title: Smoking, posttraumatic stress disorder, and alcohol use disorders in a nationally representative sample of Australian men and women.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) and alcohol use disorders (AUDs) often co-occur with smoking and tobacco use disorders. Each of these disorders is known to have negative health consequences and impairment independently, but little is known about the impact of their co-occurrence. The aim of the present study is to examine the prevalence, correlates, order of onset, and impact of co-occurring daily smoking, PTSD, and AUDs.
  
  
  METHODS
  The 2007 Australian National Survey of Mental Health and Wellbeing (2007 NSMHWB) was a nationally representative survey of 8841 Australians. The survey assessed for 12-month DSM-IV mental disorders; the age respondents first started smoking daily, experienced a traumatic event, or developed problems with alcohol; and self-reported mental and physical health and impairment.
  
  
  RESULTS
  There were systematic patterns of co-occurrence between daily smoking, PTSD, and AUDs. Daily smoking and problems with alcohol use tended to develop after first trauma exposure, which is broadly consistent with the self-medication hypothesis. Daily smoking, PTSD, and AUDs were also associated with additive negative effects on mental and physical health and functioning, after controlling for demographics.
  
  
  CONCLUSIONS
  Smoking, PTSD, and AUDs commonly co-occur in this nationally representative sample of Australian men and women, and this comorbidity was associated with greater severity of mental and physical health problems and impairment in several areas of functioning. This study highlights the importance of identifying and eliminating these patterns of co-occurrence, potentially through integrated interventions.
authors.affiliation: Centre for Emotional Health and Centre of Research Excellence in Mental Health and Substance Abuse, Macquarie University, Sydney, NSW 2109, Australia. Electronic address: miri.forbes@mq.edu.au.
authors.forename: Miriam K
authors.initials: MK
authors.lastname: Forbes
authors.affiliation: Medical University of South Carolina, 5 Charleston Center Drive, Suite 151, Charleston, SC 29401, United States. Electronic address: hellmuth@musc.edu.
authors.forename: Julianne C
authors.initials: JC
authors.lastname: Flanagan
authors.affiliation: Centre of Research Excellence in Mental Health and Substance Abuse and National Drug and Alcohol Research Centre, UNSW, Sydney, NSW 2052, Australia. Electronic address: e.barrett@unsw.edu.au.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Barrett
authors.affiliation: Centre for Emotional Health and Centre of Research Excellence in Mental Health and Substance Abuse, Macquarie University, Sydney, NSW 2109, Australia. Electronic address: erica.crome@mq.edu.au.
authors.forename: Erica
authors.initials: E
authors.lastname: Crome
authors.affiliation: Centre for Emotional Health and Centre of Research Excellence in Mental Health and Substance Abuse, Macquarie University, Sydney, NSW 2109, Australia. Electronic address: andrew.baillie@mq.edu.au.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Baillie
authors.affiliation: Centre of Research Excellence in Mental Health and Substance Abuse and National Drug and Alcohol Research Centre, UNSW, Sydney, NSW 2052, Australia. Electronic address: k.mills@unsw.edu.au.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Mills
authors.affiliation: Centre of Research Excellence in Mental Health and Substance Abuse and National Drug and Alcohol Research Centre, UNSW, Sydney, NSW 2052, Australia. Electronic address: m.teesson@unsw.edu.au.
authors.forename: Maree
authors.initials: M
authors.lastname: Teesson
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology*; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006233:Persons with Disabilities; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008603:Mental Health; D008875:Middle Aged; D015995:Prevalence; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires
keywords: Alcohol use disorders; Comorbidity; PTSD; Smoking