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Tob Control. 2016 Mar;25(2):129-40. doi: 10.1136/tobaccocontrol-2014-052054. Epub 2015 Mar 13.

A systematic review on tobacco use among civilian populations affected by armed conflict.

Author information

1
Faculty of Public Health and Policy, ECOHOST-The Centre for Health and Social Change, The London School of Hygiene and Tropical Medicine, London, UK.
2
Department of War Studies, King's College London, London, UK.

Abstract

OBJECTIVE:

To systematically examine evidence on tobacco use among conflict-affected civilian populations.

DATA SOURCES:

Primary quantitative and qualitative studies published in English up to April 2014. Bibliographic databases searched were EMBASE, Global Health, MEDLINE, PsycEXTRA, PsycINFO, Web of Science, Cochrane; with the main terms of: (Smoke*, tobacco*, cigarette*, nicotine, beedi, bidi, papirosi, dip, chew, snuff, snus, smokeless tobacco) AND (armed-conflict, conflict-affected, conflict, war, refugee, internally displaced, forcibly displaced, asylum, humanitarian). Grey literature was searched using humanitarian databases, websites and search engines.

STUDY SELECTION:

Studies were independently selected by two reviewers, with a study outcome of tobacco use and a population of conflict-affected civilian populations such as internally displaced persons, refugees, residents in conflict-affected areas, residents and returning forcibly displaced populations returning in stabilised and postconflict periods. 2863 studies were initially identified.

DATA EXTRACTION:

Data were independently extracted. The Quality Assessment Tool for Quantitative Studies and the Critical Appraisal Skills Programme for qualitative studies were used to assess study quality.

DATA SYNTHESIS:

39 studies met inclusion criteria and descriptive analysis was used. Findings were equivocal on the effect of conflict on tobacco use. Evidence was clearer on associations between post-traumatic stress and other mental disorders with nicotine dependence. However, there were too few studies for definitive conclusions. No study examined the effectiveness of tobacco-related interventions. The quantitative studies were moderate (N=13) or weak (N=22) quality, and qualitative studies were moderate (N=3) or strong (N=2).

CONCLUSIONS:

Some evidence indicates links between conflict and tobacco use but substantially more research is required.

KEYWORDS:

Global health; Low/Middle income country; Priority/special populations

[Indexed for MEDLINE]

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