Table 1

Summary of final selected studies on tobacco use

AuthorStudy design and sampleTobacco outcomes measuredStudy quality*
Alajbegovic et al27Repeated cross-sectional study of 506 patients with acute myocardial infarction in CroatiaPrevalence of smoking (prewar): diabetic 28.7%; non-diabetic 46.4%
Prevalence of smoking (war): diabetic 38.8%; non-diabetic 55.9%
Prevalence of smoking (postwar): diabetic 3.7%; non-diabetic 27.5%
Barnes et al28Cross-sectional study of 591 refugees in the USAPrevalence of smoking: 38.5%
Light to moderate cigarette use (<20 cigarettes/day): 53.1%
Blight et al29Cross-sectional study of 413 Bosnian refugees in SwedenPrevalence of daily cigarette smoking: 41%Moderate
Cajdric-Vrhovac et al30Qualitative study (semistructured interview) of 15 Bosnian refugees in the USANAModerate
Chaaya et al31Cross-sectional study of 740 elderly in LebanonPrevalence of smoking (overall): 28.1%; male 41.6%; female 17.3%
Prevalence of smoking (by location): refugee camp 34.3%; Nabaa 25.1%; Hay-El-Sullum 20.4%
Age started smoking: 21.9. Years smoked: 40.1
Creson et al32Cross-sectional study of 39 health professional in Bosnia and HerzegovinaCigarette consumption per day: prewar 17.05; war 26.07Weak
Delic-Ovcina33Cross-sectional study of 637 male Bosnian refugees in the USANAWeak
Eytan and Gex-Fabry34Cross-sectional study of 864 conflict-affected Albanians in KosovoPrevalence of smoking: male 34.7%; female 11%Moderate
Farhood et al35Cross-sectional study of 208 former prison detainees in LebanonPrevalence of smoking: former prisoners 58.5%; control 33.3%Weak
Giuliani et al38Qualitative study (structured interview and focus groups) of 111 Somalis in the USANAModerate
Giuliani et al36Cross-sectional study of 302 Somali youths in the USAPrevalence any tobacco use: ever 22.2%; current 6.3%
Tobacco product use: cigarette 4.7%; waterpipe 2.3%; chewing 1.7%; cigar 2.3%; bidi 1.3%; kretek1%
Giuliani et al37Cross-sectional study of 392 Somali adults in the USAPrevalence of any form of tobacco use: 25.7%
Prevalence of cigarette smoking: overall 24.5%: male 44.1%; female 3.7%
Light cigarette use (<10 cig/day) 52.5%; moderate cigarette use (11–20 cig/day) 19.8%; heavy cigarette use (>20 cig/day): 22.8%
Harel-Ftsch et al39Cross-sectional study of 24 935 children in Israel, West Bank, GazaDifferences in smoking prevalence between regions, p<0.001Moderate
Harris et al41Cross-sectional study of 499 Bosnian refugees in the USAPrevalence of smoking: 66.4%.
Light cigarette use (<10 cigarettes/day) 37%; moderate cigarette use (11–20 cigarettes/day) 41%; heavy cigarette use (>20 cigarettes/day) 23%
Harris et al40Cross-section study of 802 secondary school students in LiberiaPrevalence of cigarette use: 6.8%; occasional cigarette use: 67.5%; at least once a month use: 32.5%Weak
Helweg-Larsen and Stancioff42Cross-sectional study of 55 Bosnian refugees in the USANAWeak
Isralowitz and Rawson43Cross-sectional study of 911 youths in IsraelPrevalence of smoking: male 69%; female 70%Weak
Keinan-Boker et al44Cross-sectional study of 425 Israeli smokers in GazaPrevalence of daily smoker: 85.4%; moderate cigarette use (11–20 cigarettes/day) 55%; heavy cigarette use (>20 cigarettes/day) 14.1%Weak
Khader et al45Cross-sectional study of 14 513 Palestinian refugee students in Gaza, Syria, Jordan, Lebanon, West BankPrevalence of cigarette smoking: Gaza 3.2–6.6%; Jordan 11.1–14%; Syria 11.5–13.8%; Lebanon 8.4–12.6%; West Bank 16.5–24.4%
Prevalence of waterpipe: Gaza 11.7–12.6%; Jordan 14.1–25.6%; Lebanon 33.5–33.7%; Syria 24.7-33.5%; West Bank 27.8–31.2%
Prevalence of smokeless tobacco: Gaza 8.9%; Jordan 7.7%; Lebanon 6.5%; Syria 5.5%; West Bank 9.1%
Kopinak46Qualitative study (semistructured interview) of 10 Bosnian refugees in CanadaNAStrong
