Population-Based Assessment of Post-Katrina Smoking Relapse

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DESCRIPTION (provided by applicant): Each year in the U.S., millions of people are affected by natural disasters such as earthquakes, floods, hurricanes, tornados, and wildfires. Survivors of these devastating events experience multiple stressors, including the danger of death or physical injury and the loss of their communities, homes, jobs, and possessions. Stress-related psychological symptoms and disorders are common after such disasters, especially among those most directly affected, such as refugees, and include depression, anxiety, posttraumatic stress disorder, and increased use of psychoactive substances, such as alcohol, marijuana, and cigarettes. Cigarette smoking is a common form of psychoactive substance use, engaged in regularly by 23% of U.S. adults, that is strongly associated with stress. Smokers often report smoking to reduce stress and negative affect, and relapse among former smokers commonly occurs as a response to stress and negative affect. Similar to other drugs of abuse, relapse to smoking remains a formidable challenge, with only 2.5-7.5% of quitters maintaining long term abstinence (CDC, 1996). Given the public health importance of preventing smoking relapse, and the strong association between smoking relapse and stress, it is surprising that no data are available on smoking relapse following disasters. Recent survey data from Manhattan residents living in the vicinity of the World Trade Center at the time of the September 11, 2001 terrorist attacks, show that substantial numbers of smokers (especially those most directly affected by the attacks, e.g., job loss) increased their daily smoking rate 5-8 weeks after the attack, and this increase persisted for at least 6-9 months. No data, however, are available on smoking relapse prevalence or characteristics. As such, we propose to conduct formative work and a population-based, longitudinal, controlled survey using a telephone interview, comparing relapse rates and characteristics among former smokers who were most severely impacted by Hurricane Katrina (New Orleans residents) and residents of a nearby community that was not severely impacted by the hurricane (Memphis, TN). Research questions include: (1) What is the prevalence and time course of smoking relapse among Katrina victims compared to individuals not severely impacted by the hurricane? (2) What predisposing, precipitating, and perpetuating factors act as mediators and moderators of post-disaster smoking relapse? (3) How motivated and confident are individuals who relapsed after Katrina to make a renewed quit attempt? and (4) What is the prevalence and time course of renewed quit attempts?