Health Vulnerability Research Articles

Pre-disaster Health Vulnerabilities Predict Major Depressive Disorder Symptoms Among High-Risk Puerto Rican Adults after Hurricanes Maria and Irma.

Robust research has established that preexisting physical and mental health conditions increase risk for adverse psychiatric outcomes after disasters. However, it is unclear if increased risk is independent of disaster exposure, and most studies have relied on retrospective reports of pre-disaster functioning. In a pre-post sample of high-risk Puerto Rican adults (N = 361) who experienced Hurricanes Irma and Maria, we assessed: 1) whether indicators of pre-disaster depression and physical health conditions were associated with posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) symptoms; and 2) whether the effects of pre-disaster depression and physical health conditions on PTSD and MDD symptoms were indirect via disaster exposure or had exacerbated the effects of disaster exposure on PTSD and MDD symptoms. Pre-disaster depression and physical health problems were significantly associated with higher post-disaster MDD symptoms (B = 1.50, SE = 0.36, p < .001, and B = 0.21; SE = 0.09, P = 0.016), but not PTSD symptoms. Indirect effects of pre-disaster depression and physical health symptoms via disaster exposure were non-significant, and neither moderated the association of disaster exposure on PTSD and MDD symptoms. Research is needed to understand other pathways through which pre-disaster health conditions predict post-disaster mental health.

Patient passports and vulnerability: Disjunctures in health policy instruments for people with rare diseases.

Rare diseases have had a special status within European Union (EU) health policy since the late 1990s. According to key EU legal documents, rare disease patients are entitled to the same good quality care as others. These individuals are particularly vulnerable due to the "low prevalence" and "uniqueness" of their disease. To ensure that patients with rare disorders in Europe can access high-quality care in their respective countries, the Council of the European Union (2009) recommended that member states adopt plans or strategies for rare diseases. Poland adopted its first Plan for Rare Diseases in 2021. This article draws from bioethical and social science scholarship on vulnerability as well as ethnographic research that I conducted among people with rare metabolic diseases, their families, health professionals, and patient advocacy groups in Poland between 2016 and 2023. I examine instruments developed within healthcare policies that are tailored to rare diseases, notably the patient passport, which is a site of disjuncture (Appadurai, 1990) embedded in healthcare policies and practices tailored to people with rare diseases. I argue that although such instruments are meant to benefit patients, they almost exclusively focus on the patient's sick body and the needs of health professionals, who are unfamiliar with a given rare disease. Thus, these instruments may engender paternalistic practices and they may contribute to discrimination and stigmatization as well as to the datafication of health vulnerabilities. Furthermore, the focus on inherent vulnerability obscures its other "layers" (Luna, 2009, 2019) or "degrees" (Traianou and Hammersley, 2023).

Barriers LGBTQ+ Individuals Face in Accessing Healthcare Services Including HIV Prevention and Treatment Due to Stigma and Discrimination in Lesotho

Background: Lesotho faces significant challenges in providing equitable healthcare services to LGBTQ+ individuals, particularly regarding HIV prevention and treatment. The country has one of the highest HIV prevalence rates globally, with marginalized populations, including LGBTQ+ individuals, experiencing heightened vulnerability due to systemic stigma and discrimination. Aim: The study assessed the barriers LGBTQ+ individuals face in accessing healthcare services including HIV prevention and treatment due to stigma and discrimination in Lesotho. Setting: The study was conducted in three districts of Lesotho which are Maseru, Leribe, and Mokhotlong. Methods: The study cross-sectional, descriptive, qualitative research study utilized semi-structured interviews with LGBTQ+ individuals and healthcare providers to explore the interplay between stigma, mental health, and HIV vulnerabilities. Results: The findings reveal a complex relationship between stigma and health outcomes, where social marginalization leads to increased HIV vulnerabilities among LGBTQ+ populations. Discriminatory attitudes within healthcare settings discourage individuals from seeking major HIV preventive services, ultimately impacting public health efforts to control the epidemic. Conclusion: Addressing the barriers faced by LGBTQ+ individuals in Lesotho requires a multifaceted approach such as training for healthcare providers on LGBTQ+ issues, and integrating sexual and reproductive health services into community outreach programs. By fostering an inclusive healthcare environment, can enhance access to HIV prevention and treatment services, improving overall public health outcomes in Lesotho. Contribution: The findings and recommendation of the study could contribute to a better health outcome for LGBTQ+ individuals in Lesotho.

