Violence prevention can be a form of substance use prevention
A study from Brown University places a quiet but urgent finding into the larger story of adolescent suffering: young people who experience violence — whether in hallways, online, at home, or in moments of violation — are measurably more likely to reach for tobacco as a means of coping. Researchers Nicole Haderlein and Alexander Sokolovsky, drawing on CDC surveillance data, found that each form of violence independently raised the risk of smoking, and that multiple exposures compounded that risk in a clear, cumulative pattern. The study invites us to see tobacco use not merely as a behavioral choice but as a signal — a visible trace of invisible wounds that schools, clinics, and communities have yet to fully answer.
- Every form of violence studied — bullying, cyberbullying, sexual violence, domestic violence — independently raised the likelihood that a teenager would smoke cigarettes or use e-cigarettes.
- The risk does not plateau: teens exposed to multiple forms of violence face a steeply climbing dose-response effect, meaning the more harm they absorb, the more they reach for tobacco.
- The gender gap that once existed — boys smoking more than girls in response to violence — had fully closed by 2023, signaling that young women are now equally burdened by this coping pattern.
- With one in five teens reporting bullying and 15% reporting cyberbullying, these are not edge cases — they are the daily texture of adolescent life for millions of American youth.
- Researchers are calling on doctors, teachers, and counselors to routinely screen for violence exposure, arguing that preventing violence may be one of the most effective tools for preventing addiction.
Public health researchers at Brown University have confirmed what many educators have long sensed: teenagers who experience violence are significantly more likely to smoke cigarettes or use e-cigarettes. The study, published in Substance Use & Misuse, was led by Nicole Haderlein alongside assistant professor Alexander Sokolovsky, and drew on CDC data tracking health behaviors among American youth.
The team examined four forms of violence — bullying, cyberbullying, sexual violence, and domestic violence — and found that each one independently increased tobacco use risk. More striking still, when teenagers experienced multiple forms of violence, their risk climbed further in a clear dose-response pattern. That pattern held for both boys and girls. Notably, a gender gap that existed in 2021 — with boys more likely to smoke in response to violence — had disappeared by 2023, with young men and women now using tobacco at comparable rates.
The scale of exposure makes the findings especially pressing. About one in five teens report bullying, 15 percent report cyberbullying, and five percent report sexual or domestic violence. These are not rare experiences — they are woven into the daily lives of millions of adolescents.
Haderlein and Sokolovsky frame their findings as a call to action. Medical providers, school counselors, and educators should routinely ask young people about violence exposure and assess tobacco risk in the same breath. The researchers argue that violence prevention programs should be understood as substance abuse interventions too — that when a teenager reaches for a cigarette after a day of bullying, they are responding to something real, and the adults around them must learn to respond in kind.
A team of public health researchers at Brown University has documented what many educators and counselors have long suspected: teenagers who experience violence are significantly more likely to smoke cigarettes or use e-cigarettes. The finding, published in Substance Use & Misuse, suggests that for many young people, tobacco may function as a way to manage the stress and trauma of violent exposure.
The study examined four distinct forms of violence—bullying, cyberbullying, sexual violence, and domestic violence—and their relationship to tobacco use among adolescents. Nicole Haderlein, who led the research as part of her master's thesis at Brown, analyzed data from the Youth Risk Behavior Surveillance System, a CDC database that tracks health behaviors among American youth. She and her collaborator, assistant professor Alexander Sokolovsky, looked at how each type of violence independently affected smoking rates, and also examined what happened when teenagers experienced multiple forms of violence simultaneously.
The prevalence of these exposures is sobering. About one in five teenagers report experiencing bullying. Roughly 15 percent have encountered cyberbullying. And five percent report having experienced sexual violence or domestic violence. These are not rare occurrences in the lives of American youth—they are widespread realities that shape how millions of adolescents move through their days.
Every single form of violence the researchers examined was associated with increased cigarette and e-cigarette use in the past month. But the relationship did not stop there. When teenagers experienced multiple types of violence, their risk for tobacco use climbed further. The more violence a young person was exposed to, the more likely they were to smoke. This dose-response pattern held true for both boys and girls, though the researchers did notice something shifting over time. In 2021, boys who experienced violence were more likely to smoke than girls in similar circumstances. By 2023, that gap had closed. Young men and women were now using tobacco at comparable rates in response to violence exposure.
Haderlein and Sokolovsky interpret these findings as a call to action for the adults who work with teenagers. Medical providers, teachers, school counselors, and other professionals who interact with young people should routinely ask about violence exposure and assess tobacco use risk. The researchers argue that identifying students who have experienced violence—or who are at risk of experiencing it—could be crucial for preventing substance use before it takes hold. Violence prevention programs, they suggest, should be understood not only as efforts to reduce harm in the moment but as potential interventions against future tobacco addiction.
Sokolovsky framed the stakes plainly: teenagers exposed to violence face elevated risk for tobacco use, and that risk can be addressed. The pathway forward is not to treat violence and substance abuse as separate problems but to recognize them as connected. When a young person reaches for a cigarette after a day of bullying, or turns to vaping after witnessing domestic conflict, they are responding to something real. The question for schools, clinics, and communities is whether they will respond in turn.
Notable Quotes
These violence exposures are sadly common among youth, and it is important for medical providers and health researchers to pay attention to the relationship between violence and tobacco use.— Nicole Haderlein, Brown University researcher
Violence prevention can be a form of substance use prevention.— Alexander Sokolovsky, assistant professor of behavioral and social sciences, Brown University
The Hearth Conversation Another angle on the story
Why would violence exposure specifically lead to tobacco use rather than, say, other coping mechanisms?
The study doesn't definitively answer that, but the researchers suggest tobacco may be functioning as a coping tool—something accessible, something peers might normalize, something that provides immediate relief from stress. It's not the only response, but it's a common one.
The gap between boys and girls closed between 2021 and 2023. What does that tell us?
It suggests that girls' tobacco use in response to violence is rising, or boys' is staying steady while girls catch up. Either way, it means the protective factors that may have once existed for girls are eroding. Violence exposure is becoming an equally powerful driver for both.
If a school counselor identifies a student exposed to violence, what should they actually do?
The researchers don't prescribe specific interventions, but the implication is clear: screen for both violence and tobacco use together, treat them as connected problems, and connect students to violence prevention and mental health support. You can't address the smoking without addressing what's driving it.
Does this mean violence prevention is now a substance abuse prevention strategy?
That's exactly what Sokolovsky is arguing. If you reduce violence exposure, you reduce one major driver of tobacco use. It reframes violence prevention as having a public health benefit beyond the immediate harm it prevents.
What about the one in five teens experiencing bullying—is that number surprising?
Not to anyone working in schools. It's high, but it's the baseline reality. What's important is that the study quantifies the cost: those teens are at measurably higher risk for tobacco use. The prevalence makes the connection between violence and smoking a population-level problem, not an edge case.