Table 2

Summary of risk factors associated with tobacco use

AuthorStudy design and sampleRisk factors
DemographicsConflict and population displacementMental health
Alajbegovic et al27Repeated cross-sectional study of 506 patients with acute myocardial infarction in CroatiaNAHigher prevalence of smoking in prewar and war periods than postwar, p<0.05NA
Barnes et al28Cross-sectional study of 591 refugees in the USASmoking prevalence: male>female, p<0.05.
Smoking history >20 years: male (93.8%); female (6.3%)
Blight et al29Cross-sectional study of 413 Bosnian refugees in SwedenSmoking prevalence: gender: no association (p=0.184)
Urban/rural setting: no association (p=0.451)
Cajdric-Vrhovac et al30Qualitative study (semistructured interview) of 15 Bosnian refugees in the USANANANA
Chaaya et al31Cross-sectional study of 740 elderly in LebanonNACamps (compared with other sites): higher rates of smoking (34.3%, p<0.001); older starting age (23.8 years old, p=0.002); shorter smoking history (37.9 years, p<0.001)NA
Creson et al32Cross-sectional study of 39 health professional in Bosnia and HerzegovinaNAIncrease smoking since war: 89%
Cigarette consumption: prewar (17.05 cigarettes) and war (26.07 cigarettes), p<0.0001
Delic-Ovcina33Cross-sectional study of 637 male Bosnian refugees in the USANANADaily smoking associated with PTSD: χ2=11.3, p<0.005
Eytan and Gex-Fabry et al34Cross-sectional study of 864 conflict-affected Albanians in KosovoCurrent smoker: male (4.7%)>female (p≤0.001).
Age: highest prevalence in age 30–49 (OR=2.1, p=0.001)
NACurrent smoker associated with: PTSD (OR=1.2, p=0.36); major depressive episode (OR=1.5, p=0.017)
Farhood et al35Cross-sectional study of 208 former prison detainees in LebanonNASmoking prevalence between detainees (58.5%) and host (33.3%), p≤0.001NA
Giuliani et al38Qualitative study (structured interview and focus groups) of 111 Somalis in the USANANANA
Giuliani et al36Cross-sectional study of 302 Somali youths in the USASmoking prevalence: close friends who smoke cigarette (p<0.01) or use chewing tobacco (p=0.02). Living with someone who smokes (p<0.01), uses chewing tobacco (p=0.03) or waterpipe (p=0.02)NANA
Giuliani et al37Cross-sectional study of 392 Somali adults in the USASmoking prevalence: gender: male >female (p≤0.01).
Age: higher prevalence in 20–29 years (29%), 40–49 years (29.2%) (no p value provided)
Education: no education and non-smoking status (p=0.02)
Harel-Ftsch et al39Cross-sectional study of 24 935 children in Israel, West Bank, GazaParental support significantly reduced the impact of subjective threat from armed conflict in smoking rates in Jewish Israeli respondentsSmoking rates associated with increased in subjective threat from armed conflict eventsNA
Harris et al41Survey of 499 Bosnian refugees in the USANANANA
Harris et al40Cross-section study of 802 secondary school students in LiberiaSmoking prevalence: gender: male>female (p=0.005)
Age: higher prevalence in ≥19 years old compared with <19 years old (p=0.010)
Helweg-Larsen et al42Cross-sectional study of 55 Bosnian refugees in the USANANANA
Isralowitz and Rawson 43Cross-sectional study of 911 youths in IsraelSmoking prevalence: female>male, p<0.05NANA
Keinan-Boker et al44Cross-sectional study of 425 Israeli smokers in GazaSmoking prevalence and amount: male>female (p=0.0004). Older initiation age in female (p<0.001)
Higher smoking with lower education, p=0.002, OR 2.11 (1.31 to 3.40)
Smoking habits changed during military operation: 38.4%, with 88% reporting increase in smoking. Increases in female>male OR 2.39 (p<0.001). Increase in heavy cigarette user (>20 cig/day): 11.8%NA
Khader et al45Cross-sectional study of 14 513 Palestinian refugee students in Gaza, Syria, Jordan, Lebanon, West BankGender: male>female in smoking cigarettes (all 5 regions) and shisha (Jordan and West Bank)NANA
Kopinak46Qualitative study (semistructured interview) of 10 Bosnian refugees in CanadaNANANA
Koupil et al47Cross-sectional study of 5634 adults survivors of Siege of Leningrad, RussiaNANo difference (p>0.05) in male smoking prevalence between siege exposed (80.8%) and unexposed (78.8%)NA