Prenatal depression and child developmental vulnerability.

Prenatal depression is a potentially important fetal exposure as it may alter fetal development and have lasting effects. We examined all live births from 2001 to 2012 in British Columbia with follow-up data on the Early Development Instrument (EDI) in Kindergarten. The odds of developmental vulnerability on EDI domains among those with and without depression during pregnancy were estimated. A matched sibling analysis was run using conditional logistic regression within the same birth parent. We included 130,631 births among 108,340 pregnant people, with 6089 children (4.7%) exposed to prenatal depression. Children exposed to depression during pregnancy were significantly more likely to be considered vulnerable on physical health and well-being (OR, 1.19 [95% CI, 1.10-1.29]), social competence (OR, 1.25 [95% CI, 1.15-1.36]), emotional maturity (OR, 1.18 [95% CI, 1.08-1.28]), language and cognitive development (OR, 1.14 [95% CI, 1.04-1.26]), and multiple domains (OR, 1.18 [95% CI, 1.09-1.27]). No significant associations were found in our matched sibling pair analysis, but effect sizes remained above 1 for physical health and social competences. More research is needed to determine whether fetal exposure to prenatal depression may predispose to childhood vulnerability on physical health and well-being, language and cognition, and socio-emotional domains. Prenatal depression is common (9-22% of pregnancies) and research has suggested a negative impact on the developing fetal brain but data on long term child development following prenatal depression is sparse. Using a unique population-based dataset with developmental data from children, we found increased risk for developmental vulnerability in physical health and well-being and socio-emotional development. Sibling matched analyses suggested the presence of some residual confounding and associations were no longer statistically significant but effects sizes did not substantially attenuate for physical health and social competence.

Investigating the association between health vulnerabilities and police enforcement during the Covid-19 pandemic: A novel study using linked administrative data in Scotland

Public health regulations introduced in response to the Covid-19 pandemic placed unprecedented restrictions on the U.K. public. To maximise compliance with the regulations, new policing powers were introduced enabling officers to issue Fixed Penalty Notices (FPNs) to those believed to have breached them. In Scotland, where over 20,000 Covid-FPNs were issued for regulatory breaches, police officers reported particular challenges dealing with non-compliance amongst people with health vulnerabilities involving mental illness and substance use. Health studies suggest that people with such conditions were most severely impacted by the pandemic in a whole range of ways; however, there are no existing studies on whether this includes police use of enforcement. Our study addresses this gap using linked administrative data from police and health organisations in Scotland. Using a case-control design, we found that people who had accessed health services for psychiatric conditions or substance use were more likely to have received a Covid-FPN, especially during the first lockdown. The strength of this association was greatest amongst people with multiple health conditions and those accessing health services both before and during the pandemic. The findings suggest the new policing powers impacted disproportionately on people suffering from mental illness and/or addictions and point to a previously unidentified justice inequality. This novel administrative data linkage study highlights the importance of taking health vulnerabilities into greater consideration when planning for future pandemic preparedness.

Mental Health Vulnerabilities and Environmental Justice: A Collaborative Online International Learning Experience.

Collaboration and intercultural interaction and engagement are relevant to all aspects of higher education including distance/remote/virtual courses. Collaborative Online International Learning (COIL) experiences connect students in different countries and provide them with meaningful and significant opportunities for global and intercultural exposure. Such an educational environment enhances students' cultural awareness and knowledge, and guides their personal, relational, and professional actions. Accordingly, engagement in COIL experiences can increase students' understanding of and ability to respond to significant global health-care issues both locally and internationally and to recognize their impact on mental health, and can lead to reflection and awareness that will endure beyond students' individual class experiences. One of these urgent issues is mental health vulnerabilities associated with environmental justice issues. This article describes participation in an international collaborative experience between the Universidad San Francisco de Quito, Ecuador, and the College of Nursing at the University of South Alabama, USA.

Heatwave induced health vulnerability assessment in Bangladesh

Heatwave induced health vulnerability assessment in Bangladesh

Differences in US Adult Dietary Patterns by Cardiovascular Health and Socioeconomic Vulnerability.

