Smoking behaviour under intense terrorist attacks

Background: Smoking is one of the varied psychological reactions to stress. This study examined the rate and changes in cigarette smoking among former Gaza and current West Bank Jewish settlers subjected to direct and indirect terrorist attacks during the Al-Aksa Intifada. The relationship with degree of religious observance and emotional distress was explored as well. Methods: In this cross-sectional study, the respondents were settlers randomly selected and interviewed by telephone (N = 706). The interview schedule included socio-demographic items, information on direct exposure to terrorist attacks (e.g. threat to life or physical integrity, personal losses, property damage) and on steady and changes in smoking habits, and a scale to measure emotional distress. Results: In contrast with the country population, a larger percentage of settlers who smoked increased the number of cigarettes consumed with exposure to terrorism (10 and 27%, respectively). Respondents who were injured or had their home damaged reported a higher rate of smoking during the preceding year (30 and 20%, respectively). Emotional distress was related to cigarette smoking, but not in the controlled analysis. Religious observance had no effect. Conclusion: Direct or indirect exposure to terrorist attacks had an impact on smoking prevalence rates and on changes in smoking habits. Studies investigating reactions to traumatic events should include a detailed section on smoking while mental health interventions should address the needs of smokers.