Cigarette use and exposure to second-hand smoke and tobacco advertising among Tunisian adolescents

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Background: The Global Youth Tobacco Survey was conducted in Tunisia in 2001, 2007, 2010 and 2017. It is the only national survey that examined exposure to second-hand smoke and tobacco advertising among young people, and there has been no description of the trend. Aims: To describe cigarette use trends among Tunisian adolescents and their exposure to second-hand smoke and tobacco advertising from 2001 to 2017. Methods: The Global Youth Tobacco Survey is a school-based cross-sectional survey conducted by the World Health Organization. It uses a two-stage cluster sampling design to obtain a representative sample of students aged 13-15 years. A standardized questionnaire is used for data collection. We compared the prevalence and 95% confidence intervals (CI) of ever and current cigarette use, exposure to second-hand smoke in and outside the home, and exposure to tobacco advertising, over 4 years (2001, 2007, 2010 and 2017). Results: Current cigarette use decreased from 11.1% (95% CI: 10.0-12.3%) in 2001 to 7.7% (95% CI: 6.5-9.0%) in 2017 (P < 0.001). Exposure to second-hand smoke at home decreased from 62.5% (95% CI: 60.7-64.2%) to 46.7% (95% CI: 44.5-49.0%) over the same period (P < 0.001), but exposure outside the home increased from 65.4% (95% CI: 63.7-67.1%) in 2001 to 73.3% (95% CI: 71.2-75.3%) in 2017 (P < 0.001). Exposure to anti-tobacco messages in the media decreased from 87.8% (95% CI: 86.3-89.1%) in 2001 to 64.4% (95% CI: 62.2-66.5%) in 2017 (P < 0.001). Conclusion: While the prevalence of cigarette use and second-hand smoke exposure at home decreased, exposure outside the home increased. Efforts are needed to ensure compliance with smoke-free laws to decrease the prevalence of exposure to second-hand smoke.

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