Prevalence and factors associated with cigarette smoking in police forces: a systematic review and meta-analysis

Purpose - The knowledge of cigarette smoking among police forces is limited. The aims of this review were to synthesize the prevalence of cigarette smoking among police forces worldwide and factors associated with cigarette smoking in the police population. Design/methodology/approach - The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Studies from 1st January 2000 to 7th July 2023 were identified from PubMed, Web of Science and Scopus using search terms: (("cigarette" OR "tobacco" OR "smoke" OR "smoker" OR "smoking") AND ("police" OR "enforcement")). Quality assessment was performed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Pooled prevalence was performed and sub-analysed based on time period, the income group classification of countries and geographical location of countries. A meta-analysis using Mantel-Haenszel statistics and random-effect models was conducted using both RStudio and Review Manager 5.3. Heterogeneity was measured using I-2 statistics. Findings - Data from 105,457 police (55 studies) were included. The prevalence of current smokers among police forces worldwide was 25.28% (95% CI: 20.76-29.79%, I-2: 100%). The smoking prevalence was higher among law enforcement officers than the general population (OR = 2.74, 95% CI = 1.34-5.60, p = 0.006, I-2 = 95%). A declining trend in smoking prevalence was observed based on studies published from 2000 to 2023. By geography, smoking prevalence was lowest in North America, followed by Europe and then Asia. This trend was not impacted by income group, though variations were observed between studies (I-2 > 80%). While there was no gender difference in the odds of smoking (OR = 0.73, 95% CI = 0.40-1.33, p = 0.30, I-2 = 98%), geographic sub-analysis showed that male police were at higher odds of being current smokers than female police in Asia (OR = 9.09, 95% CI = 3.85-25.0, p < 0.001, I-2 = 95%). In contrast, in North America, female police were at higher odds of being current smokers than male police (OR = 1.68, 95% CI = 1.19-2.36, p = 0.003, I-2 = 33%). Factors associated with smoking among police also included operational vocation (OR = 1.23, 95% CI = 1.09-1.40, p = 0.001, I-2 = 0%; compared to administrative roles) and the presence of metabolic syndrome (OR = 1.90, 95% CI = 1.70-2.13, p < 0.001, I-2 = 0%). Research limitations/implications - Law enforcement officers were more likely to smoke than the general population. The prevalence of smoking among police was generally lower in North America, with a decreasing trend in prevalence over time worldwide. This trend was not impacted by the income group of countries. Vocation type and the presence of metabolic syndrome were associated with current smoking and may have implications for occupational medicine in the policing community. Originality/value - This is the first systematic review synthesising data across published literature to identify an aggregate prevalence rate and factors associated with cigarette smoking across police forces.