Tobacco Use and Nicotine Dependence among Conflict-Affected Men in the Republic of Georgia

Article published on International Journal of Environmental Research and Public Health ISSN 1660-4601

by Bayard Roberts, Ivdity Chikovani, Nino Makhashvili, Vikram Patel and Martin McKee

There is very little evidence globally on tobacco use and nicotine dependence among civilian populations affected by armed conflict, despite key vulnerability factors related to elevated mental disorders and socio-economic stressors.

The study aim was to describe patterns of smoking and nicotine dependence among conflict-affected civilian men in the Republic of Georgia and associations with mental disorders.

As research in populations free from conflict has shown that greater tobacco use and nicotine dependence are associated with both post-traumatic stress disorder (PTSD) and common mental disorders such as depression, anxiety and alcohol use, it might be expected that those exposed to conflict may be more vulnerable to heightened tobacco use. Indeed, there is increasing concern over chronic diseases among conflict-affected populations, including tobacco-related diseases. Yet despite this potential vulnerability for heightened tobacco use, there are very few studies on tobacco use among conflict-affected civilian populations and they are generally characterized by small sample sizes and limited analysis, with only a few examining associations between tobacco use and mental disorders or trauma exposure. Identified papers include those addressing: smoking patterns of 989 Kurdish youth in Iraq; antismoking messages and current cigarette smoking status among 1,122 youth in Somaliland; current smoking and smoking cessation rates among 740 elderly people (including refugees) in Beirut, Lebanon; variances in smoking rates between 32 adolescent IDPs with 528 non-IDPs adolescents in Belgrade, Serbia; links between subjective threat of armed conflict and psychosocial outcomes (including cigarette smoking) among 24,935 conflict-affected Israeli and Palestinian youth; tobacco use among 194 immigrant and refugee youth in British Columbia, Canada; and smoking patterns, nicotine dependence and correlations with PTSD among 66 Bosnian refugees in a primary care setting in the United States.

Better understanding of patterns and determinants of smoking is a first step in strengthening tobacco control, tackling tobacco use and its effects and thus of improving the long-term health of conflict-affected populations. This paper takes advantage of data collected as part of a broader study on mental health among conflict-affected populations in Georgia to examine smoking and nicotine dependence among conflict-affected civilian men in the Republic of Georgia.

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