Why Is Smoking Cessation So Hard for People With IBS?

Adults with irritable bowel syndrome (IBS) who smoke may face more challenges quitting, as severe IBS symptoms and high anxiety sensitivity increase perceived barriers to smoking cessation, make quitting more difficult, and strengthen the belief that smoking helps relieve negative feelings, according to a study.

IBS, previously known as functional gastrointestinal disorder, is the most prevalent condition involving gut-brain interaction, impacting 7% to 16% of individuals. | Image credit: PR Image Factory - stock.adobe.com

The study, published in Addictive Behaviors, was conducted to explore the connection between IBS and smoking, as both IBS symptom severity and anxiety sensitivity contribute to negative smoking-related behaviors and make quitting more difficult, highlighting their role in sustaining smoking habits.

IBS, previously known as functional gastrointestinal disorder, is the most prevalent condition involving gut-brain interaction, impacting 7% to 16% of individuals.² It is primarily marked by abdominal discomfort and disruptions in bowel function.

The condition is associated with high medical costs, work-life impairment, and psychological distress, yet lacks a reliable biomarker, making it challenging to treat. Previous research has shown that smoking may exacerbate IBS symptoms, but little is known about how smoking cessation processes, such as perceived barriers to quitting and past quit attempts, influence IBS outcomes.

Additionally, the authors noted: “Given initial empirical evidence that anxiety sensitivity may moderate cognitive-behavioral treatment response for IBS…, there is a need to examine the role of anxiety sensitivity in smoking-cessation–related beliefs and processes among persons with IBS.

The study recruited participants from across the US via Qualtrics Panels, allowing adults to self-select based on eligibility criteria. After screening, eligible participants provided informed consent and completed the survey. Compensation was offered in the form of gift cards, reward miles, or points.

The final sample included 263 participants with IBS who smoked at least 5 cigarettes daily. Demographic, smoking history, cigarette dependence, IBS symptom severity, anxiety sensitivity, and barriers to cessation were measured using self-report scales.

The participants were predominantly White and non-Hispanic/Latino (69.6%), with a significant portion also identifying as Hispanic/Latino White (11.0%) or non-Hispanic/Latino Black (9.5%). Chronic fatigue syndrome (39.2%) and chronic low back pain (38.8%) were the most common co-occurring conditions. The mean (SD) age of smoking onset was 17.8 years (6.93), and participants smoked an average of 18.5 cigarettes per day (16.42). Many also used other tobacco products, including cigars (51.0%), smokeless tobacco (38.4%), pipe tobacco (30.0%), and electronic cigarettes (24.3%).

Bivariate correlations revealed significant relationships between IBS symptom severity and cigarette dependence (risk ratio [RR], 0.34; P < .001), anxiety sensitivity (RR, 0.35, P < .001), perceived barriers to smoking cessation (RR, 0.44, P < .001), severity of problems during past quit attempts (RR, 0.30, P < .001), and negative reinforcement smoking expectancies (RR, 0.46, P < .001). Anxiety sensitivity was positively correlated with cigarette dependence (RR, 0.27, P < .001), perceived barriers to smoking cessation (RR, 0.56, P < .001), severity of problems during past quit attempts (RR, 0.46, P < .001), and negative reinforcement smoking expectancies (RR, 0.33, P < .001). These correlations highlight the interconnectedness of IBS symptoms, anxiety sensitivity, and smoking behaviors.

Hierarchical regression analysis showed that IBS symptom severity and anxiety sensitivity were significant predictors for perceived barriers to smoking cessation (P < .001) and severity of problems during past quit attempts (P < .001). For negative reinforcement smoking expectancies, IBS symptom severity was a significant predictor (P < .001), and a statistically significant interaction was found with anxiety sensitivity (P = .019). Specifically, IBS symptom severity had a stronger impact on negative reinforcement smoking expectancies for individuals with higher anxiety sensitivity (P < .001) compared to those with lower anxiety sensitivity (P = .020). The authors said that their findings emphasized the role of anxiety sensitivity in amplifying the relationship between IBS symptoms and smoking expectancies.

Study limitations included the cross-sectional design, the inclusion of only White participants, and the reliance on self-report measures, which suggests future research should incorporate diverse, longitudinal approaches with multimethod assessments.

The authors said that identifying factors preventing smoking cessation could lead to targeted interventions to reduce smoking-related health risks in the IBS population. Currently, no specialized smoking cessation programs exist for individuals with IBS, highlighting the need for integrated approaches that address both IBS management and anxiety sensitivity.

The authors concluded, “There is a continued need to further scientific understanding of smoking among IBS samples and to identify novel methods that can improve quitting among this vulnerable population.”

References

1. Zvolensky MJ, Smit T, Dragoni I, et al. Irritable bowel syndrome (IBS) and smoking: an evaluation of IBS symptom severity and anxiety sensitivity among adults in the United States. Addict Behav. 2025:160:108187. doi:10.1016/j.addbeh.2024.108187.

2. Camilleri M. Diagnosis and treatment of irritable bowel syndrome: a review. JAMA. 2021;325(9):865-877. doi:10.1001/jama.2020.22532