The predictors of cigarette smoking, smokeless tobacco consumption and use of both forms in adolescents in South Asia: a secondary analysis of the Global Youth Tobacco Surveys (GYTS).

BACKGROUND Tobacco uptake in adolescents is associated with a range of predictors. We examined the predictors of cigarette smoking, smokeless tobacco (ST) consumption and use of both ST and cigarettes among adolescents in four South Asian countries. METHODS We analysed the Global Youth Tobacco Surveys (GYTS) data for Bangladesh (2013), India (2009), Pakistan (2013), and Sri-Lanka (2015), using multinomial regression to examine associations between several predictors and tobacco use. RESULTS Data from 23,681 adolescents were analyzed. Overall, 82.8% of the study population were between 13 and 15 years and 52.7% were girls, 2% were cigarette smokers, 6.5% were ST users and 1.1% used both ST and cigarettes, in the past 30-days. Exposure to smoking in public places was associated with past 30-days smoking (RRR 5.59, 95%CI 4.28-7.28), ST use (RRR 2.07, 95%CI 1.84-2.32) and use of both ST and cigarettes (RRR 11.42, 95%CI 7.44-17.54). Exposure to tobacco use in electronic media and being offered free tobacco products were associated with all forms of tobacco use. Shopkeepers' refusal to sell cigarettes protected adolescents from smoking (RRR 0.47, 95%CI 0.36-0.63) and ST use (RRR 0.65, 95%CI 0.45-0.95). However, exposure to anti-tobacco mass media messages was not protective for any form of tobacco use. Adolescents taught at school about harmful effects of tobacco were less likely to use ST; no evidence of this association was observed for smoking. CONCLUSION The associations between tobacco use and pro-tobacco factors were strong but the associations with anti-tobacco factors lacked strength and consistency in this study population.