Perceived Stress Mediates the Association between Deployment Sexual Trauma and Nicotine Dependence in Women Veterans

Published:April 19, 2020DOI:



      Rates of smoking and related health consequences are higher for women veterans as compared with their civilian counterparts, and trauma is a known risk factor associated with smoking. Military sexual trauma is prevalent among women veterans and associated with deleterious health outcomes, including tobacco use. However, research has not examined variables that may explain this association. The purpose of the present study was to examine the association between deployment sexual trauma (DST; military sexual trauma that occurs during deployment) and nicotine dependence, and whether perceived stress is a potential explanatory variable (i.e., mediator) in this relationship.


      Cross-sectional associations and Hayes mediation models were examined using baseline interview data from the Survey of Experiences of Returning Veterans sample (352 recently returned women veterans).


      DST was associated with postdeployment nicotine dependence and greater perceived stress. Further, perceived stress was a significant mediator between DST and binary nicotine dependence (indirect effect [standard error] of DST on nicotine dependence through perceived stress, 0.04 [0.01]; 95% confidence interval, 0.01–0.07; odds ratio, 1.04; p < .01) when controlling for education.


      Findings suggest that perceived stress may be a clinical target for decreasing nicotine dependence among women veterans who have experienced DST.
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      Georgina M. Gross, PhD, is a Clinical Psychologist at the Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention and VA Connecticut Healthcare System. Their interests include suicide prevention, military sexual trauma, PTSD, and the mental health of LGBT veterans.


      Richard Colon, PhD, is an Applied Medical Anthropologist at VA Connecticut Healthcare System. His interests include PTSD, sexual assault prevention, military sexual trauma, intimate partner violence, and cardiovascular disease prevention.


      Lori A. Bastian, MD, MPH, is Section Chief, General Internal Medicine and Director of Pain Research, Informatics, Multimorbidities, and Education at VA Connecticut and Professor of Medicine at Yale School of Medicine. Her longstanding interest is in health behaviors among women veterans.


      Rani Hoff, PhD, MPH, is Director, Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, and Professor of Psychiatry, Yale School of Medicine. She has longstanding interests in veteran mental health and program evaluation of the VA health care system.