Student Research: Matthew Chambers
MPH, , 2010
Tobacco Use Among Soldiers is Higher Following Combat Trauma and Posttraumatic Stress Disorder
Background: According to Department of Defense surveys tobacco use increased during the onset of war in Iraq and Afghanistan. A few studies suggest that combat trauma may be a cause of increased tobacco use. Also, posttraumatic stress disorder is strongly associated with both combat trauma and tobacco use.
Purpose: This study investigated whether combat trauma increased Soldiers initiating or continuing tobacco use post-deployment, and whether this association is substantially mediated by posttraumatic stress disorder (PTSD).
Methods: 2505 Soldiers from a single combat brigade who deployed to Iraq from 2006 to 2007 and completed both a pre- and post-deployment survey that included tobacco use questions, a PTSD screening tool and combat trauma questions. Results: Adjusting for age, gender, race, ethnicity, education, and pay grade, abstainers exposed to any combat trauma were significantly more likely to initiate tobacco use post-deployment (RR =2.57, 95% CI=1.65, 3.99). In the same model, tobacco users were significantly more likely to continue tobacco use post-deployment (RR=1.73, 95% CI=1.10, 2.73). In the subsequent analysis, a series of models suggest that PTSD is a mediator of the association between combat trauma and post-deployment tobacco use in the combined cohort.
Conclusions: Soldiers are vulnerable to either initiating or continuing tobacco use after exposure to combat. The implication is that tobacco cessation services should be offered immediately upon return from deployment and that tobacco cessation counseling in PTSD therapy. Future directions include evaluating strategies to deter tobacco use: increasing prices in on-post stores which would have a greater impact on younger soldiers, promoting leadership modeling of alternative stress coping such as physical exercise, and expanding tobacco bans to outdoor areas further denormalizing use in any setting.