Koupil et al47Cross-sectional study of 5634 adults in RussiaPrevalence of (current/past) smoking exposed to siege: male 80.8%; female 18%.
Prevalence of (current/past) smoking unexposed to siege: male 78.8%; female 14%
Leavey et al48Cross-sectional study of 329 refugee school children in the UKPrevalence of smoking: 11%Weak
Luitel et al49Cross-sectional study of 8021 refugees in NepalNAWeak
Makhoul and Nakkash50Qualitative study (focus groups) of 41 adolescents refugees in LebanonNAStrong
Maksimovic et al51Cross-sectional study of 560 IDP and host city adolescents in SerbiaPrevalence of smoking: IDPs 65.6%; host population 6.4%Weak
McLeod and Reeve52Cross-sectional study of 2992 refugees in New ZealandPrevalence of smoking: 20.1%; male 32.3%; female 5.6%Weak
Morikawa53Cross-sectional study of 143 children in KosovoNumber of smokers in household: IDP 0.7; non-IDP 0.79Weak
Mousa et al54Case series study of 7762 Palestinian refugees from health clinics in Jordan, Lebanon, Syria, Gaza and West BankLevel of smoking (overall): male 50.8%; female 10.5%
Level of smoking (Jordan): male 48%; female 8.4%
Level of smoking (Lebanon): male 59.5%; female 39.9%
Level of smoking (Syria): male 57.1%; female 15.3%
Level of smoking (Gaza): male 49.5%; female 0.6%
Level of smoking (West Bank): male 43.7%; female 6.1%
Nguyen-Van-Tam et al55Cross-sectional study of 135 Vietnam refugees in the UKPrevalence of smoking: daily 21.6%; occasional 3.7%; ex-smoker 6%Weak
Okello et al56Cross-sectional study of 551 school-going adolescents in northern UgandaPrevalence of smoking: 2.18%; male 2.82%; female 1.5%Weak
Roberts et al57Cross-sectional study of 3600 conflict-affected persons in GeorgiaPrevalence of smoking (all conflict-affected): male 47.4%; female 1.17%
Prevalence of smoking: male IDPs 51.2%; male returnees 40.4%
Heavy cigarette use (>20 cigarettes/day): all conflict-affected 70.9%; male IDPs 68.9%; male returnees 75.9%
High nicotine dependence: all conflict-affected 41.4%; male IDPs 47%; male returnees 39%
Rudatsikira et al58Cross-sectional study of 2182 adolescents in the West Bank (Judea and Samaria)Prevalence of smoking: 18.9%; male 28.7%; female 9.6%Moderate
Sharon et al59Cross-sectional study of 298 Holocaust survivors and European-born Jews in IsraelPrevalence of smoking (Holocaust survivor): current 10%; ever 48.4%Weak
Siziya et al60Cross-sectional study of 1989 adolescents in IraqPrevalence of smoking: 15.3%; male 25.1%; female 2.7%Moderate
Siziya et al61Cross-sectional study of 1563 youths in SomalilandPrevalence of smoking: 15.8%; male 10.3%; female 11.1%Moderate
Sokolova-Djokic et al62Cross-sectional study of 317 conflict-affected adults in SerbiaPrevalence of smoking (prewar): male 63.5%; female 48.8%
Prevalence of smoking (war): male 70.7%; female 52.2%
Prevalence of smoking (postwar): male 59.2%; female 44.3%
Stoll63Mixed methods study (cross-sectional survey and focus groups) of 194 immigrants and refugees in CanadaPrevalence of smoking: all 12%; male 18%; female 6%
Prevalence of smoking in parents: father 24%; mother 6%
Turek et al64Cross-sectional study of 5840 adults in CroatiaPrevalence of smoking (regular): male 34.5%; female 26.6%
Prevalence of smoking (occasional): male 6.6%; female 10.1%
Form of tobacco product: cigarette 98.6%; cigar 0.9%; pipe 0.5%
Weaver et al65Cross-sectional study of 66 Bosnian refugees in the USAPrevalence of smoking: current 59%; prewar 44%
Heavy cigarette use (>20 cigarettes/day): 62%
  • *Quality rating for quantitative studies based on Effective Public Health Practice Project (EPHPP) quality assessment tool.25 Quality rating for qualitative studies based on CASP tool26, with scores of 8–10 considered strong; 5–7 considered moderate; and 1–4 weaks.

  • CASP, Critical Appraisal Skills Programme; IDP, internally displaced person; NA, not applicable.