Worldwide, approximately 20% of adolescents aged 13 to 15 years who don’t smoke are susceptible to cigarette use, including 20.4% of boys and 19.4% of girls, researchers reported in Pediatrics.
The study estimated nonsmoking adolescents’ susceptibility to cigarette smoking worldwide, using data from the Global Youth Tobacco Survey (GYTS) from 2010 to 2020 and trends in smoking susceptibility from 1999 to 2020. Study authors defined smoking susceptibility as “a lack of firm decision against smoking” that is “a strong predictor of smoking experimentation during adolescence.” The GYTS was developed by the World Health Organization (WHO) and the US Centers for Disease Control and Prevention and is a school-based cross-sectional survey on tobacco use, initiation, and susceptibility in young adolescents.
Data from 129 countries and territories that administered at least 1 survey from 2010 to 2020 were used to evaluate susceptibility to smoking, and data from 82 countries and territories that conducted at least 3 repeated surveys from 1999 to 2020 were used to assess trends in smoking susceptibility over time.
The study included 270,585 adolescents 13 to 15 years of age (44.0% male) from 129 countries that had conducted at least 1 survey between 2010 and 2020. Among the countries, 31 (24.0%) were in the European region, and 27 (20.9%) were in the American region.
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Preventing susceptibility to cigarette smoking among early adolescents is crucial to tobacco control and prevention initiatives for adults.
Cigarette smoking susceptibility ranged from 0.9% in Turkmenistan to 44.1% in Vanuatu. Overall, cigarette smoking susceptibility was 19.6% (95% CI, 18.2-21.1), 20.4% (95% CI, 18.9-21.8) in boys, and 19.4% (95% CI, 17.8-21.0) in girls.
Among WHO regions, cigarette smoking susceptibility was 22.1% (95% CI, 18.3-25.8) in the African region, 18.9% (95% CI, 15.8-22.0) in the Eastern Mediterranean region, 18.2% (95% CI, 15.3-21.0) in the European region, 20.1% (95% CI, 18.1-22.1) in the American region, 15.7% (95% CI, 7.4-23.9) in the Southeast Asian region, and 20.8% (95% CI, 16.8-24.7) in the Western Pacific region.
Cigarette smoking susceptibility and a country’s economic development level had a U-shaped association. A relatively low susceptibility prevalence was observed in middle-income countries and in countries with moderate purchasing power parity (PPP), and a relatively increased prevalence occurred in high-income countries and low-income countries. The U-shaped prevalence of susceptibility was observed in both sexes.
Regarding trends in cigarette smoking susceptibility from 82 countries, 35 had a subzero average annual rate of change (AARC) in susceptibility. The overall AARC in global susceptibility to cigarette smoking was 0.2% (95% CI, –1.0 to 1.5). Linear secular trends were comparable in both sexes, although secular trends varied among WHO regions. Cigarette smoking susceptibility significantly decreased in the European region (AARC: –3.3%; 95% CI, –5.8 to –0.8), and it increased significantly in the American region (AARC: 2.2%; 95% CI, 1.3-3.1).
Cigarette smoking susceptibility tended to increase among low-income countries (AARC: 2.0%; 95% CI, –4.1 to 8.1) and in those with a reduced PPP (Q1) (AARC: 1.8%; 95% CI –2.8 to 6.3), but not significantly.
Limitations include use of the school-based GYTS, as adolescents who did not attend school were not interviewed. Also, the cross-sectional analysis used self-reported information, and the study did not assess tobacco products other than cigarettes.
“Preventing susceptibility to cigarette smoking among early adolescents is crucial to tobacco control and prevention initiatives for adults,” the study authors stated.
