Background: Tobacco use either in the form of smoking or smokeless tobacco is typically initiated or established behaviorally for adult smokers before 18 years of age. Given that data from monitoring and surveillance systems drives every policy and program, accurate surveillance of tobacco consumption by adolescents is a major part of curbing tobacco addiction. Methodology: The consistency and reliability of youth smoking prevalence data was assessed by investigating discrepancies within versions of the Global Youth Tobacco (GYTS) as well as between GYTS and the Global School-based Health Survey (GSHS). Sources of errors and biases were examined in order to determine the cause for discrepancies in results. Results: Significant discrepancies were found within GYTS versions as well as between the survey results produced by GYTS and GSHS. Discrepancies within GYTS versions were determined to be due to quality control errors. Analyzed by gender, negligible variation was found between boys and girls. When comparing the total smoking prevalence estimates between GYTS and GSHS, four of the six WHO administrative regions (Africa, Americas, Eastern-Mediterranean, South-Eastern and Western- Pacific) were found to have significantly different estimates. The European region did not consist of any significantly different estimates. When comparing variance in total smoking prevalence estimates, GSHS results were found to be lower than GYTS estimates with the exception of the EMRO region. The EMRO region was further analyzed to explore gender variation within the region and boys were found to have 44.5% more significantly different estimates in comparison to girls. Conclusion: Up-to-date, reliable and consistent surveillance and monitoring efforts are part and parcel to solving this tobacco epidemic and fighting wealthy and powerful tobacco companies.

Objectives: To estimate prevalence and identify correlates of age of smoking initiation among adolescents in Africa. Methods: Data (n = 16,519) were obtained from nationally representative Global Youth Tobacco Surveys in nine West African countries. Study outcome was adolescents’ age of smoking initiation categorized into six groups: ≤7, 8 or 9, 10 or 11, 12 or 13, 14 or 15 and never-smoker. Explanatory variables included sex, parental or peer smoking behavior, exposure to tobacco industry promotions, and knowledge about smoking harm. Weighted multinomial logit models were conducted to determine correlates associated with adolescents’ age of smoking initiation. Results: Age of smoking initiation was as early as ≤7 years; prevalence estimates ranged from 0.7 % in Ghana at 10 or 11 years age to 9.6 % in Cote d’Ivoire at 12 or 13 years age. Males, exposures to parental or peer smoking, and industry promotions were identified as significant correlates. Conclusions: West African policymakers should adopt a preventive approach consistent with the World Health Organization Framework Convention on Tobacco Control to prevent an adolescent from initiating smoking and developing into future regular smokers.

Purpose To estimate the prevalence of secondhand smoke (SHS) exposure among never-smoking adolescents and identify key factors associated with such exposure. Methods Data were obtained from nationally representative Global Youth Tobacco Surveys conducted in 168 countries during 1999-2008. SHS exposure was ascertained in relation to the location - exposure inside home, outside home, and both inside and outside home, respectively. Independent variables included parental and/or peer smoking, knowledge about smoke harm, attitudes toward smoking ban, age, sex, and World Health Organization region. Simple and multiple logistic regression analyses were conducted. Results Of 356,414 never-smoking adolescents included in the study, 30.4%, 44.2%, and 23.2% were exposed to SHS inside home, outside home, and both, respectively. Parental smoking, peer smoking, knowledge about smoke harm, and positive attitudes toward smoke ban were significantly associated with increased odds of SHS exposure. Approximately 14% of adolescents had both smoking parents and peers. Compared with never-smoking adolescents who did not have both smoking parents and peers, those who had both smoking parents and peers had 19 (adjusted odds ratio [aOR], 19.0; 95% confidence interval [CI], 16.86-21.41), eight (aOR, 7.71; 95% CI, 7.05-8.43), and 23 times (aOR, 23.16; 95% CI, 20.74-25.87) higher odds of exposure to SHS inside, outside, and both inside and outcome home, respectively. Conclusions Approximately one third and two fifths of never-smoking adolescents were exposed to SHS inside or outside home, and smoking parents and/or peers are the key factors. Study findings highlight the need to develop and implement comprehensive smoke-free policies consistent with the World Health Organization Framework Convention on Tobacco Control.

