title: Associations between posttraumatic stress disorder symptom clusters and cigarette smoking.
abstract: Understanding the relationship between Posttraumatic stress disorder (PTSD) and cigarette smoking has been difficult because of PTSD's symptomatic heterogeneity. This study examined common and unique lifetime cross-sectional relationships between PTSD symptom clusters [Re-experiencing (intrusive thoughts and nightmares about the trauma), Avoidance (avoidance of trauma-associated memories or stimuli), Emotional Numbing (loss of interest, interpersonal detachment, restricted positive affect), and Hyperarousal (irritability, difficulty concentrating, hypervigilance, insomnia)] and three indicators of smoking behavior: (1) smoking status; (2) cigarettes per day; and (3) nicotine dependence. Participants were adult respondents in the National Epidemiologic Survey of Alcohol and Related Conditions with a trauma history (n = 23,635). All four symptom clusters associated with each smoking outcome in single-predictor models (ps <. 0001). In multivariate models including all of the symptom clusters as simultaneous predictors, Emotional Numbing was the only cluster to retain a significant association with lifetime smoking over and above the other clusters, demographics, and Axis-I comorbidity (OR = 1.30, p < .01). While Avoidance uniquely associated with smoking status and nicotine dependence in multivariate models, these relations fell below significance after adjusting for demographics and comorbidity. No clusters uniquely associated with cigarettes per day. Hyperarousal uniquely related with nicotine dependence over and above the other clusters, demographics, and Axis-I comorbidity (OR = 1.51, p < .001). These results suggest the following: (a) common variance across PTSD symptom clusters contribute to PTSD's linkage with smoking in the American population; and (b) certain PTSD symptom clusters may uniquely associate with particular indicators of smoking behavior. These findings may clarify the underpinnings of PTSD-smoking comorbidity and inform smoking interventions for trauma-exposed individuals.
authors.affiliation: University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA.
authors.forename: Jodie B
authors.initials: JB
authors.lastname: Greenberg
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Ameringer
authors.forename: Michael A
authors.initials: MA
authors.lastname: Trujillo
authors.forename: Ping
authors.initials: P
authors.lastname: Sun
authors.forename: Steve
authors.initials: S
authors.lastname: Sussman
authors.forename: Molly
authors.initials: M
authors.lastname: Brightman
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Pitts
authors.forename: Adam M
authors.initials: AM
authors.lastname: Leventhal
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004644:Emotions; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology; D014728:Veterans / Q000523:psychology