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Randomized Controlled Trial
. 2024 Jul 3;19(7):e0298576.
doi: 10.1371/journal.pone.0298576. eCollection 2024.

Does smoking cessation reduce other substance use, psychiatric symptoms, and pain symptoms? Results from an emulated hypothetical randomized trial of US veterans

Kaoon Francois Ban  1 , Erin Rogers  1 , Maria Khan  1 , Joy Scheidell  1 , Dyanna Charles  1 , Kendall J Bryant  2 , Amy C Justice  3   4 , R Scott Braithwaite  1 , Ellen C Caniglia  5
Affiliations
Randomized Controlled Trial

Does smoking cessation reduce other substance use, psychiatric symptoms, and pain symptoms? Results from an emulated hypothetical randomized trial of US veterans

Kaoon Francois Ban et al. PLoS One. .

Abstract

Background: Quitting smoking may lead to improvement in substance use, psychiatric symptoms, and pain, especially among high-risk populations who are more likely to experience comorbid conditions. However, causal inferences regarding smoking cessation and its subsequent benefits have been limited.

Methods: We emulated a hypothetical open-label randomized control trial of smoking cessation using longitudinal observational data of HIV-positive and HIV-negative US veterans from 2003-2015 in the Veterans Aging Cohort Study. We followed individuals from the first time they self-reported current cigarette smoking (baseline). We categorized participants as quitters or non-quitters at the first follow-up visit (approximately 1 year after baseline). Using inverse probability weighting to adjust for confounding and selection bias, we estimated odds ratios for improvement of co-occurring conditions (unhealthy alcohol use, cannabis use, illicit opioid use, cocaine use, depressive symptoms, anxiety symptoms, and pain symptoms) at second follow-up (approximately 2 years after baseline) for those who quit smoking compared to those who did not, among individuals who had the condition at baseline.

Results: Of 4,165 eligible individuals (i.e., current smokers at baseline), 419 reported no current smoking and 2,330 reported current smoking at the first follow-up. Adjusted odds ratios (95% confidence intervals) for associations between quitting smoking and improvement of each condition at second follow-up were: 2.10 (1.01, 4.35) for unhealthy alcohol use, 1.75 (1.00, 3.06) for cannabis use, 1.10 (0.58, 2.08) for illicit opioid use, and 2.25 (1.20, 4.24) for cocaine use, 0.78 (0.44, 1.38) for depressive symptoms, 0.93 (0.58, 1.49) for anxiety symptoms, and 1.31 (0.84, 2.06) for pain symptoms.

Conclusions: While a causal interpretation of our findings may not be warranted, we found evidence for decreased substance use among veterans who quit cigarette smoking but none for the resolution of psychiatric conditions or pain symptoms. Findings suggest the need for additional resources combined with smoking cessation to reduce psychiatric and pain symptoms for high-risk populations.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Causal directed acyclic graph (DAG) for estimating the effect of smoking cessation (A) on co-occurring conditions (Y) under various assumptions about the causal structure of the data.
1A depicts assumptions for the adjusted models with following temporal ordering of variables: L1, A1, M1. Some potential time-varying covariates (L1) measured at the first follow-up visit and V0 are included for the weights. 1B depicts assumptions for the adjusted models with following temporal ordering of variables: A1, L1, M1. All potential time-varying covariates measures at the first follow-up visit are excluded from the weight model. Only V0 included for the weights. 1C depicts assumptions for the adjusted models with following temporal ordering of variables: L1, M1, A1. All potential time-varying covariates measures at the first follow-up visit and V0 are included for the weights. V0 Baseline covariates (e.g., HIV status, race, age, education, income), past year unhealthy alcohol use, cannabis, cocaine, other stimulants at time 0, and current smoking, depression, anxiety, and pain measured at time 0. L1 Past year unhealthy alcohol use, cannabis, cocaine, other stimulants and opioids measured at first follow-up visit. A1 Current cigarette smoking measured at first follow-up visit. M1 Current depression, anxiety, and pain measured at first follow-up visit. Y2 Outcome measured at second follow-up visit (for all outcomes).
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References

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Publication types

Grants and funding

This work was supported by the National Institutes of Health on Alcohol Abuse and Alcoholism [NIAAA R01AA024706: PI: Braithwaite] and Veterans Aging Cohort Study primary data collection (U24-AA020794, U01-AA020790, U24-AA02001, and U10-AA013566; PI: Justice).