title: Tobacco use and nicotine dependence among conflict-affected men in the Republic of Georgia.
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.
authors.affiliation: European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK. bayard.roberts@lshtm.ac.uk
authors.forename: Bayard
authors.initials: B
authors.lastname: Roberts
authors.forename: Ivdity
authors.initials: I
authors.lastname: Chikovani
authors.forename: Nino
authors.initials: N
authors.lastname: Makhashvili
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000209:etiology; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D005846:Georgia (Republic) / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000453:epidemiology*; D014857:Warfare; D055815:Young Adult