Date of Award


Degree Type

Closed Thesis

Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Michael Eriksen - Chair

Second Advisor

Karen Gieseker

Third Advisor

Ike Okosun


Background: As the number of smokers in industrialized nations declines the number of smokers in developing countries increases. Many of the nations that are experiencing an increase in smoking prevalence are poor, politically unstable countries. The smoking rates among adolescents are increasing at an especially alarming rate. The tumultuous sociopolitical conditions such as civil unrest, the overthrowing of government regimes and the presence of political violence makes adolescents in these environments susceptible to engagement in high risk behavior such as smoking as a means of self- medicating the symptoms of mental disorder or unhealthy coping mechanisms. The purpose of this study was to analyze the difference in smoking behaviors and beliefs among adolescents in politically unstable countries compared to those in more stable areas. Methods: The West Bank, Gaza Strip, Yemen, Iraq, United Arab Emirates, Oman, Qatar and Kuwait were selected for inclusion in the study based on their World Bank Indicators. Stable countries were defined by their ranking in the 50th percentile or higher on the Political Stability and Absence of Violence Index, whereas unstable countries were defined as being in the 10th percentile or lower. Using secondary data from the 2001, 2002, 2003, 2004, 2005 and 2006 Global Youth Tobacco Survey (GYTS) for eight countries, univariate and multivariate analyses were conducted to assess the factors associated with smoking behaviors. Cases were truncated for 13- 15 year old respondents. A p- value of < .05 and 95% confidence intervals was used to determine statistical significance through the various analyses performed. Results: The univariate and multivariate analysis found that living in an unstable country and being male was associated with increased odds of smoking and experimentation among 13- 15 year old adolescents. Conclusion: The study results suggest that political stability may be associated with smoking behaviors and beliefs among adolescents. Since the factors that create political instability are multi-factorial and beyond the scope of this study, interventions should be designed to address smoking and other risk behaviors within this unique sociopolitical context. Previous interventions in similar settings have found programs integrating mental health dimension and religious leaders have been successful in staving off the onset of smoking among study populations. INDEX WORDS: teens, adolescents, trauma, political instability, risk behavior, tobacco, smoking, interventions,