认为社区不太安全的参与者中，患有和未患PTSD的参与者之间的平均CPD没有显著差异。
感知住房质量和社区安全性调节了PTSD症状与CPD之间的关联。研究结果对于制定考虑创伤因素的多层次烟草使用干预措施具有启示意义，这些措施将个体导向方法与考虑居住环境的方法相结合。
