Machine learning models of tobacco susceptibility and current use among adolescents from 97 countries in the Global Youth Tobacco Survey, 2013-2017

Adolescents are particularly vulnerable to tobacco initiation and escalation. Identifying factors associated with adolescent tobacco susceptibility and use can guide tobacco prevention efforts. Novel machine learning (ML) approaches efficiently identify interactive relations among factors of tobacco risks and identify high-risk subpopulations that may benefit from targeted prevention interventions. Nationally representative cross-sectional 2013–2017 Global Youth Tobacco Survey (GYTS) data from 97 countries (28 high-income and 69 low-and middle-income countries) from 342,481 adolescents aged 13–15 years (weighted N = 52,817,455) were analyzed using ML regression tree models, accounting for sampling weights. Predictors included demographics (sex, age), geography (region, country-income), and self-reported exposure to tobacco marketing, secondhand smoke, and tobacco control policies. 11.9% (95% CI 11.1%-12.6%) of tobacco-naïve adolescents were susceptible to tobacco use and 11.7% (11.0%-12.5%) of adolescents reported using any tobacco product (cigarettes, other smoked tobacco, smokeless tobacco) in the past 30 days. Regression tree models found that exposure or receptivity to tobacco industry promotions and secondhand smoke exposure predicted increased risks of susceptibility and use, while support for smoke-free air policies predicted decreased risks of tobacco susceptibility and use. Anti-tobacco school education and health warning messages on product packs predicted susceptibility or use, but their protective effects were not evident across all adolescent subgroups. Sex, region, and country-income moderated the effects of tobacco promotion and control factors on susceptibility or use, showing higher rates of susceptibility and use in males and high-income countries, Africa and the Americas (susceptibility), and Europe and Southeast Asia (use). Tobacco policy-related factors robustly predicted both tobacco susceptibility and use in global adolescents, and interacted with adolescent characteristics and other environments in complex ways that stratified adolescents based on their tobacco risk. These findings emphasize the importance of efficient ML modeling of interactions in tobacco risk prediction and suggest a role for targeted prevention strategies for high-risk adolescents.

Tobacco smoking initiation among students in Samoa and health concerns

Background High prevalence of tobacco smoking among young students remains a serious health concern given the positive association between smoking and NCDs. More recently, some studies also noted young smokers were more likely to get infected with COVID-19 compared to non-smokers. This study aims to assess the factors that influence smoking uptake among young students in Samoa. Findings from this study will provide valuable insight to policymakers and health authorities on policies and strategies to combat smoking among youth in Samoa and the Pacific Island Countries (PICs). Methods The 2017 Global Youth Tobacco Survey data of Samoa, available from the World Health Organization is used in the analysis. We use the multinominal logistic model to investigate the effects of socio-economic and demographics factors on young students’ uptake of smoking in Samoa. Result The main findings of this study indicate that sex, age, friendship, parental smoking, family discussion, outside influence, pocket money, and mother’s education are important determinants of tobacco smoking initiation among youths in Samoa. Conclusion Our findings contribute towards the evidence of the imperative health impact of friends, parents, and public smoking on students in Samoa. This warrants strategies that are effective in discouraging parents from smoking and implement measures that prevent smoking in public places. Moreover, educational efforts, particularly those that encourage more discussion at home settings on the harmful effects of smoking are strongly recommended. Parents are strongly encouraged to regularly monitor children’s spending behaviour.

