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Tobacco use among youth: a cross country comparison
  1. The Global Youth Tobacco Survey Collaborative Group*
  1. Correspondence to:
 Charles W Warren, PhD, 4770 Buford Highway, NE, Mailstop K-50, Atlanta, Georgia 30341, USA;


Objective: The Global Youth Tobacco Survey (GYTS) is a worldwide collaborative surveillance initiative that includes governments and non-governmental organisations under the leadership of the World Health Organization/Tobacco Free Initiative (WHO/TFI) and the US Centers for Disease Control and Prevention/Office on Smoking and Health (CDC/OSH). The GYTS was developed to enhance the capacity of countries to design, implement, and evaluate tobacco control and prevention programmes.

Methods: The GYTS employs a standard methodology where self administered questionnaires, consisting of a set of core questions, are completed by a representative school based sample of students primarily between the ages of 13–15 years.

Results: Data are presented from 75 sites in 43 countries and the Gaza Strip/West Bank region. Current use of any tobacco product ranges from 62.8% to 3.3%, with high rates of oral tobacco use in certain regions. Current cigarette smoking ranges from 39.6% to less than 1%, with nearly 25% of students who smoke, having smoked their first cigarette before the age of 10 years. The majority of current smokers want to stop smoking and have already tried to quit, although very few students who currently smoke have ever attended a cessation programme. Exposure to advertising is high (75% of students had seen pro-tobacco ads), and exposure to environmental tobacco smoke (ETS) is very high in all countries. Only about half of the students reported that they had been taught in school about the dangers of smoking during the year preceding the survey.

Conclusions: Global youth tobacco use is already widespread throughout the world, but there is great variation among nations. Valid and reliable data on the extent of youth tobacco use, and correlates of use, are essential to plan and evaluate tobacco use prevention programmes. The GYTS has proven the feasibility of an inexpensive, standardised, worldwide surveillance system for youth tobacco use. The GYTS will be expanded to the majority of countries in the next few years, and can serve as a baseline for monitoring and evaluating global and national tobacco control efforts.

  • Global Youth Tobacco Survey
  • cross country comparison
  • CDC, Centers for Disease Control and Prevention
  • ETS, environmental tobacco smoke
  • GYTS, Global Youth Tobacco Survey
  • HBSC, Health Behavior in School-aged Children
  • OSH, Office on Smoking and Health
  • TFI, Tobacco Free Initiative
  • WHO, World Health Organization

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  • * The core 2001 GYTS questionnaire in English and example GYTS questionnaires in Arabic, French, and Spanish can be found at:

  • In total, 66.2% of all students who participated in the GYTS from the countries included in this paper are age 13–15 years (table 1).

  • Details can be found at:

  • § Cigarettes—manufactured and “roll-your-own” cigarettes (tobacco wrapped in paper).14 GYTS question: “Have you ever tried or experimented with cigarette smoking, even one or two puffs?”

  • GYTS question: “During the past 30 days (one month), have you used any form of tobacco products other than cigarettes (for example, chewing tobacco, snuff, dip, cigars, cigarillos, little cigars, pipe)?”

  • ** Core GYTS questions and response categories are available at the following web site:

  • †† Population estimates are from The World Gazetteer: The estimate of 3% of the population being aged 13–15 years and in school was derived from the population counts from The World Gazetteer and school enrollment counts for each of the 73 sites in this paper.


    World Health Organization Headquarters
 Derek Yach, Vera Luiza da Costa e Silva, Leanne Riley, Michael P Eriksen

    Centers for Disease Control and Prevention
 Rosemarie Henson, Samira Asma, Curtis Blanton, Ralph Caraballo, Reta Horton, Danielle Kahn, Veronica Lea, Juliette Lee, LaTisha Lord, Stephanie Staras, Mark Tablidilo, Charles W Warren, Leah Zinner

    Canadian Public Health Association
 James Chauvin, Laura Nue, Chris Rosene

    National Cancer Institute
 Scott Leischow, Stephen Marcus

    Research Triangle Institute
 Donald Smith

    GYTS was coordinated through WHO Regions
 WHO:Regional Office for Africa (AFRO)

    • Ghana: Edith Wellington, SO Sackey

    • Malawi: John Kapito

    • Nigeria: Ima-Obong A Ekanem

    • South Africa: Dehran Swart, Priscilla Reddy

    • Zimbabwe: Pepukai Chikukwa

    • AFRO Regional Office: Karen Klimowski, Charles Maringo

    WHO: Regional Office for the Americas/Pan American Health Organization (AMRO/PAHO)

    • Antigua & Barbuda: Colin O'Keiffe, Joan A Moses

    • Argentina: Hugo Miguez

    • Bahamas: Larrie Williams

    • Barbados: Sean Daniel

    • Bolivia: Franklin Alcaraz de Castillo

    • Chile: Luis Caris

    • Costa Rica: Julio Bejarano

    • Cuba: Luisa Lances Cotilla

    • Dominica: Joan Henry

    • Grenada: A Alister Antoine

    • Guyana: Shradhanand Hariprasha

    • Haiti: Gilbert Jean-Charles, Gerald Lerebours

    • Jamaica: Karen A Prendergast

    • Mexico: Maria J Hoy, Pablo Kuri-Morales

    • Montserrat: Almae O'Garro

    • Peru: Alfonso Zavaleta

    • St. Lucia: Elvina Lawrence, Edward L Emmanuel

    • St. Vincent, the Grenadines: Patsy Wyllie

    • Suriname: Gerold Vliet, Oscar Bhagwandin

    • Trinidad & Tobago: Diane Renaud, Leo Alleyne

    • USA: Cheryl Healton

    • Uruguay: Raquel Magri

    • Venezuela: Ricardo Granero, Natasha Herrera

    • Virgin Islands (Am.): Melanie Dockery, Julia Sheen

    • AMRO/PAHO Regional Office: Beverley Barnett, Armando Peruga, Maritza Rojas, Heather Selin

    WHO: Regional Office for the Eastern Mediterranean (EMRO)

    • Gaza Strip/West Bank: Samah Eriqat

    • Jordan: Mohammed Shreim

    • EMRO Regional Office: Fatimah El Awa

    WHO: Regional Office for Europe (EURO)

    • Poland: Krzysztof Prezewozniak, Witold Zatonski

    • Russian Federation: Andrei Demine, Konstantine Vitalievich Vyshinsky, Elena Skovortsova

    • Ukraine: Konstantin Krasovsky, Tatiana Andreeva

    • EURO Regional Office—Haik Nikogosian, Ionela Petrea

    WHO: Regional Office for South-East Asia (SEARO)

    • India: Prakash Gupta, Urmi Sen, Surendra Shastri, Dhirendra Sinha, Gajalakshmi Vendhan

    • Indonesia: Tjandra Yoga Aditama

    • Nepal: Hom Lal Shrestha, MR Pandey

    • Sri Lanka: PW Gunasekera

    • SEARO Regional Office: Martha Osei

    WHO: Regional Office for the Western Pacific (WPRO)

    • China: Jiang-ping Sun

    • Fiji: Ilisapeci Movono

    • Northern Mariana Islands: Isamu Abraham

    • Palau: Valerie Whipps, Lisa Hansen, Annabel Lyman, Andrew Tabelual

    • Philippines: Marina Miguel-Baquilod

    • Singapore: Chng Chee Yeong

    • WPRO Regional Office: Annette David, Harley Stanton