Naturally occurring dietary patterns, a major contributor to health, are not well described among those with cardiovascular disease (CVD) - particularly in light of socioeconomic vulnerability. We sought to identify major dietary patterns in the US and their distribution by CVD, social risk factors, and Supplemental Nutrition Assistance Program (SNAP) participation. This was a cross-sectional study among 32,498 noninstitutionalized adults from the National Health and Nutrition Examination Survey (2009-2020). We used principal component analysis to identify common dietary patterns. Individuals were assigned to the pattern for which they had the highest component score. Using multinomial logit regression, we estimated the percentage whose diets aligned with each pattern in population subgroups stratified by CVD, social risk factors, and SNAP. Analyses were adjusted for age, gender, race and ethnicity, total energy intake, and year, with sampling weights to provide nationally representative estimates. Four dietary patterns were identified among US adults: American (33.7%; high in solid fats, added sugars, and refined grains), Prudent (22.6%; high in vegetables, nuts/seeds, oils, seafood, and poultry), Legume (15.8%), and Fruit/Whole Grain/Dairy (27.9%), that together explained 29.2% of dietary variance. More adults with prevalent CVD (37.1%) than without (33.3%, p=0.005) aligned with the American Pattern, with no differences among other patterns. Each additional social risk factor associated with more adults aligned with American (2.5% absolute increase) and Legume (1.3%), and fewer aligned with Prudent (-1.9%) and Fruit/Whole Grain/Dairy (-1.9%) patterns (p<0.001 each). Analysis of dietary patterns across SNAP participation showed higher proportion of SNAP participants and income-eligible SNAP non-participants compared to non-eligible adults for the American (40.2% [38.1, 42.3%], 35.1% [32.7, 37.5%], 31.9% [31.0, 32.8%], respectively) and Legume patterns (17.2% [15.6, 18.8%], 17.8% [16.1, 19.5%]), 15.4% [14.6,16.1%], respectively) and less for Prudent (17.0% [15.5, 18.6%], 20.2% [18.2, 22.3%], 24.2% [23.3, 25.1%], respectively) and Fruit/Whole Grain/Dairy Patterns (25.6% [23.8%, 27.3%], 26.9%[27.6%,29.5%], 28.6% [27.6%, 29.5%], respectively). Empirical dietary patterns vary by CVD and socioeconomic vulnerability. Initiatives to improve nutrition in at-risk individuals should consider these naturally occurring dietary patterns and their variation in key subgroups.

Experiences of south Asian key workers in COVID-19 lockdowns in the United Kingdom.

This study aims to explore the experiences, challenges, and support given to South Asian Key Workers (food and necessary goods, Transport (delivery and taxi drivers,) working in the United Kingdom in times of the COVID-19 lockdowns between March 2020 to March 2021. The qualitative study aims to explore the experiences, challenges, and financial support given to South Asian Key Workers working in the United Kingdom in times of the COVID-19 lockdowns. A phenomenological approach was used to explore the experiences of key workers during the COVID-19 lockdowns in the UK. Snowball sampling was used to contact participants, who were South Asian key workers working in food, necessary goods and transport during COVID-19 lockdown in United Kingdom. Semi-structured, in-depth face to face and telephonic interviews were conducted with study participants in February and March 2021. Inductive qualitative approach was used for data analysis, and data analysis was done parallel with data collection. Researcher interviewed 17 key workers. During the data analysis four theme categories emerged: 1) Precarious working conditions, 2) Coping with stress and fear, 3) Sustainability pressures, and 4) Insufficient support. Overall, the results show that the many participants had been working in close interaction with co-workers, customers and clients, poor protective measures to prevent catching infection, excessive workload, received limited support from employer, no access to furlough pay, restriction based on immigration status and limited economic support. Instead, they had to use self-devised strategies to cope with the increased workload, economic burdens and protection from infection. The precarious working conditions exhausted participants physically and economically. They were holding a lot of grievances and hurt inside due to long existing inequalities in the society, where many highly educated and skilled individuals were unable to get stable and secure employments, despite the health vulnerabilities, South Asian key workers worked through the Covid-19 lockdowns to overcome difficulties stem from precarious work. Although currently coping with increased debts, economic burdens and long COVID symptoms, comprehensive job security and entitlement to secure contracts with provisions to sick leaves and pays should be made available to address economic vulnerabilities of south Asian key workers.

Multidimensional vulnerability and financial risk protection in health in contexts of protracted conflict: Evidence from the Occupied Palestinian Territory.

