Even as the health authorities across countries have intensified efforts to curb youth tobacco use amid growing concerns over aggressive industry marketing tactics and the rapid rise of e-cigarettes, new research has suggested another powerful and often overlooked driver pushing adolescents towards nicotine addiction: exposure to violence.
A study by researchers at Brown University in the United States has found that teenagers exposed to bullying, cyberbullying, sexual violence and domestic violence are significantly more likely to use cigarettes and e-cigarettes.
The findings, published in the journal ‘Substance Use & Misuse’, add a new dimension to the growing public health challenge of adolescent tobacco use, indicating that prevention efforts may need to go beyond regulating products and advertising to address the social and emotional environments in which young people live.
The study comes at a time when countries across the world, including India, are grappling with rising nicotine experimentation among adolescents. Public health experts have repeatedly warned that tobacco and vaping companies are increasingly using attractive packaging, flavouring, digital marketing and influencer-driven content to make nicotine products appealing to younger audiences.
However, the new research suggests that vulnerability to tobacco use may also be deeply rooted in experiences of violence and trauma.
Researchers analysed data from the Youth Risk Behavior Surveillance System of the U.S. Centers for Disease Control and Prevention (CDC), examining the relationship between tobacco use and four forms of violence exposure among adolescents: bullying, cyberbullying, sexual violence and domestic violence.
The findings were striking.
Each form of violence exposure was independently associated with increased cigarette and e-cigarette use during the previous 30 days. More importantly, the risk increased progressively when adolescents were exposed to multiple forms of violence.
“We wanted to hone in on the fact that these violence exposures are sadly common among youth,” said study author Nicole Haderlein, a researcher at Brown University.
“About one in five reported bullying, about 15% reported cyberbullying, and 5% reported experiencing sexual violence or domestic violence,” she said. “This is what is happening among youth, and I think it is important for medical providers and health researchers to pay attention to the relationship we highlighted in our paper between violence and tobacco use.”
The researchers found evidence of what they described as a “dose-response effect”. In simple terms, adolescents exposed to multiple forms of violence were increasingly likely to use tobacco products.
“Every single form of violence was related to increased risk for using each substance,” said senior author Alexander Sokolovsky, Assistant Professor of Behavioural and Social Sciences at Brown University.
“In addition to the risk from each form of violence, there was also a dose-response effect: the risk for using tobacco goes up if you are exposed to multiple forms of violence,” he added.
The findings reinforce concerns that many teenagers may be turning to nicotine not merely because of curiosity or peer pressure, but as a coping mechanism for emotional distress, trauma and chronic stress.
For India, the implications are particularly significant.
The country is already battling a substantial tobacco burden. According to the Global Youth Tobacco Survey (GYTS), millions of Indian adolescents continue to be exposed to tobacco products despite legal restrictions on sales to minors. Public health experts have also highlighted the increasing influence of indirect advertising, social media promotion and surrogate marketing in shaping youth attitudes towards tobacco and nicotine products.
The Brown University study suggests that even if marketing influences are addressed, tobacco prevention programmes may remain incomplete unless they also tackle underlying psychosocial risk factors.
Notably, the study found that differences between boys and girls are narrowing. In 2021, violence exposure was more strongly associated with cigarette use among boys. By 2023, however, there were no significant sex-based differences in either cigarette or e-cigarette use.
“The gap that may have existed in 2021 and years prior seems to be closing over time, such that in 2023, boys and girls were using tobacco at similar frequencies in response to risk factors such as violence exposure,” Haderlein said.
The researchers said the findings should serve as a warning for educators, healthcare professionals and policymakers.
Schools, they argue, should not view bullying prevention merely as a behavioural or disciplinary issue. It may also be an important tobacco-control intervention. Similarly, healthcare providers and school counsellors should routinely assess violence exposure among adolescents and identify those at heightened risk of nicotine use.
“Identifying students who have experienced violence or are at risk of experiencing violence and assessing their risk for tobacco use may be crucial for effective prevention,” Haderlein said.
Violence prevention, early identification and timely intervention programmes could play an important role in reducing adolescent tobacco use, the study said.