Leavey et al48Cross-sectional study of 329 school children in the UK (war status?)UK-born more likely to smoke (OR=2.3, p=0.02)NANA
Luitel et al49Cross-sectional study of 8021 refugees in NepalNANAHazardous/harmful drinking with smoking (OR=2.1, p<0.01)
Makhoul and Nakkash 200950Qualitative study (focus groups) of 41 adolescents refugees in LebanonNANANA
Maksimovic et al51Cross-sectional study of 560 IDP and host city adolescents in SerbiaNASmoking prevalence: no difference (p=0.88) between IDP (65.6%) and host (64.4%)NA
McLeod and Reeve 52Cross-sectional study of 2992 refugees in New ZealandSmoking prevalence: male>female, RR 6.03, p<0.001NANA
Morikawa53Cross-sectional study of 143 children in KosovoNANo significant difference (p=0.2) in smoking prevalence between IDP and non-IDPsNA
Mousa et al54Case series study of 7762 Palestinian refugees from health clinics in Jordan, Lebanon, Syria, Gaza and West BankSmoking rate: male>female (p<0.01)Lower smoking rates among refugees in Syria, Lebanon and Jordan than host. Higher smoking rates among male refugees in Gaza and West Bank than hostNA
Nguyen-Van-Tam et al55Cross-sectional study of 135 Vietnam refugees in the UKSmoking prevalence: male>female (p<0.01)NANA
Okello et al56Cross-sectional study of 551 school-going adolescents in Northern UgandaSmoking prevalence: no significant (p>0.05) differences between gendersNANA
Roberts et al57Cross-sectional study of 3600 conflict-affected persons in GeorgiaAge associated (p<0.05) with nicotine dependence (except >65 years)Prevalence: IDPs (51.2%) > returnees (40.4%). Heavy cigarette use (> 20 cigarettes/day): returnees>IDPs. High nicotine dependence: returnees>IDPsAssociation of nicotine dependence with PTSD (p=0.02) and depression (p=0.03)
Rudatsikira et al58Cross-sectional study of 2182 adolescents in the West Bank (Judea and Samaria)Smoking prevalence: male>female (OR=2.29)
One or both parents smokers (OR=1.85)
Some friends who smoke (OR=4.68); most or all friends who smoke (OR=9.79)
Sharon et al59Cross-sectional study of 298 Holocaust survivors and European-born Jews in IsraelNANon-significant difference in prevalence of smoking: Holocaust 10%; control 8.1% (OR=1.3 (CI 0.5 to 3.0)) NA
Siziya et al60Cross-sectional study of1989 adolescents in IraqSmoking prevalence: male>female, OR=2.21.
Age: 15 years OR=1.07 (CI 1.03 to 1.11); 16 years OR=1.30 (CI 1.25 to 1.35); 17 years OR=1.93 (CI 1.86 to 2.0)
Mother smokes OR=1.65 (CI 1.55 to 1.77), father smokes OR=1.14 (CI 1.10 to 1.18). Close friends smoke: all OR 3.83 (CI 3.66 to 4.00); most smoke OR=2.37 (CI 2.29 to 2.45)
Siziya et al61Cross-sectional study of1563 youths in SomalilandSmoking prevalence: no association for gender (p=0.248)NANA
Sokolova-Djokic et al62Cross-sectional study of 317 conflict-affected adults in SerbiaNADuring war: increase prevalence of smoking in male (7.2%) and female (3.4%); increased consumption in male (36%) and female (32%); but returned to prebombing level within 1 monthNA
Stoll63Mixed methods study (cross-sectional survey and focus groups) of 194 immigrants and refugees in CanadaSmoking prevalence: no association with gender (p=0.07). Non-smoking associated with paternal smoking status (OR=10.84, p=0.004). Number of close friends who smoke (OR=0.85, p=0.011)NANA
Turek et al64Cross-sectional study of 5840 adults in CroatiaGender: male>female heavy smoking (p<0.001);
Age: increase in heavy smoking in age middle age group in male (31–50 years) but decline after 50 years old
Weaver et al65Cross-sectional study of 66 Bosnian refugees in the USAAssociation with nicotine dependence: increasing age (p<0.01); gender: (p>0.05); marital status (p>0.05); employment status (p>0.05); smoking history (p>0.05)NAAssociation with nicotine dependence: PTSD (p<0.01); difficulty falling/staying asleep (p<0.01); irritability (p<0.05); concentration difficulties (p<0.05); hypervigilance p<0.01
  • Significance assumed to be p<0.05.

  • IDP, internally displaced person; NA, not applicable; PTSD, post-traumatic stress disorder.