Department of Health Science, University of York, York, UK.
Usher Institute, University of Edinburgh, Edinburgh, UK.
Nicotine Tob Res. 2021 May 24;23(6):956-965. doi: 10.1093/ntr/ntaa202.
Tobacco uptake in adolescents is associated with a range of predictors. We examined the predictors of cigarette smoking, smokeless tobacco (ST) consumption, and use of both ST and cigarettes among adolescents in four South Asian countries.
We analyzed the Global Youth Tobacco Surveys (GYTS) data for Bangladesh (2013), India (2009), Pakistan (2013), and Sri Lanka (2015), using multinomial regression to examine associations between several predictors and tobacco use.
Data from 23 681 adolescents were analyzed. Overall, 82.8% of the study population were between 13 and 15 years and 52.7% were girls, 2% were cigarette smokers, 6.5% were ST users, and 1.1% used both ST and cigarettes, in the past 30 days. Exposure to smoking in public places was associated with past 30-day smoking (relative risk ratio [RRR] 5.59, 95% confidence intervals [CI] 4.28-7.28), ST use (RRR 2.07, 95% CI 1.84-2.32), and use of both ST and cigarettes (RRR 11.42, 95% CI 7.44-17.54). Exposure to tobacco use in electronic media and being offered free tobacco products were associated with all forms of tobacco use. Shopkeepers' refusal to sell cigarettes protected adolescents from smoking (RRR 0.47, 95% CI 0.36-0.63) and ST use (RRR 0.65, 95% CI 0.45-0.95). However, exposure to antitobacco mass media messages was not protective for any form of tobacco use. Adolescents taught at school about harmful effects of tobacco were less likely to use ST; no evidence of this association was observed for smoking.
The associations between tobacco use and protobacco factors were strong, but the associations with antitobacco factors lacked strength and consistency in this study population.
The predictors of adolescents using different tobacco products, crucial to inform and evaluate tobacco control efforts, are poorly understood. We investigated the associations between several environmental-level factors and cigarette smoking, ST consumption, and use of both forms among adolescents, whereas most of the previous studies focused on individual-level factors. Our study found strong associations between tobacco use and protobacco factors and lack of strength and consistency in associations between antitobacco factors and tobacco use in the study population. Our results indicate that the current tobacco control policies need strengthening to curb the tobacco epidemic in these countries.
青少年吸烟与一系列预测因素有关。我们研究了四个南亚国家青少年中香烟吸烟、无烟烟草（ST）消费以及同时使用 ST 和香烟的预测因素。
我们使用多项回归分析方法分析了全球青年烟草调查（GYTS）的数据，该调查包括孟加拉国（2013 年）、印度（2009 年）、巴基斯坦（2013 年）和斯里兰卡（2015 年），以研究多种预测因素与烟草使用之间的关联。
对 23681 名青少年进行了数据分析。总体而言，研究人群中 82.8%的人在 13 到 15 岁之间，52.7%是女孩，2%是香烟吸烟者，6.5%是 ST 用户，1.1%是在过去 30 天内同时使用 ST 和香烟。在公共场所接触吸烟与过去 30 天内吸烟（相对风险比[RRR]5.59，95%置信区间[CI]4.28-7.28）、ST 使用（RRR 2.07，95%CI 1.84-2.32）和同时使用 ST 和香烟（RRR 11.42，95%CI 7.44-17.54）有关。接触电子媒体中的烟草使用和提供免费烟草产品与所有形式的烟草使用有关。店主拒绝销售香烟可保护青少年免受吸烟（RRR 0.47，95%CI 0.36-0.63）和 ST 使用（RRR 0.65，95%CI 0.45-0.95）的影响。然而，接触反烟草大众媒体信息并不能保护任何形式的烟草使用。在学校接受有关烟草危害的教育的青少年不太可能使用 ST；但在本研究人群中没有观察到这种关联与吸烟有关。
烟草使用与支持烟草的因素之间的关联很强，但与反烟草因素之间的关联在本研究人群中缺乏强度和一致性。
青少年使用不同烟草制品的预测因素对于告知和评估烟草控制工作至关重要，但目前对这些因素的了解还很有限。我们调查了几个环境层面因素与青少年香烟吸烟、ST 消费以及同时使用两种形式之间的关联，而之前的大多数研究都集中在个体层面因素上。我们的研究发现，烟草使用与支持烟草的因素之间存在很强的关联，而与反烟草因素之间的关联在研究人群中缺乏强度和一致性。我们的结果表明，当前的烟草控制政策需要加强，以遏制这些国家的烟草流行。