This paper proposes a multidimensional vulnerability index for a setting of protracted conflict, which is applied to study the relationship between financial vulnerability and catastrophic healthcare expenditure (CHE) incidence in the Occupied Palestinian Territory in 2018. We find that our index better captures the extent of financial risk protection in health compared to conventional measures of financial welfare. Results indicate that the most vulnerable groups experience a significantly higher likelihood of incurring CHE, and this likelihood is increased for those living in the West Bank compared to the Gaza Strip. We also find a lack of protection from existing health insurance types against the risk of CHE. Our analysis provides valuable insights about key aspects, such as health financing and insurance bottlenecks, that will deserve careful policy attention in efforts to rebuild the Palestinian health system, following the Israel-Hamas war.

The impact of extreme weather phenomena on public health: An analysis of Indonesia national policies on adaptation/mitigation strategies

Global climate change has led to an increase in the frequency of extreme weather phenomena, which have major impacts on public health. In response, Indonesia has developed the National Action Plan for Climate Change Adaptation (RAN-API) to enhance climate resilience. The RAN- API recognizes the health sector as a critical subject for adapting to climate change and establishes three primary goals: (a) Strengthening and updating of information on health risk and vulnerability due to climate change, (b) Development of policies, planning, networking, and cooperation among government agencies at the local, regional and national levels regarding climate change health risk, and (c) Strengthening capacity and early awareness of climate change-related threats to health in the community. However, despite the presence of national policies responding to health impacts due to climate change, the effectiveness of the RAN-API remains limited. This study will analyse the existing national policies regarding mitigation and adaptation programs designed to address climate change impacts of extreme weather phenomena on public health, and giving the contribution to strengthening adaptation and mitigation strategies, including strengthening climate resilience for vulnerable communities.

An Assessment of High-Risk Sexual Behavior and Associated Factors Among Self-identified Hijras Residing in an Urban Slum of Mumbai, India

Background: A high proportion of sexual minorities like Hijras/Eunuch engage in sex work and thus become a high-risk population for HIV and sexually transmitted infections (STIs). Hence, we conducted a study with objective to assess prevalence of high-risk behavior among self-identified Hijras/Eunuch and associated factors. Material and Methods: A cross-sectional study was conducted in a field practice area of Tertiary Care Hospital from December 2019 to December 2020. All participants in the age group of 18 to 45 years were interviewed. Univariate and bivariate analysis was done to determine the correlates. Results: Out of 163, 85% of participants were involved in high-risk sexual behavior and 46.63% did only sex work, 51.5% of participants had comprehensive knowledge about HIV/STI. On applying logistic regression, the factors associated with high-risk sexual behavior include 18–24 years of age group, history of addiction, practicing paid sex, using psychotropic substances, comprehensive knowledge regarding HIV/STI, and comprehensive exposure to preventive measures. Conclusion: Our study findings suggest the urgent need for appropriate preventive measures to understand and address sexual health and risk behavior vulnerabilities faced by Hijras to make significant progress against the HIV epidemic in the country.

Healthcare provision for displaced people in transit: Analyses of routinely collected data from INTERSOS clinics at the Ukrainian border with Moldova and Poland.

The Russian military invasion of Ukraine has sparked Europe's largest forced displacement since World War II, bringing about significant health vulnerabilities for migrants and refugees. European health information systems lack comprehensive data coverage, especially in underrepresented migration stages like transit. This study aims to address this gap by analyzing data from INTERSOS clinics at the Moldovan and Polish borders with Ukraine to identify the common health conditions prompting people to seek healthcare services during transit. From 6th March to 31st May 2022, this cross-sectional study observed migrants and refugees receiving INTERSOS services at two mobile clinics in Moldova, and a facility in Poland. We analyzed data by age, sex, nationality, and reported disease frequencies and care provided. This study used routinely collected data from 1756 patients. The majority of the adult population seeking healthcare were females (76.5 %), 26.1 % were children and 18.7 % were older individuals. Noncommunicable diseases (NCDs) were the primary reason for seeking healthcare at these clinics, with 23.3 % of the study population being diagnosed with at least one chronic disease, and 3.4 % of people having multimorbidity. Mental and behavioural disorders were diagnosed in 12.6 % of the population, and somatoform disorders and related stress (F40-F48) in 10.8 %. Our study indicates the diversity of forcibly displaced populations and the corresponding diversity of their healthcare needs. In the shadow of a forced displacement crises triggered by the conflict in Ukraine, there is an urgent need to give more attention to subgroups of the population that are often neglected in humanitarian crises. These include older adults, females, and ethnic minorities. Additional attention should also be given to NCDs and sexual and reproductive health (SRH) care needs, especially given the high numbers of older adults and females in this population. Early medical support, psychological first aid and interventions in transit centers that promote survivor resilience and recovery are required. Our findings shed light on the healthcare needs of forcibly displaced populations during transit, a stage often overlooked in migration health research. They underscore the diverse healthcare needs of forcibly displaced populations, emphasizing the necessity for humanitarian aid programs to acknowledge and address this diversity. Accessing data on displaced populations' healthcare needs in transit can help the preparing and planning of healthcare services for these populations in host or destination countries. Ensuring objective anonymization and preventing patient re-identification are essential, particularly in safeguarding refugee privacy and data protection to avoid the misuse of their data.

