A cross-country comparison of the prevalence of exposure to tobacco advertisements among adolescents aged 13-15 years in 20 low and middle income countries

Background: This study assessed the prevalence and influence of exposure to pro-tobacco advertisements among adolescents in 20 low and middle income countries (LMICs). Methods: The 2007-2008 Global Youth Tobacco Survey was analyzed for students aged 13-15 years in 20 LMICs. Overall and sex-specific prevalence of exposure to tobacco advertisements in several media, as well as the prevalence of smoking susceptibility (i. e., the lack of a firm commitment among never smokers not to smoke in the future or if offered a cigarette by a friend) were assessed. The variability of the point estimates was assessed using 95% confidence intervals (CI). Logistic regression was used to assess the effect of exposure to multiple (i.e., >= 2) pro-tobacco advertisements on current smoking, adjusting for age and sex (P < 0.05). Data were weighted and analyzed with Stata version 11. Results: Overall country-specific prevalence for different advertisement sources ranged as follows: movies/videos (78.4% in Lesotho to 97.8% in Belize); television programs (48.7% in Togo to 91.7% in the Philippines); newspapers/ magazines (29.5% in Togo to 89.7% in the Philippines); and outdoor community events (30.6% in Rwanda to 79.4% in the Philippines). The overall proportion of never smokers who were susceptible to cigarette smoking ranged from 3.7% in Sri Lanka to 70.1% in Kyrgyzstan. Exposure to >= 2 sources of pro-tobacco advertisements was associated with significantly increased odds of cigarette smoking among adolescents in several countries including South Africa (adjusted odds ratio, aOR = 4.11; 95% CI: 2.26-7.47), Togo (aOR = 3.77; 95% CI: 1.27-11.21), the Former Yugoslav Republic of Macedonia (aOR = 1.42; 95% CI: 1.01-1.99), Republic of Moldova (aOR = 1.53; 95% CI: 1.11-2.12), Belize (aOR = 13.95; 95% CI: 1.91-102.02), Panama (aOR = 5.14; 95% CI: 2.37-11.14) and Mongolia (aOR = 1.52; 95% CI: 1.19-1.94). Conclusion: Prevalence of exposure to various pro-tobacco advertisements was high among adolescents in the LMICs surveyed. Enhanced and sustained national efforts are needed to reduce exposure to all forms of tobacco advertising and promotional activities.