UC San Diego

Background: Research has indicated that exposure to traumatic events is associated with cigarette use and with related outcomes such as pulmonary disease. Better characterizing the connection between trauma exposure and cigarette use and related outcomes remains a critical gap. Theoretical Framework: We developed the Trauma-Informed Theory of Individual Health Behavior (TTB) to guide the aims of this dissertation. TTB articulates three types of trauma: historical trauma, acute experiences of trauma, and trauma-replicating environments. Aims: Aim 1 (Historical Trauma): Identify how historical trauma has been conceptualized within the academic literature studying substance use and produce recommendations for incorporating the historical trauma concept into tobacco use research. Aim 2 (Trauma-Replicating Environments [i.e., poverty]): Examine the impact of income level on cigarette use transitions (initiation, cessation, reinstatement) and on cigarette use prevalence. Aim 3 (Acute Experiences of Trauma): Evaluate the mediating role of cigarette smoking on the relationship between trauma exposure during childhood and chronic obstructive pulmonary disorder (COPD) and chronic heart disease (CHD). Methods: Aim 1 employed a scoping review strategy to identify relevant literature. Aim 2 was undertaken through the development of statistical models and a novel mathematical model of income and cigarette use. Aim 3 employed a causal mediation approach, based on inverse probability weighting, to assess the mediating role of lifetime cigarette smoking on the relationship between childhood trauma exposure and COPD and CHD incidence. Results: Aim 1: We identified literature examining the relationship between historical trauma and substance use. We highlight that quantitative methods may be poorly suited to the study of this topic. Aim 2: We identified that lower income level is associated with increased risk of adopting cigarette use and a diminished likelihood of cessating use. Further, that income is attributable to a substantial amount of cigarette use prevalence, particularly among those who have never used cigarettes before. Aim 3: We identified that cigarette use mediates the relationship between childhood trauma exposure and COPD and CHD. Conclusions: We have explored how different trauma constructs may be applied to better understanding tobacco use disparities. The findings hold important implications for policy endeavors to reduce the harms of tobacco use and for future research directions.