Cross‐lagged effects of posttraumatic stress disorder symptom severity and cigarette smoking among OEF/OIF/OND veterans

Abstract

Objectives Veterans with posttraumatic stress disorder (PTSD) are known to smoke cigarettes at elevated levels in comparison to both veterans without PTSD and civilians. This study aims to elucidate how cigarette smoking and PTSD symptoms interact over time. Materials and Methods This study examined the directionality and strength of the relationship between average daily cigarette smoking and PTSD symptom severity across three (T1–T3) time points in a large cohort (N = 851) of male and female Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn returning veterans who were either current or former smokers at T1 (mean age = 37.56; standard deviation = 10.10). We used cross‐lagged panel analyses to evaluate their temporal relations. Results The analyses indicated that PTSD symptom severity at T1 significantly predicted cigarette smoking at T2, and this predictive association was maintained from T2 to T3. Conversely, smoking at T1 and T2 did not predict PTSD symptom severity at T2 and T3, respectively. Although effect sizes were small, PTSD symptom severity was cross‐sectionally related to smoking at T1 and T2, but not T3. In addition, when analyses were examined by gender, the same results were found except these associations were stronger for women than for men cross‐sectionally. Conclusion Our findings provide some evidence of a longitudinal association between PTSD symptom severity and tobacco use and highlight potential targets of intervention.

Increased Smoking Cessation Among Veterans With Large Decreases in Posttraumatic Stress Disorder Severity

“…35 PTSD severity has also been shown to predict more cigarette consumption at 1-year follow-up. 17 However, we believe this is the first study using data from routine medical care to reveal that PTSD symptom improvement may be followed by increased smoking cessation. While novel PTSD treatment modalities that integrate smoking cessation therapy have demonstrated efficacy, 18,19 not all persons with PTSD have access to integrated care.…”

“…The severity of PTSD symptoms significantly predict the amount of cigarette smoking, while cigarette smoking did not predict PTSD symptom severity. 17 Randomized clinical trials combining PTSD psychotherapy and smoking cessation treatments have demonstrated efficacy. Such integrated care has been associated with nearly a 2.5-fold increase in self-reported prolonged smoking abstinence over the course of 18 months compared with attendance of a smoking cessation clinic alone.…”

Physical inactivity, cigarette smoking, and psychiatric comorbidity among veterans with posttraumatic stress disorder.

“…Both are well known and strong predictors of cardiometabolic disease (Arnett et al, 2019; Garber et al, 2011). In addition, PTSD and its symptoms are repeatedly linked to physical inactivity and smoking (Mahoney et al, 2020; Whitworth et al, 2017; Whitworth & Ciccolo, 2016; Winning et al, 2017).…”