Cigarette promotions and advertising in five North African countries: Exposure prevalence and relationship with adolescent smoking susceptibility and current cigarette use

Comprehensive tobacco advertising/promotions bans are effective against adolescent smoking but many developing countries have implemented only partial bans. This study examines tobacco advertising/promotions exposure prevalence among North African adolescent boys, and the association between advertising/promotions exposure and cigarette smoking risk. Adolescent male data (n=6,554) from the Global Youth Tobacco Survey were utilized (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 analyzed. Advertising/promotions exposures included media and in-person contacts. Weighted univariate and bivariate analyses with standard error corrections were conducted (Stata 10.0). Current smoking prevalence ranged from 6.1% (Egypt) to 15.9% (Tunisia); initiation susceptibility ranged from 15.8% (Sudan) to 24.9% (Tunisia). Substantial proportions of adolescent boys reported exposure to each type of advertising/promotions, although prevalence varied across countries. In bivariate analyses, each type of advertising/promotions was significantly positively associated with current smoking status; most advertising/promotion exposure types - except billboards, smoking actors on TV and being offered a free cigarette - were also positively associated with initiation susceptibility. Notably, as the number of advertising/promotion exposures increased, odds of current smoking and initiation susceptibility increased. Tobacco advertising/promotions exposure was highly prevalent and associated with adolescent boys' smoking risk in these countries. In responding to the WHO Framework Convention on Tobacco Control, the comprehensiveness and enforcement of advertising/promotions bans should be enhanced.