Nicotine dependence and generalized anxiety disorder as a public health issue in Moldova

Abstract

Despite global declines, Moldova remains the only EU region country with rising smoking prevalence: 27.6% (WHO STEPS 2021). WHO aims for a 30% reduction in tobacco use by 2025, while Moldova’s 2030 strategy targets only 3%. High rates are noted among individuals with psychiatric comorbidities, termed Dual Disorders. Tobacco is most common, followed by alcohol and cannabis. People with Generalized Anxiety Disorder (GAD) struggle more to quit, yet tobacco use is often minimized in Moldovan clinical settings. Studies show GAD patients start earlier or smoke more frequently, though findings vary due to study design, population, and diagnostic tools. This study examined the relationship between nicotine dependence and GAD symptoms in the general population. Data were collected through a questionnaire on age, sex, smoking/nicotine status, product type, anxiety symptoms, the Fagerstrom Test for Nicotine Dependence, and the GAD-7 scale. Preliminary findings from 72 adult respondents indicate male predominance, cigarette smoking, moderate to high nicotine dependence (scores 4–9), and moderate anxiety (GAD-7 scores 10–14). Results suggest a clear correlation between nicotine dependence and GAD. To reverse Moldova’s rising smoking rates, multi-sectoral approaches are required. Preventing and treating GAD may reduce smoking initiation and support cessation. A standardized clinical protocol for Dual Disorders is needed. Currently, cytisine is the only available medication for nicotine dependence in Moldovan health service.