Factors associated with smoking and e-cigarette use statuses among individuals with chronic diseases after hurricanes Helene and Milton.

INTRODUCTION

Natural disasters increase health risks for individuals with chronic diseases and may worsen substance use behaviors as a coping mechanism. The present study examined post-disaster intentions to use and past 30-day use of cigarettes and e-cigarettes and associated factors among individuals with chronic diseases who experienced hurricanes Helene and Milton.

METHODS

We conducted online panel surveys in US Federal Emergency Management Agency (FEMA)-declared disaster counties in Georgia, North Carolina, and South Carolina following hurricane Helene, and in Florida following Helene/Milton (October-November 2024). Study participants (n=418) included adults with self-reported diagnoses of diabetes, heart disease, lung/respiratory disease, or cancer. We employed validated measures of hurricane stressors, psychological distress (depression/anxiety), and climate change anxiety. Multiple logistic regression models were used to examine factors associated with intentions to use and past 30-day use of cigarettes and e-cigarettes.

RESULTS

Hurricane stressors were consistently associated with increased intentions and current use of both cigarettes and e-cigarettes (AORs ranging from 1.21 to 1.36, all p<0.001). Depression/anxiety symptoms were associated with increased post-disaster intentions to use cigarettes (AOR=1.91; 95% CI: 1.38-2.64, p<0.001) and e-cigarettes (AOR=1.66; 95% CI: 1.21-2.28, p<0.01), and past 30-day use of cigarettes (AOR=1.49; 95% CI: 1.10-2.02, p<0.05). Climate change anxiety (AOR=1.41; 95% CI: 1.07-1.85, p<0.05) was associated with increased past 30-day e-cigarette use.

CONCLUSIONS

In addition to hurricane stressors and depression and anxiety symptoms, climate change anxiety appears to be a factor associated with tobacco use, particularly, e-cigarettes. Post-disaster health assessments should incorporate substance use interventions for vulnerable populations with chronic conditions.