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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Patterns of nicotine dependence in four Eastern European countries

BMC Public Health > Ausgabe 1/2015
Dorota Kaleta, Kinga Polańska, Przemysław Korytkowski, Bukola Usidame, Leokadia Bąk-Romaniszyn
Wichtige Hinweise

Competing interest

The Authors declare that they have no competing interest.

Authors’ contribution

DK as a representative of the World Health Organization (WHO CO POL) coordinated the Global Adult Tobacco Survey in Poland, conceived the original idea for the analysis, co-drafted the paper and intellectually contributed to the development of the final manuscript. KP participated in the interpretation of the results and manuscript preparation. PK performed the data analysis. BU undertook the literature search. LBR commented on the drafts. All the authors read and approved the final paper.



Evidence of patterns of nicotine dependence, although crucial for developing and implementing effective tobacco control strategies, is limited in the Eastern European countries. The purpose of this study was to evaluate the correlates of high nicotine dependence among adults in Poland, Romania, the Russian Federation and Ukraine.


The data used in the current analysis is available from the Global Adult Tobacco Survey (2009–2011). Nicotine dependence was assessed using the Heaviness of Smoking Index (HSI), which covers two measures: reported cigarettes smoked per day and time to the first cigarette upon waking. Based on a six-point scale of HSI, nicotine dependence was categorized into low to moderate (score 0–3), and high dependence (score 4–6). Out of 31,936 completed interviews, we used data from 8229 daily smokers.


The study results indicate that more than 25 % of daily smokers were highly dependent on nicotine. Higher odds of high nicotine dependence were identified for males (OR = 1.5 in Poland and Romania, OR = 2.7 in Russia; p ≤ 0.001), people between 50–59 years of age (the highest odds in Romania; OR = 4.8; p ≤ 0.001) and those who had started smoking at a young age (the highest odds in Romania, OR = 5.0; p ≤ 0.001). Having fewer restrictions on smoking at home was significantly associated with a high level of nicotine dependence (the highest odds in Romania, OR = 3.0; p ≤ 0.001). A high proportion of the participants had no interest in quitting smoking, with a statistically significantly higher percentage observed among smokers highly dependent on nicotine compared to the less addicted (p ≤ 0.01).


Smokers highly dependent on nicotine constitute a quarter of the Romanian group of daily smokers and even more in the remaining three analyzed countries. Similar patterns of nicotine dependence were observed in all of the investigated countries showing that male gender, younger age at the smoking onset, and fewer restrictions on smoking at home were significantly associated with higher nicotine dependence. The study highlighted the fact that a high proportion of the participants had no interest in quitting smoking. These results underscore importance of policy measures as well as prevention and cessation interventions for smokers who are highly dependent on nicotine, which need to take into account the social gradient in smoking patterns.
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