Cross-lagged effects of posttraumatic stress disorder symptom severity and cigarette smoking among OEF/OIF/OND veterans.

Abstract

Veterans with posttraumatic stress disorder (PTSD) are known to smoke cigarettes at elevated levels in comparison to both veterans without PTSD and civilians. This study aims to elucidate how cigarette smoking and PTSD symptoms interact over time. This study examined the directionality and strength of the relationship between average daily cigarette smoking and PTSD symptom severity across three (T1-T3) time points in a large cohort (N = 851) of male and female Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn returning veterans who were either current or former smokers at T1 (mean age = 37.56; standard deviation = 10.10). We used cross-lagged panel analyses to evaluate their temporal relations. The analyses indicated that PTSD symptom severity at T1 significantly predicted cigarette smoking at T2, and this predictive association was maintained from T2 to T3. Conversely, smoking at T1 and T2 did not predict PTSD symptom severity at T2 and T3, respectively. Although effect sizes were small, PTSD symptom severity was cross-sectionally related to smoking at T1 and T2, but not T3. In addition, when analyses were examined by gender, the same results were found except these associations were stronger for women than for men cross-sectionally. Our findings provide some evidence of a longitudinal association between PTSD symptom severity and tobacco use and highlight potential targets of intervention.