Effect of policy changes on cigarette sales: the case of Turkey.

BACKGROUND: In 1996, Turkey made tobacco control a health priority. The tobacco control effort was extended in July 2009 with the expansion of the smoke-free law to include all enclosed workplaces and public places and, in January 2010, with a 20% increase in the Special Consumption Tax on Tobacco. METHODS: Sales data were averaged, by month, for the period January 2005 through June 2009 to establish an 'expected' monthly sales pattern. This was the period when no new tobacco control measures were implemented. The overall monthly average was then calculated for the same period. The expected monthly sales pattern was then graphed against the overall monthly sales average to delineate a seasonal sales pattern that was used to evaluate the divergence of actual monthly sales from the 'expected' pattern. RESULTS: A distinct seasonal pattern was found with sales above average from May through August. Comparison of actual cigarette sales to the 'expected' monthly sales pattern following the implementation of the expanded smoke-free law in July resulted in a 5.2% decrease. Cigarettes sales decreased by 13.6% following the January 2010 Special Consumption Tax. Since the implementation of the expanded smoke-free law in July 2009 and the tax increase in January 2010, cigarette sales in Turkey decreased by 10.7%. CONCLUSION: The effect of recent Turkish tobacco control policies could contribute to a reduction in the number of premature deaths related to tobacco use. Evidence has shown that periodic tax increases and strong enforcement of all tobacco control policies are essential to further decrease tobacco consumption.

Linking Global Youth Tobacco Survey (GYTS) data to tobacco control policy in Turkey--2003 and 2009.

OBJECTIVE: The purpose of this paper is to use data from the Global Youth Tobacco Survey (GYTS) conducted in Turkey in 2003 and 2009 to examine changes in tobacco use and important tobacco control measures. METHODS: The GYTS were conducted in grades 7-9 in 2003 and 7-10 in 2009 in Turkey. Data in this paper are limited to 13 to 15 year old students. A total of 15,957 students from 202 schools participated in 2003 and 5,054 students from 69 schools participated in 2009. The overall response rate was 92.1% in 2003 and 87.5% in 2009. RESULTS: Between 2003 and 2009 current cigarette smoking did not change significantly for either boys (9.4% to 10.2%) or girls (3.5% to 5.3%). Current cigarette smoking was higher among boys than girls in 2003 and in 2009. In 2009, half of students reported they had been exposed to second hand smoking (SHS) at home and 80% reported they had been exposed to SHS in public places. Three in ten students reported they had been exposed to pro-tobacco advertising in newspapers or magazines; one in ten had an object with a cigarette brand logo on it; and 7% had been offered free cigarettes by a cigarette company representative. Two-thirds of current cigarette smokers reported that they wanted to stop smoking; and almost two-thirds had been taught in school in the past year about the dangers of smoking. CONCLUSION: Passing and implementing the Law No. 4207 on Prevention of Hazards of Tobacco Products, ratifying the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), raising tax on tobacco, and requiring pictorial warning labels were important steps forward for tobacco control in Turkey. However, as to the tobacco control much work yet to be accomplished including developing an effective enforcement plan for all tobacco control efforts.

Children's loss of autonomy over smoking: the Global Youth Tobacco Survey.

BACKGROUND: Empirical data suggest that children with infrequent tobacco use have difficulty quitting smoking. METHODS: Data were obtained from the nationally representative Global Youth Tobacco Survey of middle-school students in Cyprus and Greece. Regression analyses examined associations between smoking frequency (smoking days per month or cigarettes smoked per day) and loss of autonomy (difficulty refraining from smoking). RESULTS: The prevalence of lost autonomy was 40% among subjects who smoked 1 or 2 days/month and 41% among subjects who averaged less than one cigarette/day and increased in a dose-response pattern. Regression models derived from the Cyprus data were replicated by the Greek data. CONCLUSIONS: Two national surveys confirm previous reports of difficulty with smoking cessation with infrequent smoking. Since loss of autonomy is universally recognised as a core feature of addiction, our data indicate that young adolescents experience symptoms of nicotine addiction with infrequent tobacco use.

