Abstract
The present study investigated smoking prevalence, smoking motives, demographic variables and psychological symptoms in 124 help-seeking, male Vietnam combat veterans with post-traumatic stress disorder (PTSD). A high percentage of these veterans with post-traumatic stress disorder (PTSD). A high percentage of these veterans smoked (60%). Vietnam veterans with PTSD who smoked were more likely than those who did not smoke to report higher levels of PTSD symptoms, depression and trait anxiety. Increased depression was associated with increased automatic smoking. Smokers reported a high frequency of smoking in response to military memories. Implications for smoking interventions, cessation, and relapse prevention efforts are discussed.
Similar content being viewed by others
References
Anda, R.F., Williamson, D.F., Escobedo, L.G., Mast E.E., Giovino, G.A., & Remington, P.L. (1990). Depression and the dynamics of smoking: A national perspective.Journal of the American Medical Association, 264, 1541–1545.
Aneshensel, C.S., & Huva, G.J. (1983). Depression, alcohol use, and smoking over one year: A four-wave longitudinal causal model.Journal of Abnormal Psychology, 92, 134–150.
Beck, A.T., & Steer, R.A. (1987).The revised Beck Depression Inventory. San Antonio, TX: Psychological Corporation.
Beck, A.T., Steer, R.A., and Garbin, M.G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation.Clinical Psychology Review, 8, 77–106.
Blanchard, E.B. (1990). Elevated basal levels of cardiovascular responses in Vietnam veterans with PTSD: A health problem in the making?Journal of Anxiety Disorders, 4, 233–237.
Breslau, N., Kilbey, M.M., & Andreski, P. (1993). Nicotine dependence and major depression: New evidence from a prospective investigation.Archives of General Psychiatry, 50, 31–35.
Breslau, N., Kilbey, M.M., & Andreski, P. (1992). Nicotine withdrawal symptoms and psychiatric disorder: Findings from an epidemiologic study of young adults.American Journal of Psychiatry, 149, 464–469.
Carmody, T.P. (1992). Affect regulation, nicotine addiction, and smoking cessation.Journal of Psychoactive Drugs, 24, 111–122.
The Centers for Disease Control Vietnam Experience Study. (1988). Health status of Vietnam veterans: II Physical health.Journal of the American Medical Association, 259, 2708–2714.
Csernansky, J.C., & Whiteford, H.A. (1987). Clinically significant psychoactive drug interactions. In R.E. Hales & A.J. Frances (Eds.),American Psychiatric Association Annual review (pp. 802–815). American Psychiatric Press, Inc., Washington, D.C.
Davidson, J.R.T., & Fairbank, J.A. (1992). The epidemiology of post-traumatic stress disorder. In J.R. Davidson & E.B. Foa (Eds.),Post-traumatic stress disorder: DSM-IV and beyond (pp. 147–169). Washington, DC: American Psychiatric Press.
Epstein, L.H., & Perkins, K.A. (1988). Smoking, stress, and coronary heart disease.Journal of Consulting and Clinical Psychology, 56, 342–349.
Fairbank, J.A., Schlenger, W.C., Caddell, J.M., & Woods, M.G. (1993). Post-traumatic stress disorder. In P.B. Sutker & H.E. Adams (Eds.),Comprehensive handbook of psychopathology (pp. 145–165). New York: Plenum Press.
Fagerstrom, K.O. (1978). Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment.Addictive Behavior, 3, 235–241.
Fagerstrom, K.O., & Schneider, N.G. (1989). Measuring nicotine dependence: A review of the Fagerstrom Tolerance Questionnaire.Journal of Behavioral Medicine, 12, 159–182.
Fleiss, J.L. (1981).Statistical methods for rates and proportions (2nd ed.). New York: John Wiley & Sons.
Gilbert, D.G., Robinson, J.H., Chamberlin, C.L., & Spielberger, C.D. (1989). Effects of smoking/nicotine on anxiety, heart rate, and lateralization of EEG during a stressful movie.Psychophysiology, 26, 311–320.
Glassman, A.H. (1993). Cigarette smoking: Implications for psychiatric illness.American Journal of Psychiatry, 150, 4546–4553.
Glassman, A.H., Helzer, J.E., Covey, L.S., Cottler, L.B., Stetner, F., Jayson, E.T., & Johnson, J. (1990). Smoking, smoking cessation, and major depression.Journal of the American Medical Association, 264, 1546–1549.
