Tunisia and the surrounding region have experienced dramatic political and social challenges in the aftermath of the 2010-2011 Arab Spring. These challenges are likely to severely limit already meager tobacco control resources and contribute to escalating threats to health in this region. There is evidence that the Arab Spring’s transition increased stress-related mental health problems, substance abuse (including escalation of tobacco use), and addiction in all sectors of society in Tunisia and the surrounding region. An essential step in curbing the development of addictive problems and in devising effective, contextually relevant prevention and intervention strategies is to define the role of psychosocial factors in initiation and progression.


There are virtually no empirical studies on effective stress-related intervention techniques to prevent or reduce initiation and escalation of tobacco use in North Africa. We will address this gap by tailoring and evaluating a contextually relevant, locally accepted interventions that are feasible, cost-effective, and scalable within Tunisia and the broader region. This research program will be the first systematic work to address psychosocial stress and its impact on tobacco use in North Africa. Results will guide subsequent efforts to intervene with young people at risk of becoming addicted tobacco users in this and surrounding regions.


Within this program we already have conducted multiple studies at different stages of completion. These focus on the following:


  1. Risk factors among young adults
  2. Stress, life adversity and health among primary health patients
  3. Stress, life adversity, and pregnancy outcome
  4. Life adversity and risk for violence and addictive behaviors
  5. Interventions to address risk factors for violence and addictive behaviors