Determinants of smokeless tobacco use and prevalence among Sudanese adolescents

Background Smokeless tobacco is a part of social and cultural life in Sudan. The affordability and availability of this kind of tobacco make it a fundamental issue in adolescents. The aim of this study is to investigate the extent of the use of smokeless tobacco in adolescents and its determinants. Methods A school-based cross-sectional study was conducted in Khartoum state in Sudan. The study targeted male and female adolescents in secondary schools. A total of 3387 students from public and private schools participated in the study. Multistage random sampling was used to select the participants. The Arabic version questionnaire from the Global Youth Tobacco Survey (GYTS) was utilised to collect the data from the participants. Results Among the participants, 57.3% were females and 42.7% were males. Students from private and public schools were 48.4 and 51.6%, respectively. The overall prevalence of those who had ever used smokeless tobacco was 7.6%, in which the prevalence among male students was 11.0% while among females was 5.0%. The determinant factors were male gender (OR 1.53 CI 95% 1.03–2.28), family structure (OR 1.52 CI 95% 1.03–2.23), exposure to second-hand smoke at home (OR 1.60 CI 95% 1.11–2.31), friends smoking cigarettes (OR 1.78 CI 95% 1.22–2.60), lack of restriction of selling tobacco to minors (OR 1.73 CI 95% 1.25–2.39), promotion of smokeless tobacco (OR 2.12 CI 95% 1.20–3.72) and low self-efficacy (OR 7.47 CI 95% 4.45–12.52). Conclusion A comprehensive prevention programme that enforces the prohibition of the promotion of smokeless tobacco and the selling of smokeless tobacco to minors is crucial. Moreover, the prevention programme should enhance adolescents’ self-efficacy.

Adolescent Tobacco Use Estimates From The Global Youth Tobacco Survey, India: Tobacco a risk factor for future spread of COVID 19

Background: Tobacco use has been identified as a risk factor and causes negative outcomes to the COVID 19 pandemic. Adolescents’ tobacco users in India are the vulnerable population to acquire COVID-19 in the future. The study aimed to understand tobacco consumption patterns among adolescents in India to highlight the vulnerability of this population to COVID-19 infection. Methods: The Global Youth Tobacco Survey (GYTS) reports were identified and recovered from the Centre for Disease Control and Prevention (CDC) data sets. The findings of the surveys in 2003, 2006, and 2009 were compared with respect to the prevalence of cigarette smoking and other tobacco use, and the determinants of initiation of tobacco use among the adolescent population. Results: The total tobacco consumption among adolescents was found to have increased from 13.7% in 2006 to 14.6% in 2009. All forms of tobacco use were higher in boys than girls across all three survey periods. Also, the trend of bidi (smoked tobacco form) use had increased in both genders. A reduction in exposure to Second Hand Smoke, with an increase in cessation services, media campaigns, and tobacco-related school curriculum was noted. If the increase in tobacco consumption between 2006 and 2009 had continued at the same rate then in 2021 around 18% of adolescents are estimated to consume tobacco in some form. Conclusion: The significant overall tobacco use and increasing bidi consumption makes the adolescent group more susceptible to COVID-19 infection. This indicates an imperative need to include this age group for COVID-19 management to reduce the burden on health care.

Tobacco use among School-going Adolescents in Comoros: A Secondary Analysis of the 2015 Comoros Global Youth Tobacco Survey.

BackgroundTobacco use among adolescents has long term adverse health consequences, especially during adulthood. Currently, little is known about tobacco use behaviour among adolescents in Comoros. Our study aims to estimate the prevalence and identify key factors associated with tobacco use among adolescents in Comoros using the 2015 Comoros Global Youth Tobacco Survey data.MethodsNational cross-sectional survey data of 2,810 eligible school-going adolescents aged between 11-17 years were analysed. Complex sample logistic regression analyses to determine the correlates of current cigarette smoking and current use of non-cigarette tobacco products.ResultsThe overall prevalence of current cigarette smoking was 14.3% [males (18.5%), females (9.9%)]. The prevalence of current use of non-cigarette tobacco products was 5.8% [males (6.7%), females (4.9%)]. Being male (AOR=2.23;95%CI:1.38-3.59), exposure secondhand smoke within (AOR=3.869;95%CI:2.835-5.280)) and outside their home (AOR= 1.514; 95%CI: 1.100-2.084) and exposure to tobacco industry promotion (AOR=2.986; 95%CI:2.246-3.969) were predictors of current tobacco use among adolescents. Similarly, Exposure to tobacco industry promotion (AOR=.2.669;95%CI:1.610-4.425) were associated with non-cigarette tobacco use. Adolescents exposed to anti-smoking education in schools were less likely to use non-cigarette tobacco (AOR=0.523;95% CI:0.311-0.881) than those not exposed to anti-smoking education in schools.ConclusionOne in seven school-going adolescents smoke cigarettes, and approximately one in 20 school-going adolescents use non-cigarette tobacco products in Comoros. Exposure to secondhand smoke within and outside the home and exposure to tobacco industry promotion were associated with tobacco use in school-going adolescents in Comoros. Our findings suggest the need for adolescent-friendly gender-sensitive tobacco interventions, including strengthening existing tobacco control laws to prevent and reduce tobacco use among school-going adolescents in Comoros.

