# The Built Environment, PTSD Symptoms, and Tobacco Use among Permanent Supportive Housing Residents

## TL;DR

This study finds that the quality of housing and neighborhood safety can influence the link between PTSD and smoking among residents in supportive housing.

## Contribution

The study identifies built environment factors as moderators in the relationship between PTSD and tobacco use in supportive housing.

## Key findings

- PTSD symptoms were linked to higher cigarette use in residents with good housing or safer neighborhoods.
- No significant difference in smoking was found among those with poor housing or unsafe neighborhoods, regardless of PTSD status.
- The findings suggest that interventions should consider both individual and environmental factors to address tobacco use.

## Abstract

50% of permanent supportive housing (PSH) residents in the U.S. smoke cigarettes, and tobacco-related mortality is their number one cause of death. Over 30% of PSH residents have post-traumatic stress disorder (PTSD), and many perceive their built environment (e.g., housing) as inadequate for mental and physical health recovery. It is unknown whether built environment factors moderate the relationship between PTSD and tobacco use among PSH residents.

We used baseline data from 400 participants in a smoke-free home intervention in PSH sites in the San Francisco Bay Area between 2022 and 2024. We explored whether perceived housing quality and perceived neighborhood safety moderated the relationship between PTSD symptoms and cigarettes per day (CPD) using linear mixed models.

62.8% of the participants were male, 41.8% were Black, 30.5% screened positive for PTSD, 54.3% rated their housing as average/poor, and the mean neighborhood safety score was 3.4 (SD 0.9). Mean CPD was significantly higher in participants with PTSD compared to those without PTSD among participants who rated their housing as good/excellent (5.1; 95% CI: 2.7, 7.5) or their neighborhood as safer (7.8; 95% CI: 2.8, 12.8). Mean CPD was not significantly different between those with and without PTSD among participants who rated their housing as average/poor or their neighborhood as less safe.

Perceived housing quality and neighborhood safety moderated the association between PTSD symptoms and CPD. Findings have implications for developing trauma-informed, multi-level interventions for tobacco use that combine individually directed approaches with those that consider the built environment.