An analysis by public health researchers at Brown University shows a strong link between the two, and one way to reduce smoking rates among teens may be to address exposure to violence.
A study published in Substance Use & Misuse found that exposure to violence, including bullying, cyberbullying, sexual assault, and domestic violence, increased the frequency of tobacco and e-cigarette use in the past 30 days for both boys and girls.
“We wanted to highlight the fact that exposure to this type of violence is sadly common among young people, with approximately 1 in 5 reporting bullying, approximately 15% reporting cyberbullying, and 5% reporting experiencing sexual or domestic violence,” said study author Nicole Harderlein, who conducted the study as part of her Master of Public Health thesis project at Brown University. “This is what is happening among young people, and I think it’s important for health care providers and health researchers to pay attention to the relationship between violence and smoking that we highlighted in our paper.”
In reviewing existing studies examining the relationship between violence and tobacco use, Harderlein found that studies tend to have mixed results because they are limited in scope (for example, they only consider the effects of one type of violence).
Harderlein worked with senior author Alexander Sokolowski, assistant professor of behavioral and social sciences at Brown University, to analyze data from the Centers for Disease Control’s Youth Risk Behavior Surveillance System. She investigated four forms of violence (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 exposure was associated with increased frequency of tobacco and e-cigarette use in the past 30 days. This could mean that teens are using tobacco as a coping mechanism.
All forms of violence were associated with an increased risk of using each substance. In addition to the risks associated with each form of violence, there were also dose-response effects. Exposure to multiple forms of violence increases the risk of tobacco use. ”
Alexander Sokolowski, Assistant Professor of Behavioral and Social Sciences, Brown University
Researchers found that there are some differences between boys and girls, but those differences seem to be decreasing over time. The study found that as of 2021, the association between exposure to violence and past 30-day smoking is stronger for boys than for girls. However, in 2023, there were no gender differences in either past 30-day tobacco use or e-cigarette use.
“Differences that may have existed in 2021 and several years earlier appear to be narrowing over time, with boys and girls using tobacco with similar frequency in 2023 in response to risk factors such as exposure to violence,” Harderlein said.
The researchers said that given that all types of violence examined in this study are risk factors for smoking behavior, it may be important to regularly assess students’ violence exposure so that health care providers, teachers, school counselors, and other care workers can intervene.
“Identifying students who have experienced violence or who are at risk of experiencing violence and assessing their risk for tobacco use may be important for effective prevention,” Harderlein said.
The researchers concluded that violence prevention, early detection, and intervention programs targeted at youth may effectively reduce tobacco use in this population.
“Seeing results like this raises alarm bells,” Sokolowski said. “We need to focus on this group. Teens who are exposed to violence are at high risk for tobacco use. Our findings suggest that violence prevention can be a form of drug use prevention.”
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Reference magazines:
Harderlein, North Dakota, and Sokolowski, AW (2026). The effects of exposure to multiple forms of violence on tobacco and e-cigarette use among high school boys and girls. Substance use and misuse. DOI: 10.1080/10826084.2026.2670628. https://www.tandfonline.com/doi/full/10.1080/10826084.2026.2670628
