Tobacco Use Among Young People Exposed to Armed Conflicts: A Systematic Review and Meta-Analysis

Abstract

Introduction: Tobacco use is a major public health problem associated with significant physical and psychological harms later in life. The vulnerability is higher among young people exposed to armed conflicts, as developmental changes combined with armed conflicts-related stressors, including trauma, displacement, and school disengagement, increase the risk of tobacco use. Although these behaviors among adolescents are extensively explored, evidence on young people living in armed conflict settings is limited. Little is known about gender roles and associated risk and protective factors of tobacco use in such settings. Method: A systematic review and meta-analysis were conducted, including observational studies (1980–2025) from PubMed, PsycINFO, and Web of Science. Peer-reviewed studies in the English language reporting tobacco use among young people exposed to armed conflicts were included. Heterogeneity, sensitivity (leave-one-out), and subgroup analyses were performed and reported following the PRISMA guidelines. Risk of bias was assessed using JBI tools. Findings: Of 2,209 records, 25 were included for final review. The pooled last 30 days prevalence of tobacco use was 16.00% (95% CI [14.00%, 19.00%]), higher among males (19.00%) than among females (10.00%). Pooled prevalence was 17.00% for tobacco smoking, 14.00% for electronic cigarette use, and 7.00% for non-smoking tobacco use. Male gender, younger age, living in a city, psychiatric symptoms, and tobacco availability were reported as risk factors, while social support, anti-tobacco message, and religiosity were reported as protective factors. Conclusion: Tobacco use is common among young people exposed to armed conflicts. Stakeholders should prioritize targeted tobacco prevention programs in affected settings.