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

BACKGROUND: Smoke-free policies (SFPs) in public places are increasing globally, but developing countries are lagging behind. Understanding youth attitudes towards SFPs can inform SFP initiatives. METHODS: A multilevel logistic regression analysis of data collected from youth aged 13-15 years (2000-2006) who completed the Global Youth Tobacco Survey (GYTS) in 115 countries, primarily in the developing world, was conducted. The analysis examined relationships between support for SFPs and individual-level measures related to smoking status, and exposure to secondhand smoke (SHS), controlling for demographic and environmental factors of interest and country-level policy factors. RESULTS: In all, 77.3% of 356,395 youth in 115 countries favoured SFPs, including majorities of non-smokers (78.7%) and smokers (63.6%). In the multivariable analysis knowledge of smoke harm was the strongest predictor of favouring SFPs (OR 2.42, 95% CI 2.27 to 2.67). Exposure to countermarketing (OR 1.40, 95% CI 1.25 to 1.57) and school anti-smoking education (OR 1.22, 95% CI 1.13 to 1.31) were also positively associated. Current smoking (OR 0.48, 95% CI 0.41 to 0.53), susceptibility to smoking (OR 0.46, 95% CI 0.40 to 0.52) and exposure to tobacco promotion were negatively associated. Significant country-level variation was observed. The presence of any national smoke-free legislation in a country was positively associated with youth favouring such policies. CONCLUSIONS: The majority of youth worldwide support, yet lack, smoke-free policies in public places, while being regularly exposed to SHS. Youth support of SFPs is most positively associated with knowledge of the harmful effects of tobacco smoke. Redoubling education efforts represents an opportunity to establish smoke-free environments and improve health of children in developing countries.

Tobacco use, exposure to secondhand smoke, and cessation counseling among medical students: cross-country data from the Global Health Professions Student Survey (GHPSS), 2005-2008.

BACKGROUND: GHPSS is a school-based survey that collects self-administered data from students in regular classroom settings. GHPSS produces representative data at the national or city level in each country. This study aims to investigate the prevalence of tobacco use, exposure to secondhand smoke, and cessation counseling among medical students using the GHPSS data. METHODS: The Global Health Professions Student Survey (GHPSS) was conducted among 3rd year medical students in 47 countries and the Gaza Strip/West Bank from 2005-2008 to determine the prevalence of tobacco use and amount of formal training in cessation counseling. RESULTS: In 26 of the 48 sites, over 20% of the students currently smoked cigarettes, with males having higher rates than females in 37 sites. Over 70% of students reported having been exposed to secondhand smoke in public places in 29 of 48 sites. The majority of students recognized that they are role models in society (over 80% in 42 of 48 sites), believed they should receive training on counseling patients to quit using tobacco (over 80% in 41 of 48 sites), but few reported receiving formal training (less than 40% in 46 of 48 sites). CONCLUSION: Tobacco control efforts must discourage tobacco use among health professionals, promote smoke free workplaces, and implement programs that train medical students in effective cessation-counseling techniques.

Main determinants of cigarette smoking in youth based on the 2006 Cyprus GYTS.

OBJECTIVE: The goal of the study is to identify predictors of current cigarette smoking in adolescents within the school, home, and broader social environment. METHOD: A two stage cluster sample design was used to select a representative sample of students from all middle and high schools in Cyprus in 2005-2006. Standardized Global Youth Tobacco Survey (GYTS) methodology was employed in administering the questionnaires and processing the results. Analyses were conducted using logistic regression with the outcome variable being current smoking. RESULTS: After adjusting for the effect of other predictors in the model, the strongest predictor of adolescent smoking was smoking peers. Having parents and grandparents that smoke, concerns about weight, access to pocket money, ease of buying cigarettes, owning an item with a cigarette logo on it, the belief that smokers are less attractive, and the false consensus effect all remain statistically significant predictors. CONCLUSION: In designing smoking prevention programs, factors pertaining to the school, social and familial circle of adolescents as well as misconceptions on the link between smoking and physical appearance need to be considered. Such programs can act as empowering tools to complement legal measures which need to be firmly enforced and constantly revised to be effective.

