Predictors and patterns of cigarette and smokeless tobacco use among adolescents in 32 countries, 2007-2011

Purpose This study compared data from 32 countries to assess predictors and patterns of cigarette and smokeless tobacco (SLT) use among students aged 13-15 years old. Methods Data from the 2007-2008 Global Youth Tobacco Surveys were analyzed for students aged 13-15 years in 31 countries located in all six World Health Organization regions. In addition, the 2011 National Youth Tobacco Survey was analyzed for U.S. students aged 13-15 years. Country-specific prevalence of current smoking, current SLT use, and concurrent use patterns were assessed. Results The national prevalence of current cigarette smoking among students aged 13-15 years ranged from 1.8% (Rwanda) to 32.9% (Latvia), whereas current SLT use ranged from 1.1% (Montenegro) to 14.4% (Lesotho). In the U.S. and most European countries surveyed, current smoking prevalence was significantly higher than SLT prevalence, in contrast to patterns observed in low- and middle-income countries. Also, in most of the surveyed countries outside of Europe and the United States, SLT use among girls was as common as their use of cigarettes, and not significantly different from use by boys. When compared with U.S. adolescents, the odds of SLT use were highest among African adolescents (adjusted odds ratio = 3.98; 95% CI: 2.19-7.24) followed by those in the Southeast Asian region (adjusted odds ratio = 2.76; 95% CI: 1.38-5.53). Conclusions Region-specific patterns of tobacco use were noticed. Furthermore, it is alarming that in several low- and middle-income countries, the prevalence of SLT use among females did not differ from that among males, suggesting the possibility of a future shared burden of disease between both males and females.