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Nicotine & Tobacco Research Advance Access originally published online on July 31, 2009
Nicotine & Tobacco Research 2009 11(10):1189-1195; doi:10.1093/ntr/ntp123
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© The Author 2009. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Influence of PTSD symptom clusters on smoking status among help-seeking Iraq and Afghanistan veterans

Jessica Cook, Matthew Jakupcak, Robert Rosenheck, Alan Fontana and Miles McFall

Jessica Cook, Ph.D., Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI
Matthew Jakupcak, Ph.D., Mental Illness Research, Education, and Clinical, Center, VA Puget Sound Health Care System, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
Robert Rosenheck, M.D., Northeast Evaluation Program Evaluation Center, VA National Center for PTSD, Yale University School of Medicine, New Haven, CT
Alan Fontana, M.D., Northeast Evaluation Program Evaluation Center, VA National Center for PTSD, Yale University School of Medicine, New Haven, CT
Miles McFall, Ph.D., Mental Illness Research, Education, and Clinical, Center, VA Puget Sound Health Care System, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA

Corresponding Author: Jessica Cook, Ph.D., Center for Tobacco Research and Intervention, University of Wisconsin, 1930 Monroe Street, Suite 200, Madison, WI 53711, USA. Telephone: 608-265-9775; Fax: 608-265-3102; E-mail: jwcook{at}ctri.medicine.wisc.edu


  Abstract

Introduction: 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.

Methods: Participants (N = 439) were Operation Iraqi Freedom/Operation Enduring Freedom combat veterans referred to VA mental health services.

Results: 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 (≥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.

Discussion: The association between emotional numbing and heavy daily smoking suggests that veterans with PTSD may smoke to overcome emotional blunting following trauma exposure.

Received: December 22, 2008; Accepted: May 27, 2009
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