Country and gender differences in the association between violence and cigarette smoking among youth

Exposure to violence in youth may be associated with substance use and other adverse health effects. This study examined cigarette smoking in two middle-income areas with different levels and types of exposure to violence. Association of exposure to verbal and physical violence with cigarette smoking in the West Bank oPt (2008) and in Jujuy Argentina (2006) was examined using cross-sectional surveys of 14 to 17-year old youth in 7th to 10th grade using probabilistic sampling. Violence exposure rates were more than double for Palestinian girls (99.6% vs. 41.2%) and boys (98.7% vs. 41.1%) compared with Argentinians. The rate of current cigarette smoking was significantly higher among Argentinian girls compared with Palestinian girls (33.1% vs. 7.1%, p < 0.001). Exposure to verbal violence from family and to physical violence increased the odds of current cigarette smoking, respectively, among Argentinian girls (aOR = 1.3, 95% CI = 1.0–1.7; aOR = 2.5, 95%CI = 1.7–3.8), Palestinian girls (aOR 2.2, 95%CI = 1.1–2.4; aOR = 2.0, 95%CI = 1.1–3.6) and Argentinian boys (aOR = 1.5, 95%CI = 1.1–2.0; aOR = 2.2, 95%CI = 1.6–3.0), but not among Palestinian boys. Findings highlight the importance of producing context and gender specific evidence from exposure to violence, to inform and increase the impact of targeted smoking prevention strategies.