Emotion Dysregulation Modulates the Association Between Cigarette Use and HPA-Axis Functioning Among Women Currently Experiencing Intimate Partner Violence

BACKGROUND: Cigarette use is a salient public health concern, particularly among women experiencing intimate partner violence (IPV). While smoking cigarettes may attenuate acute stress levels, it also exacerbates long-term stress reactivity by disrupting hypothalamic-pituitary-adrenal (HPA)-axis functioning. However, little is known about how emotion dysregulation may influence the impact of cigarette use on stress reactivity among women experiencing ongoing IPV. METHOD: This study examined whether emotion dysregulation moderates the association between cigarette use and HPA-axis functioning, measured by hair cortisol concentration, among 94 women currently experiencing IPV. Participants completed a baseline interview that included assessment of emotion dysregulation, followed by 30 days of thrice daily surveys that assessed cigarette use, and finally a follow-up interview where a hair sample was collected for cortisol analysis. RESULTS: Analyses revealed a significant moderating effect of emotion dysregulation on the association between cigarette use and HPA-axis functioning. Specifically, among women with low to moderate (but not high) emotion dysregulation, greater average cigarettes per day were associated with lower hair cortisol concentration during the 30-day sampling period. CONCLUSION: Findings suggest a potential stress-modulating function of cigarette use among women with low to moderate levels of emotion dysregulation, while elevated dysregulation may attenuate the stress-relieving effects of cigarette use. While the foremost priority is implementing safety-focused interventions and comprehensive domestic violence services to reduce ongoing relationship violence, our results also highlight the potential utility of tailoring smoking cessation interventions for women experiencing IPV to address emotion dysregulation and promote alternative stress-coping strategies.