Air Pollution Emergency and Human Health Crisis – Doable Risk Reduction Strategies

Background: The environmental devastation wrought by indoor and ambient air pollution is causing immeasurable stress and strain on the health of people and projected to increase mortality and morbidity rate specifically due to accumulation of particulate matter and ground-level ozone in the atmosphere. Objective: This work aims to provide a comprehensive outlook on the global death and disease burden, impact on low- and middle-income countries’ population with focus on Asian countries, health vulnerability and projected hazards of particulate air pollution. Methods: Data pertaining to air pollution and health impacts were collected from web sources following PRISMA model, analysed and interpreted. Results: The authors found that the ominous environmental magnification and accumulation of air pollutants is the greatest threat questioning human existence in the near century. Conclusion: The interdependent augmentation of global warming and air pollution is further worsening climatic conditions and disease occurrence. Hence this work recommends evidence-based policy framework and synergistic actions to allay air pollutants thereby enhancing eco-survival.

Examining health equity in Nepal’s climate change and health policies through the lens of environmental justice: insights from a content analysis

ABSTRACT Background Climate change presents a multifaceted challenge with unequal health implications, particularly for vulnerable populations with limited adaptive capacity. Socioeconomic factors are intricately linked with environmental health outcomes and environmental factors significantly exacerbate existing health inequities. Health equity as a goal of environmental justice can address these issues. Objective To examine the integration of health equity within climate change and health policy documents in Nepal. Methods Using a qualitative content analysis approach based on Schlosberg’s framework of environmental justice, we analyzed the coverage of health equity considerations in climate and health policies, assessing aspects of distribution, recognition, and participation. Results Twenty-one national-level policies, strategies, and plans/guidelines on climate change and health were analyzed. Nepal’s policy documents lack clear definitions of health equity in relation to climate change, and related terms are used inconsistently. Health vulnerability is often addressed broadly rather than specifically. Health equity-related statements from environmental justice viewpoint vary across sectors. Many documents emphasize equitable distribution of resources and benefits, with participation in decision-making processes being the least discussed. Conclusions In Nepal, lack of shared understanding of health equity across sectors hinders coordinated policy efforts. There is an urgent need to expand climate change responses to consider specific health vulnerabilities. By positioning health equity as a key element of environmental justice, this study provides a broader perspective on climate change-related health equity that could encourage collaborative action between the environment and health sectors.

SEA SURFACE SALINITY AND PRECIPITATION PATTERNS AS INDICATORS OF CLIMATE CHANGE-INDUCED HEALTH RISKS IN INDONESIAN COASTAL VILLAGES: A DATA ENVELOPMENT ANALYSIS APPROACH

Coastal communities in Indonesia face interconnected challenges from climate change and public health vulnerabilities, yet the relationships between these factors remain poorly understood. We investigated these connections across eight Indonesian provinces by analyzing marine dependency, disease susceptibility, and flood risk projections using Data Envelopment Analysis (DEA) and multiple datasets. Our analysis revealed that South Kalimantan's coastal communities are particularly vulnerable, demonstrating the highest dependency on marine resources while simultaneously facing significant health and environmental challenges. This heightened vulnerability is evidenced by elevated Marine Capture Fisheries Households (RTPT) scores and fish capture data, indicating substantial economic reliance on marine resources. The challenges are further intensified by projected flood risks expected to impact these areas within six years, alongside varying health vulnerabilities including tuberculosis, HIV, dengue fever, and COVID-19 cases. Through our DEA estimation, which incorporated six output and four input variables along with demographic information, we found that South Kalimantan's marine resource dependency significantly exceeds that of other provinces. These findings provide crucial insights for policymakers and health administrators, establishing a data-driven foundation for developing targeted interventions and resource allocation strategies. Our study underscores the necessity of implementing integrated approaches that simultaneously address environmental and public health concerns in coastal communities.