Tobacco use among Palestine refugee students (UNRWA) aged 13-15.

OBJECTIVE: The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has made tobacco use prevention a primary health issue. UNRWA provides education, health, relief and social services in five fields of operation: Jordan, Lebanon, Syria, Gaza Strip and the West Bank. The purpose of this paper is to compare tobacco use among Palestine refugee students and students in the general population of the five fields of operation. METHODS: Global Youth Tobacco Survey (GYTS) data were collected from representative samples of students in UNRWA schools in each of the five fields of operation in 2008. For comparison, previous data are included from GYTS conducted in Gaza Strip, Lebanon, and the West Bank (2005) and in Jordan and Syria (2007). Data are presented for three groups of students: refugees attending schools within and outside the camps and non-refugee students in the general population. RESULTS: In each of the five fields of operation, there was no difference in current cigarette smoking, current use of shisha, or susceptibility to initiate smoking among the three groups of students. Cigarette smoking and susceptibility was lowest in the Gaza Strip and highest in the West Bank; shisha use was lowest in the Gaza Strip but over 30% in Lebanon, Syria, and the West Bank. Exposure to secondhand smoke in public places was greater than 60% in almost all sites. Exposure to indirect advertising was almost 10%. CONCLUSIONS: The similarity in tobacco use among the three groups of students suggests that a coordinated plan between the UNRWA and the governmental authority could be most beneficial in reducing the burden of tobacco-related morbidity and mortality.

Exposure to and attitudes regarding secondhand smoke among secondary students in Taiwan.

The 2003 School Health Act of Taiwan stipulated that school campuses of senior high and below should be smoke free, but data from the Global Youth Tobacco Survey show that the majority of students are exposed to smoke in public and at home. More than 50% of nonsmokers indicated that they had been exposed to secondhand smoke (SHS) in public places, with the exposure rate as high as 90% among smokers. More than 40% of junior and senior high school students were exposed to SHS at home. Support for banning smoking in public places ranged from almost 60% to almost 80%. More than 60% of current smokers and almost 90% of never smokers think that smoke from others is harmful to them. With a clear body of evidence detailing the harmful effects, reduction and eventual elimination of exposure to SHS should be the goal of the tobacco control community.

Tobacco use and cessation counseling among health professional students: Lebanon Global Health Professions Student Survey.

INTRODUCTION: The number of deaths attributable to tobacco use is rising globally. Health professionals can help reduce tobacco use by providing advice to patients regarding smoking cessation. Very few studies have collected information on tobacco use and cessation counseling training among health professional students. The purpose of this paper is to examine these issues using data from the 2005 Lebanon Global Health Professions Student Survey (GHPSS). METHODS: The 2005 Lebanon GHPSS includes nationally representative estimates of third-year students in all dental, medical, nursing, and pharmacy schools in Lebanon. RESULTS: Current cigarette use ranged from 14.8% for pharmacy students to 26.9% for nursing students and 27.4% for medical students. Current waterpipe use ranged from 20.6% for medical students to 44.9% for nursing students. About 8 in 10 students in all four disciplines were exposed to second-hand smoke in public places. More than 8 in 10 students in medical, nursing, and pharmacy schools believed that health professionals have a role in giving advice or information on smoking cessation to patients. More than 9 in 10 students in all four disciplines believed that health professionals should receive training on smoking cessation techniques. However, those who received training ranged from 19.8% of pharmacy students to 43.7% of nursing students. CONCLUSION: Tobacco use (cigarettes and water-pipe) is high among third-year health professional students in Lebanon. Students are willing to provide smoking-cessation counseling but lack training. The Ministry of Public Health, the Ministry of Education, and educational institutions in Lebanon should work together with other interested partners in developing, testing, and implementing successful patient cessation counseling training programs for health professionals.

Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control (FCTC): the case for the Seychelles.