Gritz, E.R., Stapleton, J.M., Hill, M.A., & Jarvik, M.E. (1985). Prevalence of cigarette smoking in VA medical and psychiatric hospitals.Bulletin of the Society of Psychologists in Addictive Behaviors, 4, 151–165.
Hall, J.R. (1988). Clonidine, depression and smoking cessation.Journal of the American Medical Association, 259, 2901–2902.
Horn, D., & Weingrow, 5. (1966).Behavior and attitudes. Questionnaire.
Hughes, J.R., Hatsukami, D.K., Mitchell, J.E., & Dahlgren, L.A. (1986). Prevalence of smoking among psychiatric outpatients.American Journal of Psychiatry, 143, 993–997.
Hughes, J.R. (1992). Tobacco withdrawal in self-quitters.Journal of Consulting and Clinical Psychology, 60, 689–697.
Ikard, F.F., Green, D.E., & Horn, D. (1969). A scale to differentiate between types of smoking as related to the management of affect.International Journal of Addictions, 4, 649–659.
Joseph, A., & Korn, J. (1988). Are veterans really different? The feasibility of smoke-free VA hospitals [letter].Journal of the American Medical Association, 260, 1551–1557.
Keane, T.M. Caddell, J.M., & Taylor, K.L. (1988). Mississippi scale for combat-related post-traumatic stress disorder: Three studies in reliability and validity.Journal of Consulting and Clinical Psychology, 56, 75–80.
Keane, T.M., Fairbank, J.A., Caddell, J.M., Zimering, R.T., Taylor, K.L., & Mora, C. (1989). Clinical evaluation of a measure to assess combat exposure.Psychological Assessment: Journal of Consulting and Clinical Psychology, 1, 53–55.
Keane, T.M., Gerardi, J.R., Lyons, J.A., & Wolfe, J. (1988). The interrelationship of substance abuse and post-traumatic stress disorder: Epidemiological and clinical considerations. In M. Galanter (Ed.),Recent developments in alcoholism, Vol. 6 (pp. 27–48). New York: Plenum Press.
Keane, T.M., & Wolfe, J. (1990). Comorbidity in post-traumatic stress disorder: An analysis of community and clinical studies.Journal of Applied Social Psychology, 20, 1776–1788.
Keane, T.M., Wolfe, J., & Taylor, K.L. (1987). Post-traumatic stress disorder: Evidence for diagnostic validity and methods of psychological assessment.Journal of Clinical Psychology, 43, 32–43.
Kendler, K.S., Neale, M.C., MacLean, C.J., Health, A.C., Eaves, L.J., & Kessler, R.C. (1993). Smoking and major depression: A causal analysis.Archives of General Psychiatry, 50, 36–43.
Kleinbaum, D.G., & Kupper, L.L. (1978).Applied regression analysis and other multivariate methods. North Scituate, MA: Duxbury Press.
Kulka, R.A., Schlenger, W.E., Fairbank, J.A., Hough, R.L., Jordan, B.K., Marmar, C.R., & Weiss, D.S. (1990).Trauma and the Vietnam war generation: Report of findings from the National Veterans Readjustment Study. New York: Brunner/Mazel.
Levin, E.D., Rose, J.E., Behm, F., & Caskey, N.H. (1990). The effects of smoking-related sensory cues on physiological stress.Pharmacology, Biochemistry and Behavior, 39, 265–268.
Litz, B.T., Keane, T.M., Fisher, L., Marx, B., & Monaco, V. (1992). Physical health complaints in combat-related post-traumatic stress disorder: A preliminary report.Journal of Traumatic Stress, 5, 131–141.
Litz, B.T., Penk, W.E., Geradi, R.J., & Keane, T.M. (1992). The assessment of post-traumatic stress disorder. In P. Saigh (Ed.),Post-traumatic stress disorder: A behavioral approach to assessment and treatment (pp. 50–83). New York: Pergamon Press.
Luck, T.C., & Prochazka, A.V. (1990). Lifting the smoke screen: A look at VA patients and cigarettes.VA Practitioner, 7, 71–77.
Mathew, R.J., Weinman, M.L., & Mirabi, M. (1981). Physical symptoms of depression.British Journal of Psychiatry, 139, 293–296.
