It’s been long known how tobacco use and secondhand smoke harms health, but little is known about the exact numbers of tobacco use in adolescents.
In a landmark study, researchers have analyzed tobacco use and secondhand smoke exposure in young adolescents aged 12 to 15 years in 68 low-income and middle-income countries, by using previously collected survey data. The researchers found that tobacco use and exposure to secondhand smoke was quite common among young adolescents aged 12 to 15 years in low-income and middle-income countries.
The mean prevalence of current tobacco use was 13.6%, which ranged from a low of 2.8% in Tajikistan to a high of 44.7% in Samoa. In most countries, tobacco use was higher in boys than girls, and higher for adolescents aged 14 to 15 years than for those aged two years younger at 12 to 13 years.
The overall prevalence of secondhand smoke exposure was 55.9%, ranging from 16.4% in Tajikistan to 85.4% in Indonesia. Parental tobacco use, as informed by the young adolescents, especially smoking in mothers, was linked with high tobacco use in young adolescents. Secondhand smoke exposure was also a risk factor for tobacco use among young adolescents. However, the prevalence of tobacco use was not linked with a country’s tobacco purchasing power parity.
Tobacco use, mainly cigarette smoking, is the leading preventable cause of premature death, with approximately 6 million people dying globally from tobacco-related diseases every year. Tobacco use has decreased from 41% in 1980 to 31% in 2012 globally but number of smokers is still increasing because of better life expectancy in increasing and aging populations.
Based on current trends, smoking is predicted to cause 1 billion deaths in this century.
More than 80% of all worldwide smokers reside in low-income and middle-income countries (LMICs). Despite a large number of global tobacco control measures being put into place, such as the establishment of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), tobacco use continues to be a major public health concern, especially in LMICs.
About 90% of smokers begin to consume tobacco before reaching adulthood, that is the age of 18 years, with nearly 100,000 young people starting to smoke every day. Because of the highly addictive nature of nicotine, which is a main component of cigarettes, smoking during adolescence tends to lead into adulthood.
Tobacco use over a prolonged period not only leads to severe health consequences later in life, smoking at a young age also increases the risk of many diseases among adolescents, including respiratory disease, asthma and reduced pulmonary function. Smoking accounted for about 5·81 million deaths in 2013, mostly in LMICs.
The researchers also pointed out the serious health risks caused by secondhand smoke. Secondhand smoke accounted for an estimated 331, 000 deaths in 2013 and up to 28% of all deaths caused by secondhand smoke occur in children.
Using the Global Youth Tobacco Survey (GYTS) data from 1999 to 2005, the researchers estimated that around 44.1% of young adolescents aged 13-15 years were exposed to secondhand smoke at home and 54.2% in public places in 131 countries.
Secondhand smoking causes higher risk of initiating smoking, nicotine dependence and a lower chance of quitting cigarette smoking. There are a couple of reasons for this. Firstly, secondhand smoke is largely a result of being exposed to friends, family members, parents or teachers smoking, and could lead them to smoking out of pressure.
Secondly, secondhand smoke can lead to nicotine dependence as it lights up neural pathways in the brain, making it more sensitive to nicotine which leads to cigarette cravings, and making it harder to quit.
In order to guide tobacco control interventions worldwide, it is important to first analyze the spread of tobacco use and secondhand smoke exposure in young adolescents.
Despite having significant difference among the smoking habits of the various LMICs, tobacco use and secondhand smoke exposure was still pretty high in the 12 to 15-year-old adolescents and twice as common in boys than in girls.
What was quite alarming about the results was the fact that most young adolescents who were smoking cigarettes reported to have started before the age of 11 years. Tobacco use in young adolescents was strongly associated with parental smoking and secondhand smoking.
As little as smoking one cigarette each month during young age was strongly linked with smoking as an adult, which suggests that smoking as an adult could have been prevented if smoking didn’t initiate in adolescent years.
An estimated 40% of men and 10% of women worldwide are tobacco users. Due to which, many non-smokers, including women, children and adolescents are exposed to secondhand smoke. One previous study reported that 88% of parents who smoked were smoking at home and that more than 80% of these parents smoked at home in front of their children.
WHO FCTC has appealed to many countries to ban public smoking, but can do little about individuals smoking at home.
Some important things to remember are that since the use of tobacco products and exposure to secondhand smoke were self-reported, there is a chance of error in reporting.
Secondly, since the data was collected in different years between 2006 and 2013, a direct comparison of smoking habits between different LMICs should be made with caution.
Due to the difference in smoking habits of different LMICs, it was better to develop a national policy, according to the researchers.
The differences however gave way for better understanding about tobacco control success and failure. Research on differences at a subnational level was also important for developing better policies.
The researchers advised that to develop effective policies, it was important to focus on adolescents. Effective measures to control tobacco use should start from an early age, since it is a vulnerable age and kids can be easily influenced via peer pressure, making it even more difficult to quit smoking.
In addition to interventions focusing on adolescents, interventions should also target adults and create an environment that encourages all individuals to refrain from smoking and motivates tobacco users of all ages to quit.
This method would involve putting high taxes on tobacco products, a complete ban on tobacco advertisements and promotions, a total ban on smoking in enclosed places and public places, and developing effective programs to help smokers to quit.
Indeed, increased tax rates on tobacco products can lead to rapid decrease in cigarette smoking, has more potential to attract young individuals compared to older smokers, is achievable in LMICs, and leads to increased government revenues for implementing other tobacco control policies.