{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:18:42Z","timestamp":1787066322526,"version":"build-2736575974"},"reference-count":33,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T00:00:00Z","timestamp":1708905600000},"content-version":"unspecified","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,2,5]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe the prevalence of school-based tobacco prevention programme exposure among adolescents in low-income and middle-income countries (LMICs) and its association with psychosocial predictors of smoking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Analysis of pooled cross-sectional data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Global Youth Tobacco Survey (GYTS), conducted in 38 LMICs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>This was a pooled analysis of data involving a total of 132\u2009755 adolescent respondents to GYTS in 38 LMICs across Africa, Europe and Central\/South America between 2014 and 2017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Exposure and outcome measures<\/jats:title>\n                    <jats:p>The primary independent variable for this study was self-reported exposure to school-based tobacco prevention programmes in the past year. Five psychosocial determinants of smoking were explored as outcomes: perceived addictiveness of nicotine, perceived harm of secondhand smoke exposure, support for restricting cigarette smoking at public indoor locations, support for restricting cigarette smoking at public outdoor areas and self-reported prediction of enjoying cigarette smoking. Multivariable logistic regression models were used to examine the relationship between exposure to school-based tobacco prevention programmes and study outcomes, controlling for sociodemographic and smoking-related characteristics of respondents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 59.1% of adolescents in LMICs self-reported exposure to school-based tobacco prevention programmes. The country-specific prevalence of adolescent exposure to school-based tobacco interventions ranged from 24.9% in the Comoros to 99.3% in Turkmenistan. Exposure to school-based tobacco interventions was significantly associated with greater secondhand smoke harm perceptions (adjusted OR (AOR): 1.69; 95%\u2009CI: 1.69 to 1.70), perceptions of addictiveness (AOR: 1.37; 95%\u2009CI: 1.36 to 1.37) and supporting tobacco use restrictions indoors (AOR: 1.70; 95%\u2009CI: 1.69 to 1.70) and outdoors (AOR: 1.59; 95%\u2009CI: 1.59 to 1.60). Exposure to school-based tobacco interventions was associated with lower odds of anticipating enjoying cigarette smoking (AOR: 0.76; 95%\u2009CI: 0.76 to 0.76).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Exposure to tobacco prevention programmes in schools is suboptimal in LMICs. Given the protective associations described in this study from school-based tobacco prevention programme exposure, it is imperative that national governments implement school-based programmes into ongoing tobacco control measures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-070749","type":"journal-article","created":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T00:40:14Z","timestamp":1708994414000},"page":"e070749","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Exposure to school-based tobacco prevention interventions in low-income and middle-income countries and its association with psychosocial predictors of smoking among adolescents: a pooled cross-sectional analysis of Global Youth Tobacco Survey data from 38 countries"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9139-7645","authenticated-orcid":false,"given":"Onyema Greg","family":"Chido-Amajuoyi","sequence":"first","affiliation":[{"name":"Internal Medicine, Texas A&M University School of Medicine \/ Christus Health, Longview, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ikponmwosa","family":"Osaghae","sequence":"additional","affiliation":[{"name":"Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA"},{"name":"Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5116-2961","authenticated-orcid":false,"given":"Israel Terungwa","family":"Agaku","sequence":"additional","affiliation":[{"name":"Oral Health Policy & Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baojiang","family":"Chen","sequence":"additional","affiliation":[{"name":"Biostatistics, The University of Texas Health Science Center at Houston, Austin, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1122-4849","authenticated-orcid":false,"given":"Dale S","family":"Mantey","sequence":"additional","affiliation":[{"name":"Health Promotion\/Behavioral Science, The University of Texas Health Science Center at Houston, Austin, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,2,26]]},"reference":[{"key":"2025121515054562000_14.2.e070749.1","first-page":"1659","article-title":"Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990\u20132015: a systematic analysis for the global burden of disease study 2015","volume":"388","author":"Forouzanfar","year":"2016","journal-title":"Lancet (British Edition)"},{"key":"2025121515054562000_14.2.e070749.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60312-9"},{"key":"2025121515054562000_14.2.e070749.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2008.02.010"},{"key":"2025121515054562000_14.2.e070749.4","unstructured":"World Health Organization . 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