Deployment stress, tobacco use, and postdeployment posttraumatic stress disorder: Gender differences.

Objective: Epidemiological research has demonstrated that tobacco use and posttraumatic stress disorder (PTSD) frequently co-occur and are highly prevalent among Veterans; research with female Veterans is limited. Given the increasing numbers of women deployed to combat zones in recent conflicts, the objective of the current study was to examine gender-specific associations between deployment stress, tobacco use and postdeployment PTSD symptoms.

Method: Two thousand thirteen Veterans deployed to Afghanistan and Iraq (50.9% female; mean age = 35.53) completed a postdeployment, mailed survey that assessed tobacco use before, during, and after deployment, deployment stressors, and postdeployment PTSD symptoms.

Results: Warfare stress was associated with initiation and increases in tobacco use during deployment in both men and women, whereas harassment stress was associated with initiation and increases in tobacco use in women only. Only among women was continued postdeployment tobacco use associated with postdeployment PTSD symptoms.

Conclusions: We found a dose-dependent relationship between deployment stress and adoption and escalation of tobacco use; the stressors that provoked initiation and escalation of tobacco use differed by gender. Continued tobacco use after deployment was associated with PTSD in women suggesting that women used tobacco more selectively than men to regulate negative affect. Implications of this work are that training before combat and during combat on healthy means of coping with deployment stress is needed to prevent tobacco use. For women, reducing harassment stress during deployment and early treatment of acute stress and PTSD during and soon after deployment may prevent intractable tobacco use.