Increased tobacco use among teens linked to risk of violence

One way to reduce smoking rates among teens may be to address their exposure to violence, as an analysis by public health researchers at Brown University shows that the two are strongly linked.

According to a study published in Substance Use and Abuse, exposure to forms of violence such as bullying, cyberbullying, sexual violence and domestic violence increased the frequency of past 30-day use of cigarettes and e-cigarettes among both boys and girls.

“We wanted to understand the fact that these violence exposures are tragically common among youth: one in five reported bullying, nearly 15% reported cyberbullying, and 5% experienced sexual violence or domestic violence,” said study author Nicole Hederlein, who conducted the research as part of her Master of Public Health thesis project at Brown. “This is happening among youth, and I think it is important for medical providers and health researchers to pay attention to the links highlighted in our paper between violence and tobacco use.”

When reviewing existing research examining the relationship between violence and tobacco use, Hederlin found that the scope of the studies was limited – for example, only considering the impact of one type of violence – and the findings were mixed.

In collaboration with senior author Alexander Sokolowski, assistant professor of behavioral and social sciences at Brown, Hederlein analyzed data from the Youth Risk Behavior Surveillance System from the Centers for Disease Control. They looked at four forms of violence exposure (bullying, cyberbullying, sexual violence, and domestic violence) and tobacco use among boys and girls over two time periods, assessing the impact of each type of violence separately and the cumulative impact of multiple types of violence together.

The researchers found that each form of violence was associated with an increased frequency of cigarette and e-cigarette use in the past 30 days, which may mean teens are using cigarettes as a coping mechanism.

Each form of violence was associated with an increased risk of each substance use. In addition to the risk from each form of violence, there was also a dose response effect: The risk of using tobacco increases if you are exposed to multiple forms of violence.

Alexander Sokolowski, Assistant Professor of Behavioral and Social Sciences, Brown University

While researchers found some differences between boys and girls, those differences appear to diminish over time. According to the study, in 2021, the risk of violence was more strongly associated with past 30-day cigarette use in boys than in girls. However, in 2023, there were no gender differences for past 30-day cigarette use or e-cigarette use.

“The difference that existed in 2021 and the years before that appears to be narrowing over time, such that in 2023, boys and girls were using tobacco at the same frequency in response to risk factors such as violence exposure,” Hederlein said.

Given that all types of violence examined in the study were risk factors for tobacco use behavior, she said, it may be important for medical providers, teachers, school counselors or other care personnel to regularly assess violence risk 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 important for effective prevention,” Hederlein said.

The researchers concluded that violence prevention, early detection, and intervention programs targeting adolescents can effectively reduce tobacco use in this population.

“When you see results like this, alarm bells should go off,” Sokolowski said. “We need to focus on this group – teens who are exposed to violence are at higher risk of tobacco use. The findings suggest that violence prevention may be a form of substance use prevention.”