Introduction

Tobacco use remains the leading cause of preventable morbidity and mortality worldwide 1, 2. At a global level, estimates suggest that tobacco smoking can be attributed to 7.1 million deaths and 182 million disability-adjusted life years 2. In Serbia in 2017, tobacco smoking was largely attributed to disease-specific mortality from lung cancer (77.4%), stroke (33.2%) and ischemic heart disease (23.9%) 3. According to last national health survey, the prevalence of smoking in the Republic of Serbia was approximately 35% among persons aged 15 years and older, while among persons aged 18-64 years was as high as 41.2% 4.

Previous studies suggested that college students were not fully aware of harmful effects of tobacco smoking 5, 6. College students also had a tendency to use a wide range of definitions as to a “smoker” This, in turn, affects their beliefs, motivations for smoking cessation and barriers to quit smoking 7. The problem of tobacco smoking among college/university students has important public health implications. Specifically, this population is expected to be a major task force in the job market in the near future. However, due to the increased risk of developing various chronic diseases as a result of tobacco smoking 3, this health behavior in early adulthood may set the unfavorable health trajectories later in life.

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Following the ethnic conflict between Serbs and Albanians in 1999, the Serbian population in Kosovo remains an ethnic minority, with approximately 70,000 persons residing in northern Kosovo and 85,000 persons residing in southern enclaves (around 9.2% of the entire population of Kosovo). The ethnic tensions and occasional conflicts are ongoing between the two ethnic groups, especially in the town of Kosovska Mitrovica 8, 9. Kosovska Mitrovica is situated on the demarcation line between the two ethnic communities and is physically divided by the river Ibar to a northern Serbian part and a southern Albanian part. Foreign military is still present in the Kosovo province as the basic infrastructure is being restored. Institutions at primary healthcare level play an important role in efforts to establish a health care delivery framework to match the degree of activities before the conflict.

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Compelling data have shown that people living in regions affected by the armed conflict are more likely to smoke 10 compared to persons living in non-conflict areas. Because previous population health surveys did not include Serbs residing in Kosovo 4 it is difficult to estimate the prevalence of smoking in this particular region. We hypothesized that the prevalence of tobacco smoking among Serbian students in northern Kosovo is higher compared to their peers who study in the remainder of the Republic of Serbia. Identification of factors that contribute to smoking in a university student population is a necessary element to optimize smoking prevention in young adults.

The objectives of this study were to estimate the prevalence of tobacco smoking among Serbian students in the northern Kosovo province as well as to assess factors associated with current smoking status. Data obtained in this study aim at providing the groundwork to estimate the size of the student population who smoke as well as to understand specific behavioral patterns of students smokers in order to address smoking prevention and health care needs of students in the post-conflict period.

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