Tobacco use, trauma exposure and PTSD: a systematic review

ABSTRACT

Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets.

KEYWORDS:

• Tobacco use
• smoking
• nicotine
• PTSD
• trauma
• trauma exposure

Acknowledgments

We would like to thank Dr. Philip Smith and Prof. Marisol Hernandez for all the consultation provided for this project. Contribution: All authors have approved the final manuscript. Conceptualisation: AS, DR, JO, CS; methodology: AS, BH, DR, MJ, CS; data curation phase 1: all; data curation phase 2: AS, BH, DR, MJ, DV, LB, HT, MM, CS; extraction: AS, BH, DR, MJ, CS; writing – original draft: AS, CS; visualisation: BH; writing – main draft: AS, BH, DR, MJ, CS; writing – review and editing: all; supervision: AS, CS; and funding acquisition: CS, JO.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

A summary of all articles used in this review is available in online-only Supplementary Table 1.

Additional information

Funding

This work was supported by grants from the National Cancer Institute (5P20CA192993, PI: Christine E. Sheffer; and 5P20CA192991, PI: Jamie S. Ostroff).