Temporal changes in smoking prevalence among adolescents across 23 countries

Aim: This study aimed to investigate temporal changes in smoking prevalence among adolescents aged 13–15 across 23 countries and to assess individual and country-level factors influencing smoking behaviour.

Methods: This study used data from 168 286 young adolescents aged 13–15 years obtained from the Global School-based Student Health, 2003–2021. Linear regression models and meta-analyses were conducted to analyse the changes in current smoking prevalence among young adolescents.

Results: Among the 23 countries, smoking prevalence decreased in six countries, including Argentina, Fiji, Jamaica, Samoa, Tonga and Uruguay, while it increased in four countries, namely Guyana, Morocco, Thailand and Vanuatu. The prevalence of smoking was higher among male adolescents at 15.5% (95% CI 13.8%–17.2%) compared to females at 8.0% (95% CI 6.7%–9.3%). Adolescents exposed to secondhand smoke had a prevalence of 16.3% (95% CI 14.5%–18.2%), significantly higher than 4.2% (95% CI 3.7–4.6) in those not exposed. Smoking prevalence was 16.5% (95% CI 14.8%–18.2%) among those with smoking parents or guardians, compared to 8.1% (95% CI 7.1%–9.1%) among those without.

Conclusion: The findings highlight the need for tailored tobacco control measures to reduce adolescent smoking globally. Strengthening policy enforcement and addressing social determinants of smoking are critical to achieving further reductions.