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Understanding worldwide youth attitudes towards smoke-free policies: an analysis of the Global Youth Tobacco Survey
  1. Howard K Koh1,
  2. Hillel R Alpert2,
  3. Christine M Judge1,
  4. Robert W Caughey1,
  5. Loris J Elqura1,
  6. Gregory N Connolly2,
  7. Charles W Warren3
  1. 1Harvard School of Public Health, Boston, Massachusetts, USA
  2. 2Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts, USA
  3. 3Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Hillel Alpert, Harvard School of Public Health, Center for Global Tobacco Control, 401 Park Drive, Landmark Center, Third Floor East, Boston, Massachusetts 02115, USA; halpert{at}
  • Competing interests H K Koh, former director of the Division of Public Health Practice, Harvard School of Public Health, is currently the Assistant Secretary for Health for the US Department of Health and Human Services. This article was written prior to his appointment as the Assistant Secretary for Health and does not necessarily represent the views of the Department of Health and Human Services or the United States.


Background Smoke-free policies (SFPs) in public places are increasing globally, but developing countries are lagging behind. Understanding youth attitudes towards SFPs can inform SFP initiatives.

Methods A multilevel logistic regression analysis of data collected from youth aged 13–15 years (2000–2006) who completed the Global Youth Tobacco Survey (GYTS) in 115 countries, primarily in the developing world, was conducted. The analysis examined relationships between support for SFPs and individual-level measures related to smoking status, and exposure to secondhand smoke (SHS), controlling for demographic and environmental factors of interest and country-level policy factors.

Results In all, 77.3% of 356 395 youth in 115 countries favoured SFPs, including majorities of non-smokers (78.7%) and smokers (63.6%). In the multivariable analysis knowledge of smoke harm was the strongest predictor of favouring SFPs (OR 2.42, 95% CI 2.27 to 2.67). Exposure to countermarketing (OR 1.40, 95% CI 1.25 to 1.57) and school anti-smoking education (OR 1.22, 95% CI 1.13 to 1.31) were also positively associated. Current smoking (OR 0.48, 95% CI 0.41 to 0.53), susceptibility to smoking (OR 0.46, 95% CI 0.40 to 0.52) and exposure to tobacco promotion were negatively associated. Significant country-level variation was observed. The presence of any national smoke-free legislation in a country was positively associated with youth favouring such policies.

Conclusions The majority of youth worldwide support, yet lack, smoke-free policies in public places, while being regularly exposed to SHS. Youth support of SFPs is most positively associated with knowledge of the harmful effects of tobacco smoke. Redoubling education efforts represents an opportunity to establish smoke-free environments and improve health of children in developing countries.

  • Tobacco smoke pollution/prevention & control
  • public policy
  • world health*
  • adolescent
  • cross-sectional studies
  • environmental tobacco smoke

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  • Funding This paper was supported by a Flight Attendants Medical Research Institute, Clinical Innovator Award 072085.

  • Provenance and peer review Not commissioned; externally peer reviewed.