Abstract
BACKGROUND: Understanding global patterns of adolescent noncombustible nicotine or tobacco product (NNTP) and combustible cigarette (CC) use is vital due to rising prevalence and long-term health risks, but comparative international analyses are lacking. Thus, we aimed to assess smoking prevalence and trends among adolescents in 57 countries and territories and to identify factors associated with NNTP and CC use.
METHODS: We utilized World Health Organization (WHO) Global Youth Tobacco Survey data to investigate adolescent NNTP and CC use prevalence and trends globally from 2014 to 2021. We conducted a meta-analysis using random-effects models to identify the summary effect of smoking prevalence in each country. Weighted linear regression was used to calculate weighted β coefficients with 95% confidence intervals (CIs). Each analysis was stratified by sex, World Bank income category, e-cigarette regulatory policy status, and WHO Framework Convention on Tobacco Control ratification status. Finally, a hierarchical Bayesian statistical model was employed to precisely predict the prevalence rates of both CC and NNTP use up to 2045.
RESULTS: Among the 57 countries with 173,658 adolescents, NNTP use exhibited a higher prevalence than CC use in 31 countries. Demographic groups exhibiting higher smoking prevalence included male adolescents (NNTP use: 10.78% [95% CI, 9.38 to 12.18]; CC use: 10.36% [9.03 to 11.69]), adolescents in high-income countries (NNTP use: 11.29% [8.62 to 13.95]; CC use: 10.48% [7.27 to 13.68]), and those in countries with less restrictive policies (NNTP use: 11.18% [7.32 to 15.04]; CC use: 11.44% [7.75 to 15.13]). Global NNTP use showed an overall increase from 2014 to 2021 (β, 0.73 [0.16 to 1.30]), with a particularly notable rise among male adolescents (β, 0.81 [0.05 to 1.57]). In 2044-2045, NNTP use is expected to remain relatively stable (10.61%), while CC use is projected to show a downward trend (1.05%).
CONCLUSION: Over half of the countries exhibited a higher prevalence of NNTP use than CC use. Global smoking prevalence varied across diverse factors. NNTP use among adolescents has increased, especially among male adolescents.