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Title: Understanding worldwide youth attitudes towards smoke-free policies: An analysis of the Global Youth Tobacco Survey

Authors: H Koh, H Alpert, C Judge, R Caughey, et al. L.J.

Reference: Tobacco Control 2011; published online 26 January 2011
http://bit.ly/g5baST

Reviewer: Robert Goldberg, PhD, Contributing editor, ProCor; Professor of Medicine and Epidemiology, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA

Reviewer comments: Comprehensive smoke-free policies in public places can substantially reduce adults and children's exposure to secondhand smoke. Since many young adolescent boys and girls take up cigarette smoking during their early years, and young people can be fierce advocates for policy change, it is important to understand youth attitudes toward smoke-free policies for the purpose of developing new educational and policy initiatives.

Using data from a large global youth tobacco survey of more than 350,000 adolescents between ages 13-15 years living in 115 countries, the majority of adolescents surveyed supported a smoke-free policy in public places, including schools. While these results are encouraging, there was considerable variation in support of these policies between youths residing in different countries. These findings were observed despite the fact that the vast majority of the populations included in this survey did not have a comprehensive national smoke-free policy in place.

Continued efforts remain needed to develop smoke-free policies throughout the developing and developed world. Considerable opportunities exist to enhance the education of young adolescents and adults and develop and support societal attitudes toward smoke-free policies and improve the health of children and adults across the globe.

Purpose of study: To examine the attitudes of young boys and girls age 13-15 years residing in 115 countries, primarily in the developing world, toward smoke-free policies

Location of study: Boston, MA, US

Study design: Cross-sectional

Results: The authors used data from the Global Youth Tobacco Survey (GYTS) for the present investigation. The GYTS utilizes a standardized self-administered questionnaire to ask a variety of questions about a number of independent predictor variables. For purposes of the present investigation, a single question was asked about whether students were in favor of banning smoking in public places such as restaurants, buses, trains, and schools. Data for the present study were obtained from nearly 357,000 young boys and girls between ages 13-15 years living in 115 countries.

In this population, approximately three quarters (77%) of participating youths favored the institution of smoke-free policies in public places; 79% of reported non-smokers favored these policies compared with 64% of smokers.

Support for smoke-free policies in public places ranged widely from 54% in African populations to 86% in Eastern Mediterranean countries. Of interest, only 2.9% of the populations residing in the surveyed countries were covered by comprehensive smoke-free policies. However, the presence of any national smoke free legislation in a country was positively associated with the youth of that country favoring a smoke-free policy.

In a multivariable adjusted regression analysis, several variables were positively associated with favoring smoke-free policies in public places. These included knowledge and smoking associated harm (adjusted odds ratio (OR = 2.46), self-reported exposure to tobacco counter-marketing during the prior month (OR = 1.40), and receipt of anti-smoking education in school (OR = 1.22). On the other hand, current smokers (OR = 0.48) and young individuals who had been offered a free cigarette by an industry representative (OR= 0.83) were less likely to favor smoke-free policies than respective comparison groups. Wide variation in the support of smoke free policies was also observed between countries ranging from high support of smoke-free policies in Albania (OR=4.48) to comparatively low support among youth residing in Africa (e.g., Kenya OR = 0.13).