Examining the Role of Behavioral Health Factors on Inpatient Traumatic Brain Injury Rehabilitation Outcomes Among Service Members and Veterans.

The study had no control group, so it cannot show that the rehabilitation program caused the improvements or that tobacco use caused slower PTSD improvement. The sample was mostly men, veterans, and active-duty service members, especially Special Operations Forces, so results may not apply to other people with TBI or PTSD. The analysed sample was a convenience sample, not a randomised or representative group. Data were self-reported and collected in a quality-improvement setting, not a trial, so reporting bias and the study design limit confidence. Alcohol and tobacco use were only recorded before treatment and were prohibited during treatment; the study did not track use over time or measure preinjury substance use, so it cannot separate preinjury exposure from treatment-period effects.

Authors declared payments from Virginia Commonwealth University Partners Against Mortality in Epilepsy, consulting for Ceresant Solutions, funding from the US Department of Veterans Affairs Physical Medicine and Rehabilitation National Program Office, and travel support to the 2026 Society of Behavioral Medicine conference. The study was conducted as a nonresearch quality-improvement initiative under oversight of a VA hospital research and development committee.

Do not read this as proof that quitting tobacco improves PTSD recovery. The study had no control group, relied on self-reported measures, and only showed an association between baseline tobacco use and slower PTSD symptom change.