title: Differences in tobacco smoking prevalence and frequency between adolescent Palestine refugee and non-refugee populations in Jordan, Lebanon, Syria, and the West Bank: cross-sectional analysis of the Global Youth Tobacco Survey.
abstract: BACKGROUND
  Evidence is conflicting as to the whether tobacco smoking prevalence is higher in refugee than non-refugee populations. The aim of this study was to compare the prevalence and frequency of tobacco smoking in Palestine refugee and non-refugee adolescent populations in the Middle East.
  
  
  METHODS
  We conducted a cross-sectional analysis of the Global Youth Tobacco Survey (GYTS) conducted in Jordan, Lebanon, Syria, and the West Bank among adolescent Palestine refugees and non-refugees. Age- and sex-adjusted regression models assessed the association between refugee status and current (past-30 day) tobacco use prevalence and frequency.
  
  
  RESULTS
  Prevalence estimates for current tobacco smoking were similar between Palestine refugee and non-refugee groups in Jordan (26.7 % vs. 24.0 %), Lebanon (39.4 % vs. 38.5 %), and the West Bank (39.5 % vs. 38.4 %). In Syria, Palestine refugees had nearly twice the odds of current tobacco smoking compared to non-refugees (23.2 % vs. 36.6 %, AOR 1.96, 95 % CI 1.46-2.62). Palestine refugees consumed more cigarettes per month than non-refugees in Lebanon (β 0.57, 95 % CI 0.17-0.97) and Palestine refugees consumed more waterpipe tobacco per month than non-refugees in Syria (β 0.40, 95 % CI 0.19-0.61) and the West Bank (β 0.42, 95 % CI 0.21-0.64).
  
  
  CONCLUSIONS
  Current tobacco smoking prevalence is in excess of 20 % in both adolescent Palestine refugee and non-refugee populations in Middle Eastern countries, however Palestine refugees may smoke tobacco more frequently than non-refugees. Comparison of simple prevalence estimates may therefore mask important differences in tobacco use patterns within population groups.
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, W6 8RP UK.
authors.forename: Mohammed
authors.identifier: 0000-0002-1051-2136
authors.initials: M
authors.lastname: Jawad
authors.affiliation: United Nations Relief and Works Agency (UNRWA) for Palestine refugees in the Near East, Amman, Jordan.
authors.forename: Ali
authors.initials: A
authors.lastname: Khader
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, W6 8RP UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
keywords: Adolescents; Cigarettes; Refugee; Tobacco; Waterpipe