Youth Tobacco Surveys have been conducted in several states in the U.S. in recent years, in order to design policies with the goal of reducing tobacco use among young people. Some primary analysis of those surveys has been done, but few analyses include modeling, and the study of independence has been addressed, mainly, in the bivariate context. In this work contemporary methods, which are of relative recent appearance in categorical data analysis, will be examined, including logistic and log-linear modeling as well as graphical displays and correspondence analysis. These methods will be applied to data from the 2000 Tennessee Youth Tobacco Survey. The objective is to demonstrate that methods of multivariate categorical data analysis can provide fresh insight about the behavior of adolescents with respect to tobacco use. The ultimate purpose of this work is to recommend methodology that goes beyond that which is currently published.

Tobacco use continues to be the leading cause of preventable death in the world. The disproportionate increase in tobacco use in low- and middle-income countries needs immediate attention. Many smokers begin smoking as adolescents and are most likely to become permanent smokers. Moreover, youth are highly targeted by tobacco industry strategies. However, a gap exists in literature to understand worldwide youth tobacco use and control. The purpose of this study is to 1) identify factors that influence never-smoking youths‟ smoking susceptibility, 2) explore characteristics that influence youth exposure to environmental tobacco smoke (ETS) and 3) to delineate key determinants of youth support for smoke-free policies (SFPs). Data related to worldwide youth tobacco use was obtained from the Global Youth Tobacco Survey for the years 1999-2008. Simple and multiple logistic regression analyses were conducted, after the sample was weighted for design effect, nonresponse patterns and poststratification. Unadjusted and adjusted odds ratios along with 95% confidence intervals were reported. Around 14% of never-smoking youth were susceptible to smoking worldwide. Around 40% and 50% youth were exposed to ETS inside and outside the home respectively, and 78% supported SPFs globally. Parental and peer smoking was strongly associated with smoking susceptibility in never-smoking youth [AOR 2.63, 95% CI 2.43 to 2.84], and youth exposure to ETS inside [AOR 5.09, 95% CI 4.84 to 5.35] and outside [AOR 2.51, 95% CI 2.39 to 2.63] the home, while anti-smoking school education was negatively associated. Youth having knowledge about smoking harm [AOR 2.37, 95% CI 2.22 to 2.54] supported SFPs, while youth exposed to tobacco industry promotion [AOR 0.83, 95% CI 0.78 to 0.89] did not support. The study highlighted a number of modifiable factors that can be used for augmenting global tobacco control in youth. Well-executed anti-smoking campaigns, parental and peer education, inclusion of anti-tobacco education in school curricula, comprehensive SFPs, and comprehensive ban on tobacco industry strategies are important approaches to prevent tobacco use and advance global tobacco control in youth.

Purpose To estimate susceptibility to smoking among never-smoking youth globally and identify factors associated with such behavior. Methods Cross-sectional data for 168 countries were obtained from the Global Youth Tobacco Survey. Simple and multiple logistic regression analyses were conducted. Frequencies and proportions for descriptive statistics, and adjusted odds ratios with 95% confidence intervals for logistic regression models were reported. Results Approximately 12.5% of never-smoking youth worldwide were susceptible to smoking worldwide, of which 7.2% were males and 5.3% were females. Compared with youth in the Americas, those in other WHO regions were associated with decreased susceptibility to smoking. Regardless of gender, exposure to parental or peer smoking, secondhand smoke inside or outside home, and tobacco industry promotion was associated with increased smoking susceptibility. In contrast, support for smoke-free policies and school antismoking education was associated with decreased susceptibility to smoking among females. Moreover, exposure to antismoking media messages was associated with increased susceptibility to smoking among never-smoking youth. Conclusions Approximately 1 in 8 never-smoking youth worldwide was found to be susceptible to smoking. A comprehensive approach involving parental and peer education, smoke-free policies, ban on tobacco advertising and promotions, and antismoking education in schools should be developed by policy makers and public health professionals to protect never-smoking youth from being susceptible to smoking and transforming into future regular smokers.