Elsevier

Public Health

Volume 117, Issue 4, July 2003, Pages 228-236
Public Health

Prevalence and determinants of smoking in Tirana city, Albania: a population-based survey

https://doi.org/10.1016/S0033-3506(03)00084-2Get rights and content

Abstract

Background. Smoking is the leading cause of premature death in Europe yet there are still many countries in which there is little information on its patterns and determinants. Albania is one such country.

Methods. A survey of health and lifestyle, including questions on smoking practice and attitudes, and its determinants was undertaken in Tirana, the capital of Albania in mid 2001.

Subjects. One thousand one hundred and twenty adults aged 25 years and over (response rate 72.7%).

Results. Forty-one percent of the study population (61% male and 24% female) were current or ex-smokers—28% were current smokers (37.6% of males and 19.3% of females) and 13% were ex-smokers (23.4% of males and 4.7% of females). Age-standardized (to the European standard population) prevalence of smoking for the adult population of Tirana was 31.2% (42.8% in males and 21.2% in females). Smoking was most common among those aged 25–34 years (59% of males and 30% of females in this age group). Of the current smokers, 16.5% smoked more than 20 cigarettes/day, and 67.3% smoked the first cigarette within 30 min of waking. Only 11% of current smokers had tried to quit smoking once during their life. Concern about health was the most common reason for quitting cited by ex-smokers (44%). In men, smoking was inversely associated with educational achievement. While the probability of smoking decreases with age, there was no consistent association with employment or income.

Conclusion. The prevalence of smoking in Albania is comparable with other Western societies. The high rates of smoking among young men and women suggest that tobacco will make an increasingly large contribution to premature morbidity and mortality in the future. The high rate of smoking among young women in Albania, while a common phenomenon in post-communist countries, is especially worrying. This study emphasizes the need for a robust, evidence-based strategy for tobacco control in Albania.

Introduction

Global mortality attributable to tobacco is likely to rise from about four million deaths/year in 1998 to about 10 million deaths/year in 2030. Half of these deaths will occur between the ages of 35 and 69 years, including many in productive middle age, with an average loss of 20–25 years of life.1 In Eastern Europe, the problem is particularly critical with 20% of all men aged 35 years expected to die from a tobacco-related illness by the age of 69 years. This is twice the rate seen in Western Europe, and smoking is believed to explain a significant part of the East–West mortality gap amongst men in Europe.2

Albania was isolated economically from the rest of Europe for most of the twentieth century, although it had a sizeable domestic cigarette industry which produced mainly unfiltered, high-tar cigarettes from homegrown tobacco. Official data on the scale of the industry are limited but those that exist show that the proportion of agricultural land given over to tobacco increased from 3.2% in 1970 to 4.8% in 1992.3 In 1992, Albania produced 15,000 tonnes of unmanufactured tobacco, two-thirds of which were exported; a doubling of the amount exported in 1980. The prevalence of smoking in the pretransition period is, however, unknown. A detailed search of state archives has found no relevant surveys.4 However, from personal knowledge, smoking was relatively common among men but not women, a feature typical of countries with state-owned tobacco industries.5 This is supported by mortality data from 1990, which show that male lung cancer death rates (47.9/100,000) were about eight times higher than those of women (5.8/100,000), although even the male rates were only about half of the average level in Central and Eastern Europe.6

After 1991, Albania opened its borders to the outside world, including international tobacco companies who, although reticent to invest directly in Albania, were quick to flood the country with their cigarette imports and slick marketing techniques. Philip Morris has been paying young women several times the average income to distribute free cigarettes,7 and tobacco advertising, which was previously unknown, is now common. The impact of these changes on tobacco trade and consumption is difficult to ascertain due to the lack of data. The inadequate trade data reflects both the challenges of creating the institutions of government following the political transition and the major role Albania plays in the contraband trade with neighbouring countries, which industry documents suggest involves the customs authorities.8 It has been argued that recent decisions by transnational tobacco companies to invest in cigarette manufacturing in the Balkans reflects their desire to take advantage of existing smuggling networks.9 United States Department of Agriculture data suggest that Albania's cigarette production has increased slightly from 6.8 billion in 199110 to 7.25 billion in 2000,11 but as much production now takes place in poorly regulated small-scale enterprises, such data must be treated with caution.

There is similarly little information on the impact of transition on smoking behaviour as few surveys were conducted in Albania during this period. The first survey3 was conducted in 1990 among adults aged 25 years and above, and found that nearly half (49.8%) of the male population of Albania smoked. Among females, smoking prevalence was 7.9%. Another survey12 was undertaken in Tirana City as part of a study of allergy in the mid 1990s on a restricted age range of 20–44 year olds. It found an overall smoking prevalence among men of 44.4% and among women of 6.3%. Finally, a recent survey amongst those aged 15 years and over, covering 20 of the 36 districts of Albania,13 found an overall smoking prevalence of 39% (60% in men and 18% in women).

Given the impact that trade liberalization has had on tobacco consumption elsewhere,14 and the importance of knowing baseline prevalence and determinants of smoking for development and monitoring of effective tobacco control strategies, there is an urgent need for information on current smoking prevalence and its determinants in Albania.

This paper describes the situation in Tirana City, the capital of Albania, in mid 2001.

Section snippets

Study design

A population-based survey was undertaken in 2001 to investigate the health behaviours and health status of individuals aged 25 years and over living in Tirana City, Albania. Ethical approval was granted by the Albanian Ministry of Health and the London School of Hygiene and Tropical Medicine. The primary aim of the study was to determine the prevalence of type 2 diabetes in the Tirana population. This determined the required sample size for the study, which was estimated to be 1188 people to be

Response rate

Of 1540 individuals invited to participate, 1120 did so (response rate 72.7%). Those who declined to participate were, broadly, more likely to be younger (Fig. 1) and male than the reference Tirana population.

Prevalence of smoking

One thousand one hundred and twenty people (535 men and 585 women) participated in the study. Overall, 41% of the population (61% male and 24% female) had ever smoked. Twenty-eight percent (95% confidence interval 23–33%) were current smokers [37.6% (33.5–41.7%) of men and 19.3%

Discussion

This study provides important new evidence on the prevalence and determinants of smoking in Albania. However, before discussing the findings in detail, it is necessary to reflect on some methodological issues.

One strength of the study is its relatively high response rate (72.7%). The participation rate is equivalent to rates in a recent survey in Ukraine and higher than that seen in Belarus.17., 18. In spite of this, the final sample was not entirely representative of the general population in

Acknowledgements

We would like to thank all the staff of Diabetic Centre ‘Neo-Style’ in Tirana for their collaboration and support. This study was funded by the Wellcome Trust (Project Grant No. 061573). However, the Wellcome Trust cannot accept any responsibility for any information provided or views expressed. The authors have no conflict of interest.

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