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Tobacco Use and Nicotine Dependence among Conflict-Affected Men in the Republic of Georgia
European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
Curatio International Foundations, Tbilisi 0162, Georgia
Global Initiative on Psychiatry, Tbilisi 0162, Georgia
Ilia State University, Tbilisi 0162, Georgia
Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
* Author to whom correspondence should be addressed.
Received: 2 April 2013; in revised form: 6 May 2013 / Accepted: 16 May 2013 / Published: 29 May 2013
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.
Keywords: tobacco; nicotine; Georgia; war; forced displacement
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Roberts, B.; Chikovani, I.; Makhashvili, N.; Patel, V.; McKee, M. Tobacco Use and Nicotine Dependence among Conflict-Affected Men in the Republic of Georgia. Int. J. Environ. Res. Public Health 2013, 10, 2185-2197.
Roberts B, Chikovani I, Makhashvili N, Patel V, McKee M. Tobacco Use and Nicotine Dependence among Conflict-Affected Men in the Republic of Georgia. International Journal of Environmental Research and Public Health. 2013; 10(6):2185-2197.
Roberts, Bayard; Chikovani, Ivdity; Makhashvili, Nino; Patel, Vikram; McKee, Martin. 2013. "Tobacco Use and Nicotine Dependence among Conflict-Affected Men in the Republic of Georgia." Int. J. Environ. Res. Public Health 10, no. 6: 2185-2197.