Tobacco cessation, anti-tobacco education, and smoke-free schools: Findings from the Global Youth Tobacco Survey.

Introduction: Adolescents are especially vulnerable to the harmful effects of tobacco use. This study examined changes in tobacco use in schools, the provision of anti-tobacco education, and cessation efforts over time, and the importance of cessation support and education for cessation efforts among youth aged 13-15 years.

Methods: We performed secondary analyses of cross-sectional data from the latest two rounds of the Global Youth and Tobacco Survey (GYTS). Forty-five countries met the inclusion criteria for examining changes in quit attempts; 42 for receipt of cessation support; 28 for anti-tobacco education; 27 for tobacco use in schools, and 45 for the combined analysis of the association between cessation support and anti-tobacco education with quit attempts. To assess differences between the rounds, crude and adjusted prevalence estimates were compared as average adjusted predictions from univariate and multivariate logistic regressions. The association between quit attempts and other characteristics was examined using mixed effects binary logistic regression with a random intercept for the country.

Results: Percentages of youth who attempted to quit smoking (11/45), received cessation support (12/42), or saw others smoking on school premises (5/27) did not change in the majority of countries between survey rounds after adjusting for age and sex. Over half of the countries (15/27) reported significant changes in provision of anti-tobacco education between survey rounds, after adjustment. In 45 countries, adolescents who received help for quitting smoking (AOR=3.23; 95% CI: 3.02-3.45) or anti-tobacco education (AOR=1.13; 95% CI: 1.06-1.21) were more likely to attempt cessation than those without help or education (p<0.001).

Conclusions: Despite the importance of cessation support and anti-tobacco education in promoting quit attempts among adolescents, many countries lack sufficient cessation initiatives for youth. Monitoring these indicators is necessary for guiding the development of public health interventions to reduce tobacco and nicotine product use among youths.