Tobacco control has been recognized as a main public health concern in Seychelles for the past two decades. Tobacco advertising, sponsoring and promotion has been banned for years, tobacco products are submitted to high taxes, high-profile awareness programs are organized regularly, and several other control measures have been implemented. The Republic of Seychelles was the first country to ratify the WHO Framework Convention on Tobacco Control (FCTC) in the African region. Three population-based surveys have been conducted in adults in Seychelles and results showed a substantial decrease in the prevalence of smoking among adults between 1989 and 2004. A first survey in adolescents was conducted in Seychelles in 2002 (the Global Youth Tobacco Survey, GYTS) in a representative sample of 1321 girls and boys aged 13-15 years. The results show that approximately half of students had tried smoking and a quarter of both boys and girls had smoked at least one cigarette during the past 30 days. Although "current smoking" is defined differently in adolescents (>or=1 cigarette during the past 30 days) and in adults (>or=1 cigarette per day), which precludes direct comparison, the high smoking prevalence in youth in Seychelles likely predicts an increasing prevalence of tobacco use in the next adult generation, particularly in women. GYTS 2002 also provides important data on a wide range of specific individual and societal factors influencing tobacco use. Hence, GYTS can be a powerful tool for monitoring the situation of tobacco use in adolescents, for highlighting the need for new policy and programs, and for evaluating the impact of current and future programs.

Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control (FCTC): the case for Lebanon.

OBJECTIVES: The purpose of this paper is to use data collected in the 2001 and 2005 Lebanon Global Youth Tobacco Survey (GYTS) to monitor articles in the WHO Framework Convention on Tobacco Control (WHO FCTC). This information is necessary to enhance the capacity of the Ministry of Health and relevant organizations to design, implement, and evaluate tobacco control and prevention programs in Lebanon, especially among adolescents. METHODS: The GYTS is a school-based survey which uses a two-stage sample design to produce representative, independent, cross-sectional estimates. The GYTS was conducted in 2001 and 2005 in Lebanon to produce representative national estimates. Data in this report are limited to students aged 13-15 years. In total, 5035 students from 50 schools participated in 2001; and 3341 students from 50 schools participated in 2005. RESULTS: The data in this report show that, in 2005, 8.6% of the students currently smoked cigarettes, but 33.9% currently smoked narguileh. Half of current smokers wanted to stop smoking and 6 in 10 have tried to stop during the past year but have failed. In 2005, exposure to SHS at home (78.4%) and in public places (74.4%) was very high; while 85.2% thought smoking should be banned in public places. Nearly 9 in 10 students who usually buy their cigarettes in stores were not refused purchase because of their age. Overall, only half of the students in Lebanon reported that during the past school year they had been taught about the dangers of smoking. CONCLUSIONS: Data in this report can be used as baseline measures for future evaluation of the tobacco control programs implemented by the Ministry of Health with particular attention to youth. The key for the Lebanese parliament is to develop, endorse, implement and enforce these new tobacco control laws and use the data from GYTS to monitor progress toward achieving the goals of the WHO FCTC. One key component of tobacco control needs to be the monitoring of Narguileh use among youth, a new emergency.

Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control (FCTC): the case for the Philippines.

OBJECTIVES: The purpose of this paper is to present data from the Global Youth Tobacco Survey (GYTS) conducted in the Philippines in 2000 and 2003 which can be used as baseline measures to monitor provisions of the 2003 Tobacco Regulatory Act and Articles of the WHO FCTC. METHODS: The GYTS is a school-based survey which uses a two-stage sample design to produce representative, independent, cross-sectional estimates. In both 2000 and 2003, the GYTS was conducted in three geographic zones in the Philippines. The zones are then combined to produce a representative national estimate each year. Data in this report are limited to students aged 13-15 years. RESULTS: The findings in this study show that in the Philippines changes occurred between 2000 and 2003 in that: students were less likely to smoke cigarettes or use other tobacco products, less likely to be exposed to SHS in public places, more likely to support bans on smoking in public places, more likely to have learned in school and from the media about the health hazards of tobacco use, and less likely to have been offered "free" cigarettes by a tobacco company representative. CONCLUSION: The synergy between the Philippines' leadership in passing the Clean Air Act in 1999 and the Tobacco Regulatory Air in 2003, in ratifying the WHO FCTC in 2005, and in supporting the conduct of the GYTS offers the Philippines a unique opportunity to develop, implement and evaluate the youth component of their comprehensive tobacco control policy that can be most helpful to the country.

Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control: the case for Indonesia.

OBJECTIVES: Indonesia has the fifth highest rate of annual cigarette consumption per person of all countries worldwide. The Global Youth Tobacco Survey (GYTS) was developed to provide data on youth tobacco use to countries for their development of youth-based tobacco control programs. Data in this report can be used as baseline measures for future evaluation of the tobacco control program implemented by Indonesia's Ministry of Health. METHODS: The 2006 Indonesia GYTS is a school-based survey that included separate samples for Java and Sumatera, representing more than 84% of the population of Indonesia. Each sample used a two-stage cluster sample design that produced representative samples of students in secondary grades 1-3, which are associated with ages 13-15 years. RESULTS: This report shows that more than 1 in 10 students (12.6%) currently smoked cigarettes, with the prevalence among boys (24.5%) significantly higher than among girls (2.3%). Of the students who currently smoked, more than 7 in 10 (75.9%) reported that they desired to stop smoking now. Regarding secondhand smoke exposure, more than 6 in 10 students (64.2%) reported that they were exposed to smoke from other people in their home during the week before the survey. More than 9 in 10 students (92.9%) had seen a lot of advertisements for cigarettes on billboards during the past month and more than 8 in 10 (82.8%) had seen a lot of advertisements for cigarettes in newspapers or in magazines. CONCLUSIONS: Tobacco control in Indonesia will likely not move forward until the government evaluates and strengthens existing laws, considers passing new strong laws, and develops protocols for enforcing all laws. The Indonesian government also should strongly consider accession to the World Health Organization Framework Convention on Tobacco Control.

Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control (FCTC): the case for Mexico.

BACKGROUND: The adoption of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in 2004 marked a critical achievement in efforts to stem the tobacco epidemic in Mexico. The Global Youth Tobacco Survey (GYTS) findings are useful for evaluating achievement of FCTC articles and designing tobacco control programs. OBJECTIVE: To use data from the GYTS conducted in 21 Mexican cities between 2000 and 2005 to monitor Articles in the WHO FCTC. METHODS: The GYTS uses a two-stage cluster sample survey design that produces representative samples of students aged 13-15 years enrolled in public, private and technical schools. The survey was undertaken at 542 schools in 21 cities. The GYTS surveyed 43,950 students during 2000-2005. RESULTS: The current smoking rate ranged from 10.7% to 29.4%. Among never smokers, susceptibility to initiate smoking ranged from 20.2% to 34.4%. Among current smokers, the percentage who bought their cigarettes in a store was above 40% in 6 cities, but significantly declined over five years in the only city with two assessments (Monterrey). Exposure to secondhand smoke in public places was greater than 50% in 15 of the 21 cities. Over 80% of students in all 21 cities reported that they saw of advertisements for cigarettes on billboards. CONCLUSION: Using determinants measured by GYTS in Mexico, the government can monitor the impact of enforcing various provisions of the National Health Law and the progress made in achieving the goals of the WHO FCTC and the Regional strategy. When these goals are met, tobacco consumption and exposure in Mexico will have declined substantially.

Prevalence of smoking and other smoking-related behaviors reported by the Global Youth Tobacco Survey (GYTS) in Thailand.

INTRODUCTION: Thailand ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) on November 8, 2004. The WHO FCTC requires all parties to inform all persons of the health consequences of tobacco consumption and exposure to tobacco smoke. Each party has agreed to develop, implement and evaluate effective tobacco control programs to measure progress in reaching the goals of the WHO FCTC. METHODS: The Global Youth Tobacco Survey (GYTS) was developed to provide data on youth tobacco use to countries for their development of youth-based tobacco control programs. Data in this report can be used as baseline measures for future evaluation of the tobacco control programs implemented by the Ministry of Public Health. RESULTS: Overall, about 1 in 10 Thai students are current smokers, this number including 4 times more boys than girls (17% versus 3.9%). Almost 2 in 10 Thai students start smoking before the age of 10, and almost 7 in 10 students are reported to have been exposed to smoke from others in public places. About 4 in 10 students are reported to have an object with a cigarette brand logo on it. CONCLUSION: The key for Thailand is to implement and enforce the provisions on indirect tobacco advertising, smoking in public places, selling tobacco to youths under 18 years of age, and to use the data from the GYTS to monitor progress toward achieving the goals of the WHO FCTC. When these goals are met, tobacco consumption and exposure in Thailand will have declined substantially.

