Brown University researchers found that for adolescents, exposure to violence is strongly associated with increased usage of cigarettes and e-cigarettes.
PROVIDENCE, R.I. [Brown University] - One way to lower smoking rates among teens may be to address their exposure to violence, as an analysis from public health researchers at Brown University shows that the two are strongly linked.
According to a study published in Substance Use & Misuse, exposure to forms of violence such as bullying, cyberbullying, sexual violence and domestic violence is associated with increased past 30-day frequency of cigarette and e-cigarette use among both boys and girls.
"We wanted to hone in on the fact that these violence exposures are sadly common among youth: About one in five reported bullying, about 15% reported cyberbullying, and 5% reported experiencing sexual violence or domestic violence," said study author Nicole Haderlein, who conducted the research as part of her master of public health thesis project at Brown. "This is what is happening among youth, and I think it is important for medical providers and health researchers to pay attention to the relationship we highlighted in our paper between violence and tobacco use."
While reviewing existing research examining the relationship between violence and tobacco use, Haderlein found that studies were limited in scope - for example, considering only the effect of one type of violence - and the findings tended to be mixed.
In collaboration with senior author Alexander Sokolovsky, an assistant professor of behavioral and social sciences at Brown, Haderlein analyzed data from the Youth Risk Behavior Surveillance System from the Centers for Disease Control. She looked at four forms of violence exposure (bullying, cyberbullying, sexual violence and domestic violence) and tobacco use among boys and girls across two time periods, assessing the effect of each type of violence separately and the cumulative effect of multiple types of violence together.
The researchers found that each form of violence exposure was associated with increased past 30-day frequency of cigarette and e-cigarette use, which could mean teens are using cigarettes as a coping mechanism.
"Every single form of violence was related to increased risk for using each substance," Sokolovsky said. "In addition to the risk from each form of violence, there was also a dose response effect: The risk for using tobacco goes up if you are exposed to multiple forms of violence "
While the researchers found some differences between boys and girls, those differences appear to be decreasing over time. According to the study, in 2021, exposure to violence was more strongly linked to past 30-day cigarette use in boys than girls. In 2023, however, there were no sex differences for either past 30-day cigarette use or e-cigarette use.
"The gap that may have existed in 2021 and years prior seems to be closing over time, such that in 2023, boys and girls were using tobacco at similar frequencies in response to risk factors such as violence exposure," Haderlein said.
Given that all types of violence investigated in the study were risk factors for tobacco use behaviors, they said, it may be important for medical providers, teachers, school counselors or other care workers to routinely assess violence exposure in students so they can intervene.
"Identifying students who have experienced violence or are at risk for experiencing violence and assessing their risk for tobacco use may be crucial for effective prevention," Haderlein said.
The researchers concluded that violence prevention, early detection and intervention programs targeting adolescents may effectively reduce tobacco use in this population.
"When you see results like these, an alarm bell goes off," Sokolovsky said. "We need to focus on this group - teens that are exposed to violence are at a high risk for tobacco use. The findings suggest that violence prevention can be a form of substance use prevention."
