Cigarette smoking in Serbia. Impact of the 78-day NATO bombing campaign.

PURPOSE To estimate short-term and long-term influence of protracted stress caused by the NATO bombing of Serbia on self-reported cigarette smoking, we performed and analyzed smoking survey data. MATERIALS AND METHODS The survey included 320 adult citizens from Sombor, Novi Sad, and Belgrade, three cities that were bombed during the NATO campaign along with other Serbian target cities. We queried participants about their smoking habits before, during, and 8 years after the military intervention. We recorded smoking prevalence rates, intentions to stop smoking, and the age at which smoking began. We also recorded smoking history and cessation attempts. RESULTS Prior to bombing, 48% of the women and 63% of the men were smokers. During the bombing period, smoking prevalence in male smokers increased significantly. During this period, 32% of the women and 36% of the men increased their smoking by as much as two packs of cigarettes per week. A month after the bombing, the rate of consumption returned to the prewar levels. At present, 44% of the women, and 59% of the men smoke. The average age of current smokers is 43 years (standard deviation /SD/, 14.4) for women and 45 (SD, 16.3) years for men. Female smokers expressed greater interest in quitting smoking than their male counterparts, and they were slightly more successful than men at maintaining abstinence (20 vs. 18%). The participants in our study acknowledged that a compounding factor for successful abstinence was information on depleted uranium (DU) and other pollutants introduced into the environment by the war. CONCLUSION Prolonged stress imposed by war causes a short-term increase in smoking prevalence in male smokers and higher cigarette consumption both in male and female smokers. Even though these increases dissipated after the war was over, the prevalence of smoking within the population of urban Serbia remains very high. Counseling and pharmacological support for abstinence relapse in Serbia ere insufficient to sustain smoking cessation during the 8-year period after the NATO bombing. Motivation for smoking cessation stems primarily from governmental regulatory measures and awareness of the dangers to health posed by tobacco smoking.