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Gender and Macroeconomic Differences and Trends in Teen Smoking First Attempts: Findings from 147 Countries – BMC Medicine

Table 1 presents the characteristics of the study participants. A total of 456,634 adolescents aged 12-16 from 147 countries in six WHO regions (Africa: 36; America: 27; South-East Asia: 10; Europe: 34; Eastern Mediterranean: 20; and Pacific Western: 20) were analyzed in this study. study, with sample sizes ranging from 442 in the Cook Islands to 13,274 in the Russian Federation.

Table 1 Characteristics of the Global Youth Tobacco Survey

Figure 1 presents the prevalence of early first cigarette attempts among boys and girls at the national level. Seventy-nine (54.1%) countries had a prevalence of early first cigarette attempts ≥ 10% for boys, with a prevalence greater than 20% in Estonia, Lithuania, Russian Federation, Timor- Leste, Latvia, Palau, Cook Islands, Republic of Moldova, Bosnia and Herzegovina, Hungary, Indonesia, Micronesia, Czech Republic, New Zealand, Slovakia, Ukraine and Tonga , and 23 (15.8%) countries had a prevalence of early first cigarette attempts ≥ 10% for girls, with prevalence above 20% in Estonia, Lithuania, Cook Islands, Latvia, Palau, Montenegro and in Hungary. There was a high prevalence of early first cigarette attempts among girls compared to boys in Montenegro, the Maldives, and Antigua and Barbuda.

Fig. 1

National prevalence of early attempts to smoke cigarettes among adolescent boys and girls, based on the latest Global Youth Tobacco Surveys from 147 countries

Table 2 shows the prevalence of early attempts to smoke the first cigarette among young adolescents by WHO region, income group, PPP/capita and FCTC ratification status. The average prevalence of early first cigarette attempts was 12.2% (95% CI: 10.9–13.5) in boys and 6.7% (95% CI: 5.8–7.6) in girls, with a significant difference. The difference broadly applied to most WHO regions, income groups and PPP/capita. There were variations in the prevalence of early attempts to smoke the first cigarette across WHO regions, with the highest prevalence of 17.4% for boys and 10.7% for girls in the region European, which was higher than in Africa, the Eastern Mediterranean region and the Americas (9.1%, 9.7% and 10.8% for boys and 4.3%, 6.3% and 4.6% for girls, respectively). The prevalence of early attempts to smoke cigarettes was 8.0% in low income countries, 11.5% in lower middle income countries, 12.0% in upper middle income countries and 15 .6% in high-income countries for boys. the corresponding prevalence among girls was 3.4%, 5.2%, 7.0% and 10.1%, respectively. With the increase in PPP/capita, the prevalence of early attempts to smoke cigarettes increased from the first to the fourth trimester, but decreased in the highest quintile (Q5) for both sexes. The highest prevalence was observed in the Q4 group in terms of PPP/capita. The prevalence among boys was higher than among girls in the other PPP/capita categories (i.e. Q1, Q2, Q3 and Q5), except for the Q4 PPP/capita group, in which no difference significant between the sexes was observed. However, there was no significant difference in the prevalence of early attempts to smoke cigarettes by FCTC ratification status.

Table 2 Prevalence of early first cigarette attempts among adolescents

The average age at the first cigarette smoked was 12.0 years (95% CI: 11.9–12.2) for boys and 11.9 years (95% CI: 11.6–12, 1) for girls. The age window at the first cigarette smoked was between 10.5 and 12.5 years for both sexes (Table 3). In low-income countries, the age of first cigarette among girls, 10.7 years (95% CI: 10.0–11.4), was significantly earlier than that of boys, 11.8 years (95% CI: 11.4–12.2). Additionally, the age of first cigarette smoked was earlier for girls in low-income countries than for girls in upper-middle-income and high-income countries, at 12.3 years (95% CI : 12.0–12.6) and 12.4 years (95% CI: 12.2–12.7), respectively. Girls first tried smoking at a younger age than boys in the lower PPP quintiles (Q1). However, no significant gender difference was observed in the other PPP/capita categories (Q2–Q5). With the increase in PPP/capita, the age at first cigarette increased gradually among girls (p for trend < 0.001) but not in boys (p for trend = 0.334) (Table 3). Girls started smoking cigarettes 0.6 years, 0.6 years, and 1.0 years earlier than boys in the African, Eastern Mediterranean, and Southeast Asian regions, respectively, and the age window corresponding to the first cigarette smoked was reduced to 8.5-12.5 years from 10.5 to 12.5 years.

Table 3 Trends in first smoking attempts among adolescents

Figure 2 shows the age distribution at first cigarette smoked among adolescent male and female smokers by country income, PPP and WHO region. Among adolescent cigarette smokers, 16.0% reported having tried smoking at ≤7 years, 10.5% at 8-9 years, 16.6% at 10-11 years, 29.6% at 12-13 years, 24.4% at 14-15 years old, and 2.9% at 16 years old for girls, and 13.2%, 11.4%, 18.7%, 30.7%, 22.7% and 3.3% for boys, respectively. For girls, the average percentage reporting having smoked their first cigarette under age 12 was 58.1% in low-income countries, 47.3% in lower-middle-income countries, 36.8 % in upper middle income countries and 35.5% in upper middle income countries. high-income countries. For the PPP quintiles, the corresponding percentages were 55.7% at T1, 46.5% at T2, 40.3% at T3, 38.4% at T4 and 34.6% at T5. For boys, the average percentage reporting having smoked their first cigarette under age 12 was 46.6% in low-income countries, 45.3% in lower-middle-income countries, 40.5% in upper middle income countries and 41.8% in upper middle income countries. high-income countries. For PPP quintiles, the average percentage was 46.0% at T1, 42.8% at T2, 42.9% at T3, 43.5% at T4 and 41.1% at T5. More than 30% of adolescent smokers reported having smoked their first cigarette at age <12 years in all six regions, and one in two young girls tried to smoke a cigarette before the age of 12 in the Africa region (53 .9%) and the Southeast Asia region. (54.0%).

Figure 2
Figure 2

Age distribution at first cigarette smoked among adolescents by country income, PPP and WHO region

Figure 3 shows the evolution of the AARR in the prevalence of the first cigarette smoked before the age of 12 at the national level. For boys, 77.1% (54/70) of countries recorded a positive change in the prevalence of AAR, ranging from 0.6% in Morocco to 15.6% in the Republic of Korea, while 22.9 % (16/70) recorded a negative evolution of the AAR, ranging from −0.4% in the United Arab Emirates to −15.1% in Timor-Leste, of which 50% (8/16) came from the region of the Eastern Mediterranean, 25% (4/16) from the South East Asia region and 18.8% (3/16) came from the Africa region. For girls, 70% (49/70) of countries recorded positive TRAM trends in the prevalence of smoking attempts before age 12, ranging from 0.1% in Lebanon to 23.1% in Bangladesh , while 30% of countries (21/70) had a negative change in ARR, ranging from -0.2% in the Maldives to -11.1% in the Syrian Arab Republic, of which 38.1% (8/21 ) were from the Eastern Mediterranean region, 23.8% (5/21) were from the Southeast Asian region and 23.8% (5/21) from the African region.

Figure 3
picture 3

Average annual rate of reduction in the prevalence of early attempts to smoke cigarettes (i.e. smoking the first cigarette before age 12)

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