Nicole Haderlein was reviewing studies on teen smoking when she noticed something troubling: researchers kept looking at violence and tobacco use in isolation, missing the bigger picture. So the Brown University public health researcher decided to do what existing studies hadn't—examine all the ways violence touches teenagers' lives and how each form connects to whether they light up a cigarette or vape.
What Haderlein discovered, published in Substance Use & Misuse, matters urgently for anyone working with teens. Violence exposure—bullying, cyberbullying, sexual violence, and domestic violence—is strongly linked to increased tobacco use among adolescents. But this isn't abstract. About one in five teens report experiencing bullying, roughly 15% have faced cyberbullying, and 5% have been exposed to sexual violence or domestic violence. These aren't rare problems; they're the everyday reality for millions of young people.
Working with Alexander Sokolovsky, an assistant professor of behavioral and social sciences at Brown, Haderlein analyzed data from the CDC's Youth Risk Behavior Surveillance System across two time periods, examining four distinct forms of violence exposure and how each related to past 30-day cigarette and e-cigarette use among both boys and girls. What emerged was striking: every single form of violence exposure was associated with increased tobacco use. And the effect wasn't simply additive—there was a dose-response pattern. The more types of violence a teen experienced, the higher their risk of using tobacco.
The researchers think they know why. Teens exposed to violence may be using cigarettes and e-cigarettes as a coping mechanism, a way to manage the stress, fear, and trauma that violence creates. The stakes of understanding this relationship have only grown clearer in recent years. In 2021, boys exposed to violence showed stronger links to cigarette use than girls did. But by 2023, that gap had closed. Now boys and girls are using tobacco at similar frequencies in response to violence exposure—a troubling convergence that suggests the problem is widening rather than shrinking.
Sokolovsky's warning cuts to the heart of why this research matters: "Every single form of violence was related to increased risk for using each substance. 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." This isn't just a correlation; it's a clear signal that violence and substance use are intertwined.
The implications reshape how schools, clinics, and communities should approach teen health. If violence prevention can reduce tobacco use, then every counselor, teacher, and medical provider should be asking teens about their safety. Haderlein emphasizes the practical next step: "Identifying students who have experienced violence or are at risk for experiencing violence and assessing their risk for tobacco use may be crucial for effective prevention." The researchers concluded that violence prevention, early detection, and intervention programs targeting adolescents could effectively reduce tobacco use—reframing prevention work not as separate silos but as interconnected health protection.
When violence prevention becomes substance abuse prevention, the stakes grow even higher.