title: Prevalence and correlates of tobacco use among school-going adolescents in Madagascar.
abstract: Approximately 90% of adults start smoking during adolescence, with limited studies conducted in low-and-middle-income countries where over 80% of global tobacco users reside. The study aims to estimate prevalence and identify predictors associated with adolescents' tobacco use in Madagascar. We utilized tobacco-related information of 1184 school-going adolescents aged 13-15 years, representing a total of 296,111 youth from the 2008 Madagascar Global Youth Tobacco Survey to determine the prevalence of tobacco use. Gender-wise multivariable logistic regression models were conducted to identify key predictors. Approximately 19% (30.7% males; 10.2% females) of adolescents currently smoke cigarettes, and 7% (8.5% males and 5.8% females) currently use non-cigarette tobacco products. Regardless of sex, peer smoking behavior was significantly associated with increased tobacco use among adolescents. In addition, exposures to tobacco industry promotions, secondhand smoke (SHS) and anti-smoking media messages were associated with tobacco use. The strong gender gap in the use of non-cigarette tobacco products, and the role of peer smoking and industry promotions in adolescent females' tobacco use should be of major advocacy and policy concern. A comprehensive tobacco control program integrating parental and peer education, creating social norms, and ban on promotions is necessary to reduce adolescents' tobacco use.
authors.affiliation: Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA. Electronic address: drveeranki@gmail.com.
authors.forename: Sreenivas P
authors.initials: SP
authors.lastname: Veeranki
authors.affiliation: Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, USA.
authors.forename: Hadii M
authors.initials: HM
authors.lastname: Mamudu
authors.affiliation: Indian Institute of Technology, Jodhpur, Rajasthan, India.
authors.forename: Rijo M
authors.initials: RM
authors.lastname: John
authors.affiliation: Tobacco Control Division, WHO Regional Office for Africa, Brazzaville, Congo.
authors.forename: Ahmed E O
authors.initials: AE
authors.lastname: Ouma
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D064424:Tobacco Use / Q000453:epidemiology*
keywords: Adolescents; Africa; Low- and middle-income countries; Madagascar; Tobacco control; Tobacco use