Journal of Immigrant and Minority Health

, Volume 10, Issue 5, pp 407–414 | Cite as

Smoking Patterns within a Primary Care Sample of Resettled Bosnian Refugees

  • Terri L. Weaver
  • Aida Čajdrić
  • Erik R. Jackson
Original Paper


The interconnections among smoking status, severity of nicotine related physical dependence (NRPD), posttraumatic stress disorder (PTSD)-related physiological arousal and subjective health were explored within a sample of 66 resettled Bosnian refugees seeking primary healthcare services. Fifty-nine percent (n = 39/66) of the participants reported that they were current smokers and 44% (n = 29/66) indicated that they had smoked prior to the war. Both pre-war smoking and PTSD arousal independently predicted current smoking. In addition, total PTSD arousal and individual symptoms of sleep difficulties, irritability, concentration, and hypervigilance were significantly and positively associated with NRPD. Severity of PTSD arousal and age uniquely predicted NRPD. While poorer subjective health was significantly associated with positive current smoking status, neither poorer subjective health nor severity of PTSD arousal was significantly associated with interest in quitting/reducing smoking. Findings were discussed within the context of culture and stressor-related issues.


Refugees Tobacco smoking Posttraumatic stress disorder Health 



Terri L. Weaver and Aida Čajdrić, Department of Psychology, Saint Louis University. Correspondence can be directed to Terri L. Weaver, Ph.D., Saint Louis University, Department of Psychology, 221 North Grand Blvd., Saint Louis, Missouri, 63103, E-mail: Erik R. Jackson, Ph.D. is now at the Department of Rehabilitation Medicine at the University of Washington School of Medicine. This work was supported in part by an internal grant from Saint Louis University awarded to Terri L. Weaver, Ph.D., principal investigator. Portions of this paper were presented at the 36th annual meeting of the Association for the Advancement of Behavior Therapy, Reno, Nevada.

We would like to thank Jasmina Mandzukic for her assistance with assessment translations and conducting interviews and Patrick McCarthy for assistance with research assistant recruitment.


