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Editor,—The purpose of the current study, which was carried out in 1995, was to explore the prevalence of mental disorders, including tobacco use, in Udmurtia. Udmurtia is a former Autonomous Soviet Socialist Republic that currently is a Constituent Republic of the Russian Federation. According to the census of 1989, the population of the republic is about 1.6 million. The total rural population is 485 890, with the majority of the population being of Udmurt (57.8%) and Russian (37.1%) ethnic origin. The Udmurts are similar to Estonians, Finns, and Hungarians in that they belong to the group of Finno-Ugric nations.
The study sample of 855 subjects was drawn by systematic random sampling from the lists of rural inhabitants in the age range 18–65 years. In order to explore tobacco use patterns we used a Composite international diagnostic interview 1.1,1 which was designed for assessment of mental disorders (including tobacco dependence) according to the criteria of theInternational classification of diseases, 10th revision (ICD-10), and the Diagnostic and statistical manual of mental disorders, third edition, revised (DSM-III-R). As in our study tobacco dependency showed nearly identical prevalence by both classifications, only data according to ICD-10 are presented.
The prevalence of lifetime smoking (current and ex-smokers) in our sample was 72.3% in men and 2.5% in women, which was slightly more than the average rate of smoking in Russia.2 Sixty nine per cent (68.8%) of men and 2.3% of women were current smokers. The rate of tobacco dependent men (52.7%) was similar to the rate of heavy smokers (50.5%). Heavy smokers were defined as those who smoked 15 or more cigarettes per day. Nearly 60% of ever smokers had attempted to quit, but only 5% had been abstinent for more than one year.
We found an association between tobacco use and ethnicity. Russian men were more likely to be current smokers than Udmurt men (78.7%v 64.4% p < 0.05), although no association between the ethnicity and tobacco dependence was found. This suggests that Udmurts may be more vulnerable to tobacco dependence than Russians. A similar relation has been found for alcohol dependence.3 In Udmurt men there was a significant association between tobacco dependence and alcohol dependence (odds ratio 2.59, 95% confidence interval 1.39 to 4.88).
Our data also support an association between tobacco use and suicidal behaviour.4 A significant association was found between tobacco smoking and suicide attempts in Udmurt men. A suicide attempt was reported by 19 Udmurt men of whom 17 (89.5%) used tobacco (p = 0.048). Three of the four Russian men who had attempted suicide smoked cigarettes.
Tobacco is a leading cause of avoidable death in Russia.2The risk for smoking attributable morbidity and mortality increases the earlier in life smoking begins.5 In our study, more than half of all smokers (58%) had begun to smoke regularly before they were 20 years old, and 86% before 25 years old. The majority of smokers had a long duration of smoking: 95% of smokers had smoked regularly for five years or more, and 72% for 10 years or more. Moreover, the majority of smokers in our sample used cheap low quality cigarettes without filters that have high nicotine and tar contents, that also increase considerably the risk of mortality.6The findings of this study highlight the urgent need for a more effective tobacco control policy in the region of Udmurtia. The various public health measures that may help to reduce smoking, particularly among the young men, should be vigorously applied.
This work was supported financially by Eli Lilly (Suisse) SA Eesti Filiaal.
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