Current Tobacco Use and Susceptibility To Using Tobacco Among Non-Users of Tobacco: A Cross-Sectional Study Among School-Going Adolescents in Sierra Leone

Background Tobacco use is a global health threat associated with a high disease burden and deaths. Studies concerning current tobacco use and susceptibility to using tobacco products among adolescents who are potential adult tobacco users in Sierra Leone have not been explored. We aimed to estimate the prevalence and correlates of current tobacco use and tobacco non-users susceptibility to using tobacco amongst Sierra Leonean high-school students. Method We used data obtained from the 2017 Sierra Leone Global Youth Tobacco Survey (GYTS), which presented information collected from 6680 students aged 11-17years nationwide. Gender-based correlates of current use and susceptibility to using tobacco among non-tobacco users were determined by complex sample logistic regression analyses. Adjusted odds ratios (AOR) and respective 95% confidence intervals (CIs) were reported. p-values less than 0.005 were considered significant. Results The prevalence of current tobacco use among high school adolescents in Sierra Leone was 10.7% and was higher in males (12.2%) than in females (7.4%). Male [AOR = 1.32 (95%CI:1.01–1.72)], exposure to household secondhand smoke [AOR = 2.68(95%CI:1.71–4.20)], having peers who smoke [AOR = 3.07(1.53–6.16)] were more likely to be currently using tobacco. On the other hand, adolescents exposed to antismoking media messages were less likely to be current tobacco users [AOR = 0.45(95%CI: 0.24–0.83)]. The overall tobacco non-users susceptibility to using tobacco among adolescents in Sierra Leone was 18.2% [male (18.0%), female (18.5%)]. Exposure to tobacco promotion [AOR = 1.50(95%CI:1.07–2.11)] and non-exposure to antismoking education [AOR = 1.39(95%CI:1.04–1.85)] were significantly associated with tobacco non-users’ susceptibility to using tobacco. Conclusion Our study suggests that one-in-ten school-going adolescents currently use tobacco, with nearly one in five non-users susceptible to using tobacco. Given the high prevalence of tobacco product use among Sierra Leonean adults, our findings highlight the need for policies and interventions to prevent tobacco use behaviour among adolescents aimed at averting tobacco use in adulthood.

Main drivers of tobacco consumption among adolescents: the case of Kyrgyzstan

Tobacco smoking among youth is a global concern. Tobacco's dangers and the probability of addiction are often underestimated by young people. Preventing tobacco consumption among youth is critical since tobacco-related illnesses will take away the lives of 250 million young people who continue to smoke into adulthood. Youth are more vulnerable to nicotine and may become addicted to it quicker than adults. Even though they decide to stop in a few years, three out of four teen smokers continue to smoke into adulthood due to nicotine addiction. The main purpose of this study is to investigate tobacco consumption of adolescents in Kyrgyzstan. For this aim, a school-based survey of students aged 13-15 years was utilized. Global Youth Tobacco Survey was conducted in 2019. The questionnaire consists of 56 questions. This survey was conducted in order to get knowledge about adolescents’ attitudes about smoking. In the empirical analysis was employed Heckman selection model. In the light of obtained results it can be concluded that the main drivers of tobacco consumption among adolescents are age, gender, amount of spending money, parental smoking status, among others. The results indicate that tobacco consumption is higher among males. Parents smoking habit leads to a higher probability of an adolescents to become a smoker. The outcomes from this study may provide some insights into the policies implemented to lessen smoking among adolescents.

