Abstract
Background: 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. Methods: A cross-sectional household survey using multistage random sampling was conducted in late 2011 among conflict-affected populations in Georgia. Respondents included in this paper were 1,248 men aged ≥18 years who were internally displaced persons (IDPs) and former IDPs who had returned in their home areas. Outcomes of current tobacco use, heavy use (≥20 cigarettes per day), and nicotine dependence (using the Fagerström Test for Nicotine Dependence) were used. PTSD, depression, anxiety and hazardous alcohol use were also measured, along with exposure to traumatic events and a range of demographic and socio-economic characteristics. Results: Of 1,248 men, 592 (47.4%) smoked and 70.9% of current smokers were heavy smokers. The mean nicotine dependence score was 5.0 and the proportion with high nicotine dependence (≥6) was 41.4%. In multivariate regression analyses, nicotine dependence was significantly associated with PTSD (β 0.74) and depression (β 0.85), along with older age (except 65+ years), and being a returnee (compared to IDPs). Conclusions: The study reveals very high levels of heavy smoking and nicotine dependence among conflict-affected persons in Georgia. The associations between nicotine dependence, PTSD and depression suggest interventions could yield synergistic benefits.
Highlights
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 [6,7,8,9,10,11,12], it might be expected that those exposed to conflict may be more vulnerable to heightened tobacco use
A total sample size of 3,600 was determined to meet the statistical requirements of the overall study. This consisted of 1,200 respondents from each of the three main conflict-affected populations groups in Georgia: those displaced as a result of conflicts in the 1990s (“old internally displaced persons (IDPs)”), those displaced after the 2008 conflict (“new IDPs”) and 1,200 former “new IDPs” who have returned to their home areas (“returnees”)
Summary
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. There are currently an estimated 40 million persons that have been forcibly displaced from their home areas by armed conflict, the vast majority of whom live in low and middle income countries. 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 [6,7,8,9,10,11,12], it might be expected that those exposed to conflict may be more vulnerable to heightened tobacco use. There is increasing concern over chronic diseases among conflict-affected populations [13], including tobacco-related diseases
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