Understanding tobacco use among youth in Armenia: A multilevel analysis

Background: Tobacco is a global epidemic with its use currently shifted to low-and-middle-income countries. Armenia ranks first and sixth in number of smokers in Europe and world, with >70% of its population smoke. Up to 90% of the smokers initiate smoking during their adolescence. This study is the first investigation to estimate prevalence and identify key factors associated with youth tobacco use in Armenia.

Methods: Cross sectional data for tobacco use for 1,453 students representing 35,389 youth were obtained from 2004 Armenian Global Youth Tobacco Survey. Overall survey response rate was 84.7%. Dependent variables included current cigarette smokers and users of tobacco products. Descriptive statistics for frequencies and proportions were reported. Using , SAS v9.2, a 2-level generalized linear model was conducted to identify factors associated with youth tobacco use, adjusting for student-level characteristics including parental or peer smoking behavior, exposure to secondhand smoke (SHS), support for smoke-free policy, and school-level characteristics including anti-smoking education, tobacco industry promotions.

Results: Approximately 5% (10.3% boys; 0.9% girls) and 7.3% (13.0% boys; 2.7% girls) currently smoke or use tobacco products, with boys using tobacco significantly higher than girls. Approximately 90% were exposed to SHS, while 37% reported school anti-smoking education. Multilevel analyses identified parental or peer smoking and/or exposure to SHS significantly associated with increased tobacco use, with intra-class correlation coefficients indicating significant variability by school-level characteristics.

Conclusion: This study provides insight into tobacco use in Armenia that could aid policymakers and public health community to prevent initiation and encourage cessation among youth.