Prevalence of smoking and other smoking related behaviors reported by the Global Youth Tobacco Survey (GYTS) in four Peruvian cities.

INTRODUCTION: In 2004, Peru ratified the Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and in 2006 passed Law 28705 for tobacco consumption and exposure reduction. The Global Youth Tobacco Survey (GYTS) provides data on youth tobacco use for development of tobacco control programs. Findings from the GYTS conducted in four main cities in Peru in 2000 and 2003 are reported in this paper and can be used to monitor provisions of the WHO FCTC. METHODS: The GYTS is a school-based survey that uses a standardized methodology for sampling, questionnaire construction, field procedures, and data management. In total, 5,332 and 7,824 students aged 13 to 15 years participated in the 2000 and 2003 surveys conducted in Huancayo, Lima, Tarapoto and Trujillo. RESULTS: In both years, Lima had the highest lifetime (54.6% and 59.6%) and current use of tobacco (18.6% and 19.2%) of the four cities. According to gender, boys smoked more than girls and less than 20% of students initiated smoking before the age of 10. Among smokers, more than 60% bought their cigarettes in a store with no restriction for their age, and approximately 12% had ever been offered "free cigarettes". Around 90% of students were in favor of banning smoking in public places. Changes between 2000 and 2003 included an increase in the percentage of smokers who wanted to have a cigarette first thing in the morning in Tarapoto (from 0% to 1.2%) and a decrease in exposure to tobacco at home in Huancayo (from 23.7% to 17.8%) and Trujillo (from 27.8% to 19.8%) CONCLUSION: While few changes in tobacco use among youth have been observed in the GYTS in Peru, the data in this report can be used as baseline measures for future evaluation efforts. At this time, tobacco control efforts in Peru need to focus on enhancing Law 28705 to include enforcement of existing provisions and inclusion of new laws and regulations. Most of these provisions are required of all countries, such as Peru, that have ratified the WHO FCTC.

Evaluation of the use of Global Youth Tobacco Survey (GYTS) data for developing evidence-based tobacco control policies in Turkey.

INTRODUCTION: The tobacco control effort in Turkey has made significant progress in recent years. Turkey initiated its tobacco control effort with the passing of Law 4207 (The Prevention of Harmful Effects of Tobacco Products) in 1996 and ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in 2004. It is important to base policy decisions on valid and reliable evidence from population-based, representative studies that are periodically repeated to enable policy makers to monitor the results of their interventions and to appropriately tailor anti-tobacco activities towards future needs. METHODS: The Global Youth Tobacco Survey (GYTS) was developed to track tobacco use among young people and enhance the capacity of countries to design, implement, and evaluate tobacco control and prevention programs. Turkey conducted the GYTS in 2003 and data from this survey can be used as baseline measures for evaluation of the tobacco control programs implemented by the Ministry of Health (MOH) of the Turkish government. RESULTS: The GYTS was conducted in 2003 on a representative sample of students aged 13 to 15 years. It indicated that almost 3 in 10 students in Turkey had ever smoked cigarettes, with significantly higher rates among boys. Current cigarette smoking rates were lower, at 9% for boys and 4% for girls. The prevalence of current use of other tobacco products was about half these figures for each gender. About 80% were exposed to secondhand smoke. Exposure to pro-smoking media messages was not rare. Almost half of the smokers 'usually' bought their tobacco from a store, despite the law prohibiting this. Exposure to teaching against smoking in schools was not universal. CONCLUSION: Findings from the GYTS, with periodic repeats of the survey, can be used to monitor the impact of enforcing various provisions of the present law (No: 4207), the progress made in achieving the goals of the WHO FCTC, and the effectiveness of various preventive interventions against smoking. Such data would inform and help in the development of public health strategy.

