INTRODUCTION

Tobacco use contributes to 6.4 million deaths globally each year¹ and most tobacco smokers begin smoking during adolescence². Smoking during adolescence causes health problems, such as increased number and severity of respiratory illness, and lifelong smoking also causes cancer and cardiovascular disease³. Therefore, preventing tobacco use among youth is a critical strategy to reduce overall tobacco use^2,4. Adolescence may represent an opportune time for tobacco cessation with the goal of preventing more established or long-term tobacco use³. A recent report found that, in 40 of 51 countries, >50% of current tobacco smoking students aged 13–15 years want to quit⁵. Helping or advising youth tobacco smokers to quit smoking may lead to increased quit attempts, reduced likelihood of lifelong tobacco use, and reductions in morbidity and mortality.

This brief report describes self-reported receipt of help or advice to stop smoking among current tobacco smoking youth aged 13–15 years enrolled in school from 56 countries, chosen by criteria specified below.

METHODS

RESULTS

In 53 of 56 countries, the estimated point prevalence of reporting receiving any help or advice to quit smoking was >50%. Across all countries, the median estimated prevalence of receiving any help or advice to quit smoking among students aged 13–15 years was 72.7% (range=39.9% San Marino to 96.9% Timor-Leste). The median estimated prevalences of help or advice to quit smoking were: 1) 52.5% (range=37.2% Bahamas to 69.9% Montenegro) from a friend or family member only, 2) 8.8% (range=3.7% Latvia to 34.2% Togo) from a professional or program only, and 3) 9.9% (range=2.9% Romania to 31.4% Kenya) from both (Table 1).

DISCUSSION

Our research shows that in 53 out of 56 countries surveyed, more than half of current tobacco smoking students reported receiving some help or advice to quit. Tobacco smoking students’ family and friends were the most common sources of help or advice to quit. In contrast, public health programs and health professionals were the least common sources. These data show that more than five out of ten current tobacco smoking students seek help or advice from only non-evidence based sources in 32 countries. These students may be receiving incorrect information about how to quit smoking tobacco, which may result in poorer cessation outcomes and longer-term tobacco smoking. These findings indicate that opportunities exist to enhance promotion of evidence-based tobacco prevention and control strategies, such as advice from health professionals, in addition to populationlevel education on the dangers of tobacco smoking among youth. While our study was unable to assess whether current tobacco smoking students received advice or help from other sources, such as social media and internet-based intervention, some of these interventions are discussed in the literature as potential ways to provide important services to students^7,8. Important considerations are that any smoking cessation program/intervention needs to be age-appropriate and meet the needs of youth as well as being culturally appropriate. New technologies, such as mobile phones and social media platforms, could offer new opportunities to expand cessation services to youth, but these may not be feasible in low resource settings, which would include 40 low and middle income countries in this study at time of survey administration. Future research is needed at individual country levels to inform evidence-based leveraging of health communication related to tobacco prevention and cessation.

The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) treaty, which, as of December 2017, 55 of 56 countries in this analysis have ratified, focuses on evidence-based measures that help keep people safe from tobacco⁹. Specific Articles outlined in FCTC include warning on the dangers of tobacco use (Article 12) and highlighting the benefits of tobacco cessation (Article 14)⁹. To help countries implement FCTC, WHO developed the MPOWER demand reduction strategies¹⁰; when these strategies are implemented as part of a comprehensive tobacco control approach, they can help prevent and reduce youth tobacco use^2,11,12. Additional components of a comprehensive approach can also include sub-national efforts by health professionals and tobacco control programs. For example, health professionals could use the ‘5As’ method as a practical framework to identify and assist youth who smoke tobacco⁸. Trainings and tools for health professional, such as Treatment and Beyond¹³, are available in the Internet that may help increase their capacity to provide tobacco cessation advice and counseling, and enhance their knowledge and understanding of tobacco prevention and control strategies. Additionally, tobacco control programs could implement youth-oriented campaigns that warn about the dangers of tobacco smoking to help reduce youth smoking^2,11.

CONCLUSIONS

To our knowledge, this is the first study using GYTS data to assess current tobacco smoking students who reported receiving help or advice to stop smoking; previous findings revealed that many current tobacco smoking students report a desire to quit⁵. The desire to quit smoking among students presents potential opportunities to develop programs and cessation strategies that could assist students in stopping a behavior that has lifelong consequences to wellbeing and health. Implementing evidence-based strategies outlined in WHO MPOWER, as part of a comprehensive tobacco control approach, can help prevent and reduce tobacco use among youth¹⁰, and may help countries to move towards a tobacco-free generation.