Dissertation Defense Announcement

The School of Public Health announces the Final Dissertation of

Adam Alexander

for the Degree of Doctor of Philosophy

on April 23, 2018 at 11:00 AM in Room 217, Robinson Hall.

Advisor: Kenneth D. Ward

Identifying Pathways to Smoking and Alcohol Consumption: Findings from Hurricane Katrina

ABSTRACT: Survivors of disasters often experience severe psychological symptoms and disorders, including depression, anxiety, post-traumatic stress disorder (PTSD), and report using psychoactive substances, such as alcohol, marijuana, and cigarettes. This dissertation examined whether depression severity and PTSD were pathways to postdisaster smoking and alcohol consumption using a representative cohort of adult cigarette smokers from Memphis, Tennessee and New Orleans, Louisiana nine and eighteen months after Hurricane Katrina (N=2004). Results from path analyses showed that disaster exposure increased depression and posttraumatic stress, and the effect persisted across time for depression. Disaster exposure also increased the risk for smoking relapse and increased daily cigarette intake and nicotine dependence. Depression and posttraumatic stress seemed to be pathways for smoking relapse and nicotine dependence among individuals who reported hurricane-related trauma. These pathways were further affected by pre-existing mental health; those who reported many days spent with poor mental health, compared to those who reported fewer days, before Hurricane Katrina had higher depressive symptoms after Hurricane Katrina and subsequently had an increased risk for smoking relapse and nicotine dependence. Overall, the findings from this dissertation help fellow researchers and public health professionals, who are ever more frequently responding to the mental and behavioral health consequences of disasters worldwide, by providing beneficial information to improve smoking cessation and relapse prevention strategies for this important and understudied population.