Mental Health Condition of Adolescents to Early Adulthood: A Study of Indonesian College Students

Purpose: To detect the mental health conditions of students and identify factors influencing their reluctance to seek psychological help in order to prevent progression of more serious mental health issues.Methods: This study had a quantitative descriptive survey design. Participants were adolescent active undergraduate students aged 18-24 years. Data were collected through an online questionnaire comprising Indonesian versions of the Mental Health Inventory (MHI-38) and Health Seeking Behavior assessments. Statistical analyses were conducted using IBM SPSS 25 to evaluate respondent characteristics and mental health conditions.Results: We found that psychological wellbeing declined with age, with older people being more susceptible to depression and emotional loss than younger people. Men had higher levels of anxiety, depression, and emotional loss than women. Migrant individuals had lower wellbeing than non-migrants. Close friends were the most common source for seeking mental health support, reflecting a preference for informal help rather than professional help.Conclusion: Transition from adolescence to adulthood is associated with heightened mental health vulnerabilities, especially among first-year male students. Thus, innovative mental health education and peer counseling are needed to better support their psychological well-being.

Addressi̇ng Health Challenges Ami̇dst Cycles of Natural Di̇sasters in Afghani̇stan

Afghanistan, located in South Asia, grapples with significant health challenges worsened by recurring natural disasters. The country's health system is hampered by limited healthcare access, poor infrastructure, and a shortage of trained professionals, all exacerbated by decades of conflict and political instability. This leads to widespread preventable diseases, high maternal mortality, and malnutrition. Socio-economic disparities, poverty, and displacement further increase health inequities and vulnerability to disasters. Afghanistan faces various natural disasters like earthquakes, floods, droughts, and avalanches, which worsen public health conditions and disrupt healthcare access. Recent events, such as the 2020 floods, 2021 drought, and 2023 earthquake, have had catastrophic impacts, displacing thousands and damaging homes and health services. This interplay between health vulnerabilities and natural disasters creates a cycle of adversity. Addressing these issues requires a comprehensive strategy integrating disaster preparedness, emergency response, and health system strengthening. Building resilience, improving early warning systems, and enhancing healthcare access in disaster-prone areas is crucial. International collaboration and support from donor countries, organizations, and agencies are vital for providing technical, financial, and logistical assistance. Effective coordination and sustainable aid delivery remain challenging in Afghanistan's complex socio-political context.

사이버 폭력 피해와 청소년 정신건강 취약성의 영향 관계: 피해자-가해자 관계유형 별 집단 비교분석

사이버 폭력 피해와 청소년 정신건강 취약성의 영향 관계: 피해자-가해자 관계유형 별 집단 비교분석

Smoking as a Marker of Comorbid Vulnerability Among Persons with Probable Posttraumatic Stress Disorder Who Engage in Hazardous Drinking

Background: Persons with posttraumatic stress disorder (PTSD) compared to those without evince high rates of hazardous drinking, or patterns of alcohol consumption that increase the risk for harmful consequences. One potential marker of vulnerability for PTSD-hazardous drinking comorbidity may be smoking behavior. Individuals with PTSD have a higher prevalence of smoking and smoke at higher rates. Smokers, compared to nonsmokers, are more apt to engage in hazardous alcohol use. Notably, there is a need to expand research on smoking in the context of PTSD and hazardous drinking to inform treatment of these morbidities. Objective: The present cross-sectional investigation sought to examine smoking status as a marker of risk among persons with probable PTSD who engage in hazardous drinking (N = 647; M age = 38.90 years, SD = 10.71; 51.2% female). Results: Results indicated that trauma-exposed smokers, compared to non-smokers, evinced greater severity of PTSD symptoms, depression, emotion regulation difficulties, hazardous drinking, and substance use problems, with small effect sizes. No statistically significant group differences were found for anxiety symptom severity. Secondary analyses among only smokers supported an interrelation between cigarette dependence and each of the criterion variables that demonstrated statistically significant group differences. Specifically, cigarette dependence was statistically significantly and incrementally related to PTSD symptom severity, depression, emotion regulation difficulties, more severe hazardous drinking, and a greater degree of substance use problems. Conclusions: Overall, the current investigation found that smoking status among persons with probable PTSD who engaged in hazardous drinking was associated with numerous indicators of mental health and substance use vulnerability.