The Effects of Trauma and Stress on Tobacco Dependence Treatment Outcomes in Lower SES Individuals

Abstract

A significant proportion of individuals have experienced one or more traumatic event, and trauma exposure has been associated with increased smoking and greater difficulty quitting, yet the relationship between traumatic event exposure and smoking cessation outcomes has not been widely studied. Similarly, while the experience of stressful life events is nearly universal, and research suggests their effects may produce psychopathological outcomes similar to those of traumatic events, research on the relationship between stressful life event exposure and smoking cessation is sparse. The current study sought to investigate the effects of trauma and stress on tobacco dependence treatment outcomes in lower SES individuals, as well as whether trauma or stress moderated the effects of an adapted smoking cessation intervention. There were several notable findings with implications for future research, including a significant positive association between traumatic event exposure and cigarettes smoked at baseline, a significant relationship between stressful life event exposure and nicotine dependence, and a marginally significant association between stressful life event exposure and abstinence at week 15. However, we did not find significant evidence that either traumatic or stressful event exposure was associated with greater smoking, greater nicotine dependence, or worse tobacco cessation outcomes after smoking cessation treatment. Nor did we find that, in general, traumatic or stressful life event exposure significantly moderated the effects of the adapted smoking cessation treatment. The failure to identify a significant relationship between prior traumatic event or stressful life event exposure and treatment outcomes may indicate that the effects were too small to reliably detect or that such stressors do not effect response to smoking cessation treatment. Given the modest power of the current investigation, it is not possible to distinguish between these two possibilities. Findings are consistent with previous research in highlighting associations between trauma/stress and increased smoking behavior and dependence, as well as the potential impact of stress on cessation outcomes. Findings also support the need for further investigation of traumatic and stressful event exposure and their effects on smoking behavior and cessation, as well as reiterating the potential for incorporating stress reduction and stress management techniques into smoking cessation treatments.