title: Tobacco advertising/promotions and adolescents' smoking risk in Northern Africa.
abstract: BACKGROUND
  Comprehensive tobacco advertising/promotion bans are effective against adolescent smoking but many developing countries have implemented only partial bans. This study examines the association between advertising/promotions exposure and adolescent cigarette smoking risk in North Africa, and possible mediation of this association by parent and peer smoking.
  
  
  METHODS
  Adolescent data (n=12 329) from the Global Youth Tobacco Survey were analyzed (Libya, 2007; Egypt, 2005; Morocco, 2006; Tunisia 2007; and Sudan, 2005). Current smoking (any cigarette use in the past 30 days) and never-smokers' initiation susceptibility (composite of openness to accepting a cigarette from a friend and intention to start smoking in the next year) outcomes were examined. Advertising/promotion exposures included media and in-person contacts. Weighted univariate, bivariate and multivariable analyses were conducted.
  
  
  RESULTS
  Current smoking prevalence ranged from 5.6% (Egypt) to 15.3% (Tunisia) among boys, and 1.1% (Libya and Egypt) to 2.0% (Morocco and Sudan) among girls. Initiation susceptibility ranged from 14.1% (Sudan) to 25.0% (Tunisia) among boys, and from 13.3% (Sudan) to 15.0% (Libya) among girls. Ninety-eight percent of adolescents reported exposure to at least one type of advertising/promotion. In multivariable analyses adjusting for demographics, each type of advertising/promotion was significantly and positively associated with boys' current smoking status; most advertising/promotion exposure types were also positively associated with initiation susceptibility among boys and girls. Peer smoking only partially mediated these associations.
  
  
  CONCLUSIONS
  Tobacco advertising/promotion exposure was highly prevalent and associated with adolescents' smoking risk in these countries. The comprehensiveness and enforcement of advertising/promotion bans needs to be enhanced.
authors.affiliation: Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, , New Orleans, Louisiana, USA.
authors.forename: Aubrey Spriggs
authors.initials: AS
authors.lastname: Madkour
authors.forename: E Cannon
authors.initials: EC
authors.lastname: Ledford
authors.forename: Lori
authors.initials: L
authors.lastname: Andersen
authors.forename: Carolyn C
authors.initials: CC
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000329:Advertising; D000352:Africa, Northern / Q000453:epidemiology; D003906:Developing Countries; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D010379:Peer Group; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D000074606:Smoking Prevention; D019460:Tobacco Industry; D062789:Tobacco Products
keywords: Advertising and Promotion; Global health; Low/Middle income country; Media