Prevalence and social environment of cigarette smoking in Cyprus youth.

BACKGROUND: Tobacco use is the single most preventable cause of morbidity and mortality in humans. Limited data exist regarding the extent of the problem among Cyprus youth. We use the Global Youth Tobacco Survey to assess the prevalence of cigarette smoking among middle and high school students as well as the social environment in which this is taking place. METHODS: The survey was conducted by the Cyprus International Institute for the Environment and Public Health in association with Harvard School of Public Health. A two-stage cluster sample design was used to select a representative sample of students from middle and high schools registered with the Republic of Cyprus in 2005-2006. The study questionnaire consisted of 99 questions and participation in the survey was voluntary. Statistical analyses were performed taking into consideration the specific design of the study and the sample weights associated with each completed questionnaire. RESULTS: The prevalence of current smoking, defined as having smoked cigarettes on one or more days of the past 30 days, is 13% among boys and 7% among girls in middle schools, and 36% among boys and 23% among girls in high schools. Furthermore, 16% of middle school students and more than 24% of high school students that had never smoked indicated that they are likely to initiate smoking within the next year. Exposure to environmental tobacco smoke is also very high with 91% of students reporting being exposed to smoke in places outside home. In addition, more than 95% of current smokers reported that they had bought cigarettes in a store during the past month and were not refused cigarettes because of their age. CONCLUSION: Smoking prevalence among Cyprus middle and high school students is high and there are indications of an increase in the prevalence of smoking among girls over the last few years. Susceptibility rates, exposure to second-hand smoke, and access to and availability of cigarettes to youth are also high and concerning. The present survey indicates that the problem of cigarette smoking among youth in Cyprus is significant and requires collective action immediately.

Prevalence of tobacco use among students aged 13-15 years in the South-Eastern Europe health network.

OBJECTIVE: To examine adolescent tobacco use among members of the South-Eastern Europe (SEE) Health Network using data from the Global Youth Tobacco Survey (GYTS). METHODS: Nationally representative samples were drawn from students in grades associated with youth aged 13 to 15 in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, the Former Yugoslavian Republic of Macedonia, Montenegro, Republic of Moldova, Romania, and Serbia. RESULTS: Current cigarette smoking rates among students ranged from 5.6% to 33.1%. Current use of tobacco products other than cigarettes ranged from 3.6% to 10.2%. CONCLUSIONS: If effective programs are not developed, implemented, and enforced, morbidity and mortality attributed to tobacco use will surely increase.

Prevalence of tobacco use among students aged 13-15 years in Health Ministers' Council/Gulf Cooperation Council Member States, 2001-2004.

BACKGROUND: This article examines differences and similarities in adolescent tobacco use among Member States of the Health Ministers' Council for the Gulf Cooperation Council (HMC/GCC) using Global Youth Tobacco Survey (GYTS) data. METHODS: Nationally representative samples of students in grades associated with ages 13-15 in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates, and Yemen. Schools were selected proportional to enrollment size, classes were randomly selected within participating schools, and all students in selected classes were eligible to participate. RESULTS: GYTS results confirmed that boys are significantly more likely than girls to smoke cigarettes or use shisha (water pipe). Students had higher rates of tobacco use than adults in Bahrain, Oman, and United Arab Emirates. For boys and girls, shisha use was higher than cigarette smoking in almost all countries. Susceptibility to initiate smoking among never smokers was higher than current cigarette smoking in all countries. Exposure to secondhand smoke in public places was greater than 30%, direct protobacco advertising exposure was greater than 70% on billboards and in newspapers, and more than 10% of students were influenced by indirect advertising. Finally, less than half of the students were taught in school about the dangers of tobacco use in the past year. CONCLUSIONS: For boys and girls, high prevalence of cigarette smoking, high prevalence of shisha use, and high susceptibility of never smokers to initiate smoking in the next year are troubling indicators for the future of chronic disease and tobacco-related mortality in the Member States of the HMC/GCC.