Summary of risk factors associated with tobacco use
| Author | Study design and sample | Risk factors | ||
|---|---|---|---|---|
| Demographics | Conflict and population displacement | Mental health | ||
| Alajbegovic et al27 | Repeated cross-sectional study of 506 patients with acute myocardial infarction in Croatia | NA | Higher prevalence of smoking in prewar and war periods than postwar, p<0.05 | NA |
| Barnes et al28 | Cross-sectional study of 591 refugees in the USA | Smoking prevalence: male>female, p<0.05. Smoking history >20 years: male (93.8%); female (6.3%) | NA | NA |
| Blight et al29 | Cross-sectional study of 413 Bosnian refugees in Sweden | Smoking prevalence: gender: no association (p=0.184) Urban/rural setting: no association (p=0.451) | NA | NA |
| Cajdric-Vrhovac et al30 | Qualitative study (semistructured interview) of 15 Bosnian refugees in the USA | NA | NA | NA |
| Chaaya et al31 | Cross-sectional study of 740 elderly in Lebanon | NA | Camps (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 al32 | Cross-sectional study of 39 health professional in Bosnia and Herzegovina | NA | Increase smoking since war: 89% Cigarette consumption: prewar (17.05 cigarettes) and war (26.07 cigarettes), p<0.0001 | NA |
| Delic-Ovcina33 | Cross-sectional study of 637 male Bosnian refugees in the USA | NA | NA | Daily smoking associated with PTSD: χ2=11.3, p<0.005 |
| Eytan and Gex-Fabry et al34 | Cross-sectional study of 864 conflict-affected Albanians in Kosovo | Current smoker: male (4.7%)>female (p≤0.001). Age: highest prevalence in age 30–49 (OR=2.1, p=0.001) | NA | Current smoker associated with: PTSD (OR=1.2, p=0.36); major depressive episode (OR=1.5, p=0.017) |
| Farhood et al35 | Cross-sectional study of 208 former prison detainees in Lebanon | NA | Smoking prevalence between detainees (58.5%) and host (33.3%), p≤0.001 | NA |
| Giuliani et al38 | Qualitative study (structured interview and focus groups) of 111 Somalis in the USA | NA | NA | NA |
| Giuliani et al36 | Cross-sectional study of 302 Somali youths in the USA | Smoking 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) | NA | NA |
| Giuliani et al37 | Cross-sectional study of 392 Somali adults in the USA | Smoking 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) | NA | NA |
| Harel-Ftsch et al39 | Cross-sectional study of 24 935 children in Israel, West Bank, Gaza | Parental support significantly reduced the impact of subjective threat from armed conflict in smoking rates in Jewish Israeli respondents | Smoking rates associated with increased in subjective threat from armed conflict events | NA |
| Harris et al41 | Survey of 499 Bosnian refugees in the USA | NA | NA | NA |
| Harris et al40 | Cross-section study of 802 secondary school students in Liberia | Smoking prevalence: gender: male>female (p=0.005) Age: higher prevalence in ≥19 years old compared with <19 years old (p=0.010) | NA | NA |
| Helweg-Larsen et al42 | Cross-sectional study of 55 Bosnian refugees in the USA | NA | NA | NA |
| Isralowitz and Rawson 43 | Cross-sectional study of 911 youths in Israel | Smoking prevalence: female>male, p<0.05 | NA | NA |
| Keinan-Boker et al44 | Cross-sectional study of 425 Israeli smokers in Gaza | Smoking 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 al45 | Cross-sectional study of 14 513 Palestinian refugee students in Gaza, Syria, Jordan, Lebanon, West Bank | Gender: male>female in smoking cigarettes (all 5 regions) and shisha (Jordan and West Bank) | NA | NA |
| Kopinak46 | Qualitative study (semistructured interview) of 10 Bosnian refugees in Canada | NA | NA | NA |
| Koupil et al47 | Cross-sectional study of 5634 adults survivors of Siege of Leningrad, Russia | NA | No difference (p>0.05) in male smoking prevalence between siege exposed (80.8%) and unexposed (78.8%) | NA |
| Leavey et al48 | Cross-sectional study of 329 school children in the UK (war status?) | UK-born more likely to smoke (OR=2.3, p=0.02) | NA | NA |
| Luitel et al49 | Cross-sectional study of 8021 refugees in Nepal | NA | NA | Hazardous/harmful drinking with smoking (OR=2.1, p<0.01) |
| Makhoul and Nakkash 200950 | Qualitative study (focus groups) of 41 adolescents refugees in Lebanon | NA | NA | NA |
| Maksimovic et al51 | Cross-sectional study of 560 IDP and host city adolescents in Serbia | NA | Smoking prevalence: no difference (p=0.88) between IDP (65.6%) and host (64.4%) | NA |
| McLeod and Reeve 52 | Cross-sectional study of 2992 refugees in New Zealand | Smoking prevalence: male>female, RR 6.03, p<0.001 | NA | NA |
| Morikawa53 | Cross-sectional study of 143 children in Kosovo | NA | No significant difference (p=0.2) in smoking prevalence between IDP and non-IDPs | NA |
| Mousa et al54 | Case series study of 7762 Palestinian refugees from health clinics in Jordan, Lebanon, Syria, Gaza and West Bank | Smoking 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 host | NA |
| Nguyen-Van-Tam et al55 | Cross-sectional study of 135 Vietnam refugees in the UK | Smoking prevalence: male>female (p<0.01) | NA | NA |
| Okello et al56 | Cross-sectional study of 551 school-going adolescents in Northern Uganda | Smoking prevalence: no significant (p>0.05) differences between genders | NA | NA |
| Roberts et al57 | Cross-sectional study of 3600 conflict-affected persons in Georgia | Age 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>IDPs | Association of nicotine dependence with PTSD (p=0.02) and depression (p=0.03) |
| Rudatsikira et al58 | Cross-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 al59 | Cross-sectional study of 298 Holocaust survivors and European-born Jews in Israel | NA | Non-significant difference in prevalence of smoking: Holocaust 10%; control 8.1% (OR=1.3 (CI 0.5 to 3.0)) | NA |
| Siziya et al60 | Cross-sectional study of1989 adolescents in Iraq | Smoking 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) | NA | NA |
| Siziya et al61 | Cross-sectional study of1563 youths in Somaliland | Smoking prevalence: no association for gender (p=0.248) | NA | NA |
| Sokolova-Djokic et al62 | Cross-sectional study of 317 conflict-affected adults in Serbia | NA | During 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 month | NA |
| Stoll63 | Mixed methods study (cross-sectional survey and focus groups) of 194 immigrants and refugees in Canada | Smoking 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) | NA | NA |
| Turek et al64 | Cross-sectional study of 5840 adults in Croatia | Gender: 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 | NA | NA |
| Weaver et al65 | Cross-sectional study of 66 Bosnian refugees in the USA | Association 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) | NA | Association 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.