  1. 1.
    Tobacco Information and Prevention Source, CDC. (November, 2005) percentage of smoking prevalence among U.S. adults, 18 years of age and older, 1955–2004. Retrieved February 7, 2006 from (
  2. 2.
    Centers for Disease Control and Prevention. Cigarette smoking among adults-United States. Morb Mortal Wkly Rep 2005;54(44):1121–4.Google Scholar
  3. 3.
    WHO––Tobacco Free Initiative, The Tobacco Atlas. 2002. Tobacco control. WHO tobacco control papers. Retrieved on February 6, 2006 at
  4. 4.
    Creson D, Schmitz JM, Arnautovic A. War-related changes in cigarette smoking: a survey study of health professionals in Sarajevo. Subst Use Misuse 1996;31(5):639–46.PubMedCrossRefGoogle Scholar
  5. 5.
    Kopinak JK. The health of bosnian refugees in Canada. Ethn Health 1999;4(1):65–83.PubMedCrossRefGoogle Scholar
  6. 6.
    Kassel JD, Stroud LR, Paronis CA. Smoking, stress, and negative affect: correlation, causation, and context across stages of smoking. Psychol Bull 2003;129(2):270–304.PubMedCrossRefGoogle Scholar
  7. 7.
    Nesbitt PD. Smoking, physiological arousal and emotional response. J Pers Soc Psychol 1973;25:137–44.PubMedCrossRefGoogle Scholar
  8. 8.
    Pomerleau OF, Pomerleau CS. Neuroregulators and the reinforcement of smoking: towards a biobehavioral explanation. Neurosci Biobehav Rev 1984;8:503–13.PubMedCrossRefGoogle Scholar
  9. 9.
    Benowitz NL. Nicotine addiction. Prim Care 1999;26(3):611–31.PubMedGoogle Scholar
  10. 10.
    Breslau N, Davis GC, Schultz LR. Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who experienced trauma. Arch Gen Psychiatry 2003;60:289–94.PubMedCrossRefGoogle Scholar
  11. 11.
    Preamble to the Constitution of the WHO, Official Records of the WHO, no. 2 p. 100, New York, (June–July, 1946). Retrieved February 7, 2006 at
  12. 12.
    Froom P, Melamed S, Triber I, Ratson NZ, Hermoni D. Predicting self-reported health: the CORDIS study. Prev Med 2004;39(2):419–23.PubMedCrossRefGoogle Scholar
  13. 13.
    Shields M, Shooshtari S. Determinants of self-perceived health. Health Rep 2001;13(1):35–52.PubMedGoogle Scholar
  14. 14.
    Colsher PL, Wallace RB, Pomrehn PR, LaCroix AZ, Cornoni-Huntley J, Blazer D Scherr PA, Berkman L, Hennekens CH. Demographic and health characteristics of elderly smokers: results from established populations for epidemiologic studies of the elderly. Am J Prev Med 1990;6(2):61–70.PubMedGoogle Scholar
  15. 15.
    Kim O, Baik S. Alcohol consumption, cigarette smoking, and subjective health in Korean elderly men. Addict Behav 2004;29(8):1595–603.PubMedCrossRefGoogle Scholar
  16. 16.
    Foa EB, Riggs DS, Dancu CV, Rothbaum BO. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress 1993;6(4):459–73.CrossRefGoogle Scholar
  17. 17.
    Miller KE, Weine SM, Ramic A, Brkic N, Djuric-Bijedic Z, Smajkic A, Boskailo E, Worthington G. The relative contributions of war experiences and exile-related stressors to levels of psychological distress among bosnian refugees. J Trauma Stress 2002;15(5):377–87.PubMedCrossRefGoogle Scholar
  18. 18.
    Spasojevic J, Heffer RW, Snyder DK. Effects of posttraumatic stress and acculturation on marital functioning in bosnian refugee couples. J Trauma Stress 2000;13(2):205–16.PubMedCrossRefGoogle Scholar
  19. 19.
    Stieglitz RD, Frommberger U, Foa EB, Berger M. Evaluation of the German version of the PTSD symptom scale (PSS). Psychopathology 2001;34(3):123–33.CrossRefGoogle Scholar
  20. 20.
    Weine SM, Vojvoda D, Becker DF, McGlashan TH, Hodzic E, Laub D, Hyman L, Sawyer M, Lazrove S. PTSD symptoms in Bosnian refugees 1 year after resettlement in the United States. Am J Psychiatry 1998;155(4):562–4.PubMedGoogle Scholar
  21. 21.
    Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström Test for nicotine dependence: a revision of the Fagerström tolerance questionnaire. Br J Addict 1991;86:1119–27.PubMedCrossRefGoogle Scholar
  22. 22.
    Etter J, Vu Duc T, Perneger TV. Validity of the Fagerström test for nicotine dependence and the heaviness of smoking index among relatively light smokers. Addiction 1999;94:269–81.PubMedCrossRefGoogle Scholar
  23. 23.
    Nichter M. Smoking: what does culture have to do with it? Addiction 2003;98(suppl 1):130–45.Google Scholar
  24. 24.
    Keyes EF, Kane CF. Belonging and adapting: mental health of Bosnian refuges living in the United States. Issues Ment Health Nurs 2004;25:805–31.CrossRefGoogle Scholar
  25. 25.
    Weaver TL, Etzel JC. Smoking patterns, symptoms of PTSD and depression: preliminary findings from a sample of severely battered women. Addict Behav 2003;28:1665–79.PubMedCrossRefGoogle Scholar
  26. 26.
    Beckham JC, Kirby AC, Feldman ME, Hertzberg MA, Moore SD, Crawford AL, Davidson JR, Fairbank JA. Prevalence and correlates of heavy smoking in Vietnam veterans with chronic posttraumatic stress disorder. Addict Behav 1997;22(5):637–47.PubMedCrossRefGoogle Scholar
  27. 27.
    Colrain IM, Trinder J, Swan GE. The impact of smoking cessation on objective and subjective markers of sleep: review, synthesis, and recommendations. Nicotine Tob Res 2004;6(6):913–25.PubMedCrossRefGoogle Scholar
  28. 28.
    Forneris CA, Butterfield MI, Bosworth HB. Physiological arousal among women veterans with and without posttraumatic stress disorder. Mil Med 2004;169(4):307–12.PubMedGoogle Scholar
  29. 29.
    Beckham JC, Gehrman PR, McClernon FJ, Collie CF, Feldman ME. Cigarette smoking, ambulatory cardiovascular monitoring, and mood in Vietnam veterans with and without chronic posttraumatic stress disorder. Addict Behav 2004;29(8):1579–93.PubMedCrossRefGoogle Scholar
  30. 30.
    Tracy RP, Psaty BM, Macy E, Bovill EG, Cushman M, Cornell ES, Kuller LH. Lifetime smoking exposure affects the association of c-reactive protein with cardiovascular disease risk factors and subclinical disease in healthy elderly subjects. Arterioscler Thromb Vasc Biol 1997;7:2167–76.Google Scholar
  31. 31.
    Duncan CL, Cummings SR, Hudes ES, Zahnd E, Coates TJ. Quitting smoking: reasons for quitting and predictors of cessation among medical patients. J Gen Intern Med 1992;7(4):398–404.PubMedCrossRefGoogle Scholar
  32. 32.
    Resnicow K, Soler R, Braithwaite RL, Ahluwalia JS, Butler J. Cultural sensitivity in substance use prevention. J Comm Psychol 2000;28(3):271–90.CrossRefGoogle Scholar
  33. 33.
    Kessler RC. The epidemiology of dual diagnosis. Biol Psychiatry 2004;56(10):730–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Terri L. Weaver
    • 1
  • Aida Čajdrić
    • 1
  • Erik R. Jackson
    • 1
  1. 1.Department of PsychologySaint Louis UniversitySaint LouisUSA

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