McFall, M.E., MacKay, P.W., & Donovan, D.M. (1992). Combat-related post-traumatic stress Disorder and severity of substance abuse in Vietnam veterans.Journal of Studies on Alcohol, 53, 357–363.
Medical Economics Data. (1993).Physician's desk reference. Montvale, NJ: Medical Economics Data.
Orleans, C.T., Shipley, R.H., Wilbur, C., Piserchia, P., and Whitehurst, D. (1983, March).Wide-ranging improvements in employee health lifestyle and wellbeing accompanying smoking cessation in the “Live for Life” program. Paper presented at the Annual Meeting of the Society of Behavioral Medicine, Baltimore, MD.
Perry, P.J., Browne, J.L., Prince, R.A., Alexander, B., & Tsuang, M.T. (1986). Effects of smoking on nortiptyline plasma concentrations in depressed patients.Therapeutic Drug Monitoring, 8, 279–284.
Pokorny, A.D., Miller, B.A., & Kaplan, H.B. (1972). The brief MAST: A shortened version of the Michigan Alcoholism Screening Test.American Journal of Psychiatry, 129, 118–121.
Pomerleau, C.S., Pomerleau, O.F., Majchrzak, M.J., Kloska, D.D., & Malakut, R. (1990). Relationship between nicotine tolerance questionnaire scores and plasma cotinine.Addictive Behaviors, 15, 73–80.
Pomerleau, O.F., Turk, D., & Fertig, J. (1984). The effects of cigarette smoking on pain and anxiety.Addictive Behaviors, 9, 265–271.
Russell, M.H., Peto, J., & Patel, V.A. (1974). The classification of smoking by factorial structure of motives.Journal of the Royal Statistical Society, a. 137, 313–333.
Schlenger, W.E., Kulka, R.A., Fairbank, J.A., Hough, R.L., Jordan, B.K., Marmar, C.R., & Weiss, D.S. (1992). Prevalence of post-traumatic stress disorder in the Vietnam generation: A multimethod, multisource assessment of psychiatric disorder.Journal of Traumatic Stress, 5, 333–363.
Selzer, M.L., Vinoku, A., & van Rooijen, L. (1975). A self-administered short Michigan Alcoholism Screening Test (SMAST).Journal of Studies in Alcohol, 36, 117–126.
Shalev, A., Bleich, A., & Ursano, R.J. (1990). Posttraumatic stress disorder: Somatic comorbidity and effort tolerance.Psychosomatics, 31, 197–203.
Shiffman, S. (1993). Assessing smoking patterns and motives.Journal of Consulting and Clinical Psychology, 5, 732–742.
Sirota, A.D., Penzien, D.B., & Curran, J.P. (1987). Smoking and VA policy.VA Practitioner, 4, 11–14.
Spielberger, C. D. (1986). Psychological determinants of smoking behavior. In R.D. Tollison (Ed.),Smoking and society: Toward a more balanced assessment (pp. 89–134). Lexington, MA: Heath & Co.
Spitzer, R.L., Williams, J.B., Gibbon, M., & First, M.B. (1989).Structured Clinical Interview for DSM-III-R (SCID). Biometrics Research Department, New York State Psychiatric Institute, New York.
Stellman, J.M., Stellman, S.D., & Sommer, J.F. (1988). Social and behavioral consequences of the Vietnam experience among American Legionnaires.Environmental Research, 47, 129–149.
U.S. Department of Health and Human Services. (1993).Reducing the health consequences of smoking: 25 years of progress. A report of the Surgeon General. Washington, D.C.: U.S. Government Printing Office.
Zelman, D.C., Brandon, T.H., Jorenby, D.E., & Baker, T.B. (1992). Measures of affect and nicotine dependence predict differential response to smoking cessation treatments.Journal of Consulting and Clinical Psychology, 60, 943–952.
Zimering, R., Norris, V., Lurie, A., & Hearst, D. (1994).Elevated lipid profiles in Vietnam combat veterans with PTSD. Manuscript submitted for publication, Tufts University.
Author information
Authors and Affiliations
About this article
Cite this article
Beckham, J.C., Roodman, A.A., Shipley, R.H. et al. Smoking in vietnam combat veterans with post-traumatic stress disorder. J Trauma Stress 8, 461–472 (1995). https://doi.org/10.1007/BF02102970
Issue Date:
DOI: https://doi.org/10.1007/BF02102970