Over the past several decades, the use of combustible cigarettes (hereafter referred to as “smoking”) in the United States has declined overall (Cornelius et al., 2021) but remains elevated for persons living with PTSD (Kearns et al., 2018, Pericot-Valverde et al., 2018). Compared to people without PTSD, those with PTSD are more likely to smoke, more likely to smoke more cigarettes, and are less likely to quit smoking (Pericot-Valverde et al., 2018). General population data show that PTSD and traumatic exposure are each associated with current smoking and greater smoking intensity (Estey et al., 2021). Individuals with PTSD who smoke have more frequent quit attempts than those without PTSD (Budenz et al., 2021), but are less likely to achieve smoking cessation, due to a higher likelihood of resuming smoking (Kearns et al., 2018, Zvolensky et al., 2008).

After the World Trade Center (WTC) attack on September 11th, 2001 (9/11), the World Trade Center Health Registry (WTCHR) was established as a collaboration between New York City Department of Health (DOH) and the Centers for Disease Control and Prevention (CDC); the World Trade Center Health Program (WTCHP) has provided 9/11-related healthcare for survivors and rescue/recovery workers. Community members and responders enrolled in the WTCHR have a persistently high prevalence of PTSD (Sisti et al., 2025). Previous studies of WTC-exposed individuals report that those with PTSD are more likely to smoke (Vlahov, 2002, Zvolensky et al., 2015), though overall smoking prevalence in the exposed population has decreased in the years since the disaster (Welch et al., 2015).

Among the WTC-exposed population, PTSD is comorbid with several physical health conditions including asthma and GERD (Li et al., 2011), whose symptoms may be exacerbated or worsened by cigarette smoking. It is therefore imperative to promote targeted smoking cessation efforts in the WTC-exposed population. The WTCHR previously examined data from 2003 to 2012 and found that odds of quitting were 25–39 % lower among people who smoke with probable PTSD compared to those without PTSD (Welch et al., 2015). With eight additional years of follow-up, we build upon that previous work to examine the association between probable PTSD and subsequent smoking cessation among WTCHR enrollees who currently smoke.