Post-Traumatic Stress Symptoms & Their Association with Smoking Outcome Expectancies among Homeless Smokers in Boston

Cigarette smoking and traumatic life experiences are each common among homeless adults, but the prevalence and correlates of post-traumatic stress disorder (PTSD) symptoms among homeless smokers are not known. We assessed symptoms of PTSD and their association with smoking outcome expectancies in a sample of homeless smokers in Boston.

We used time-location sampling to conduct an in-person survey of homeless adult smokers using Boston Health Care for the Homeless Program clinical services. We assessed symptoms of PTSD with the PTSD Checklist - Civilian version and considered scores ≥14 as positive. We used the Smoking Effects Questionnaire to assess positive and negative smoking outcome expectancies. We modeled the associations between PTSD screening status and smoking expectancies using design-adjusted linear regression.

Eighty-six percent of eligible individuals participated (N=306). Sixty-eight percent of participants screened positive for PTSD. Screen-positive respondents were younger, more likely to report fair/poor health, chronic obstructive pulmonary disease, and past-month hallucinations, and had greater drug and alcohol use severity and cigarette dependence. In analyses controlling for these confounders, PTSD screen-positive participants more strongly endorsed smoking to reduce negative affect, smoking for social benefits, and smoking for weight control. Exploratory analyses suggested that these associations were driven by avoidance/numbing and re-experiencing symptoms.

Symptoms of post-traumatic stress are common among homeless smokers and strongly associated with positive smoking outcome expectancies. Tobacco cessation programs for this population should consider screening for PTSD and fostering a trauma-sensitive treatment environment.

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By: Baggett TP1, Campbell EG2, Chang Y3, Magid LM4, Rigotti NA5.

• 1Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA Boston Health Care for the Homeless Program, Boston, MA tbaggett@mgh.harvard.edu.
• 2Department of Medicine, Harvard Medical School, Boston, MA Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA.
• 3Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA.
• 4Boston University, College of Health and Rehabilitation Sciences and School of Public Health, Boston, MA.
• 5Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA.  

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