Determinants of tobacco use and nicotine dependence among healthcare students and their undergraduate peers

Background: Global estimates suggest that tobacco will account for 8 million deaths per year by 2030. The Global Adult Tobacco Survey (2016-17) reported that more than half of men and one in ten women aged 15 and above smoke in India. Introduction: Health science courses students (HCS), being the future of our health care system, are expected to be more knowledgeable regarding the hazards of tobacco and are considered less likely to use compared to their peers (non-HCS) from other fields. The study aims to determine the prevalence and determinants of tobacco use and levels of nicotine dependence amongst HCS and non-HCS students. Methods: Web-based survey (response rate of 72%) employing Global Youth Tobacco Survey (GYTS) and Fagerström standardized questionnaires; n= 4770 [21.5 (SD: ±1.61) years; 62% male]; HCS (43.5%) and non-HCS (56.3%) students from three universities. A descriptive, comparative and multivariate analysis was performed. Results: Half of non-HCS and a third of HCS used tobacco, with a higher proportion of male users in both groups. 70% of overall participants showed ‘low nicotine dependence’ with a higher proportion of ‘high dependence’ within the non-HCS group (13.89% vs. 9.2%). There were crucial differences in specific determinants and ages of initiation of tobacco use between the two groups. Conclusion: Tobacco use in HCS, apart from personal health risks to themselves, may potentially affect their future commitment to support patients in tobacco cessation programs. There is a need for further research into tobacco prevention and cessation programs tailored to the needs of student groups based on the determinants affecting them.

Perilaku Merokok pada Mahasiswa Fakultas Kedokteran dan Fakultas Pertambangan Universitas Papua, Sorong

Indonesia merupakan salah satu negara dengan prevalensi perokok tertinggi di dunia. Saat ini merokok masih menjadi gaya hidup di lingkungan mahasiswa, tetapi perilaku merokok pada populasi di wilayah TImur Indonesia terutama Papua masih jarang diteliti. Penelitian ini bertujuan untuk mengetahui perilaku merokok pada mahasiswa Fakultas Kedokteran (FK) dan fakultas non-kesehatan (Fakultas Teknik Pertambangan dan Perminyakan/FTPP). Studi ini menggunakan desain studi potong lintang. Pengambilan data dilakukan pada Maret 2019 dengan teknik total sampling dan instrument yang digunakan yaitu kuesioner tervalidasi dari Global Adult Tobacco Survey (GATS) dan Global Youth Tobacco Survey (GYTS). Didapatkan 113 responden mahasiswa FK dan 72 responden mahasiswa FTPP. Perilaku merokok 1 batang setiap hari dalam 30 hari terakhir didapatkan terbanyak pada mahasiswa FTPP (29,8%) dibandingkan FK (7,1%). Ditemukan juga kekerapan kebiasaan yang berpengaruh terhadap kesehatan seperti mengunyah sirih, mengunyah pinang, VAPE bahkan konsumsi alkohol pada populasi baik mahasiswa FK maupun mahasiswa FTPP. Prevalensi merokok, menyirih dan konsumsi alkohol pada mahasiswa fakultas teknik lebih tinggi daripada mahasiswa fakultas kedokteran dan perlu dilakukan penelitian terkait terjadinya gangguan kesehatan dimasa depan. Kata kunci: merokok, menyirih, mahasiswa kedokteran, mahasiswa teknik. Smoking Behavior among Medical and Engineering Students in Universitas Papua, Sorong Abstract Indonesia is among the highest prevalence of cigarette smoking in the world and it is a common lifestyle among undergraduate students. This study aims to measure smoking behaviour among undergraduate medical student and non medical students in West Papua. A cross sectional study with total sampling was done among undergraduate students in Faculty of Medicine and Faculty of Mining Engineering Universitas Papua, Sorong. Global Adults Tobacco Survey (GATS) and Global Youth Tobacco Survey (GYTS) questionnairre were administered with additional question regarding other habits that might be related to addiction such as betel nut chewing, consuming alcohol and vaping. There are 113 medical student and 72 non medical students were recruited. The prevalence of smoking among undergraduate medical students was 7.1% and 29.8% among undergraduate non medical students. Interestingly the prevalence of betel nut chewing is high among non medical students. The prevalence of smoking among undergraduate non medical students is higher compared with medical students in West Papua. The prevalence of betel-nut chewing and alcohol consumption were also high among non medical student and need further study regarding its health risk. Keywords: cigarette smoking, betel nut chewing, medical students, non medical students