{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:55:34Z","timestamp":1792799734500,"version":"4.5.0"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>We aimed to assess the recent levels of knowledge and attitudes toward tobacco smoking among adolescents aged 12\u201316 years in 2010\u20132019, and to examine trends from 1999 to 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used the most recent data from 145 countries\/territories (hereafter \u201ccountries\u201d) that conducted at least one Global Youth Tobacco Survey (GYTS) between 2010 and 2019 to assess the current levels of knowledge and attitudes toward tobacco smoking among adolescents aged 12\u201316 years. And 112 countries that conducted at least three GYTS surveys from 1999 to 2019 were used to assess the trends among adolescents aged 12\u201316 years over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 570,492 adolescents from 145 countries, 13.9% (95% <jats:italic>CI<\/jats:italic>, 11.9%\u221215.8%) incorrectly believed that tobacco smoking was not harmful, and 16.1% (95% <jats:italic>CI<\/jats:italic>, 15.2%\u221216.9%) believed that exposure to secondhand smoke was not harmful. A substantial proportion believed that quitting smoking was easy (42.5%; 95% <jats:italic>CI<\/jats:italic>, 36.9%\u221248.0%) or that short-term smoking was safe if followed by quitting (40.2%; 95% <jats:italic>CI<\/jats:italic>, 39.1%\u221241.3%). Additionally, 25.8% (95% <jats:italic>CI<\/jats:italic>, 24.8%\u221226.8%) believed that tobacco smoking helps young people feel more comfortable, 26.4% (95% <jats:italic>CI<\/jats:italic>, 24.8%\u221228.0%) believed that it helps them make more friends, and 15.8% (95% <jats:italic>CI<\/jats:italic>, 14.6%\u221217.0%) believed that it makes them appear more attractive. Among 1,734,258 adolescents from 112 countries, 67.9% of countries showed increasing or stable trends in the belief that smoking is not harmful, 75.9% for the belief that secondhand smoke exposure is not harmful, 38.4% for short-term smoking being safe, 32.1% for quitting being easy, and 69.6, 43.8, and 44.6% for the beliefs that smoking helps with comfort, making friends, and appearing attractive, respectively, from 1999 to 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Incorrect beliefs and positive attitudes toward tobacco smoking were prevalent among adolescents worldwide. Moreover, these beliefs and attitudes toward tobacco smoking have either persisted or increased in most included countries over time. Targeted interventions and policies are needed to reduce these and promote accurate knowledge about tobacco use and its harmful effects.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1546867","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T05:29:04Z","timestamp":1755494944000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Proportions and trends of global adolescent knowledge and attitudes toward tobacco smoking from 1999 to 2019"],"prefix":"10.3389","volume":"13","author":[{"given":"Jintang","family":"Xie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanwei","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuo","family":"Gong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costan G.","family":"Magnussen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Xi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2572","DOI":"10.1161\/CIRCULATIONAHA.117.031912","article-title":"Cigarette smoking and incident heart failure: insights from the Jackson heart study","volume":"137","author":"Kamimura","year":"2018","journal-title":"Circulation."},{"key":"B2","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1136\/thoraxjnl-2020-216296","article-title":"Cigarette smoke exposure and alveolar macrophages: mechanisms for lung disease","volume":"77","author":"Lugg","year":"2022","journal-title":"Thorax."},{"key":"B3","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1016\/j.envint.2018.05.008","article-title":"Impact of declining exposure to secondhand tobacco smoke in public places to decreasing smoking-related cancer mortality in the US population","volume":"117","author":"Garc\u00eda-Esquinas","year":"2018","journal-title":"Environ Int."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2337","DOI":"10.1016\/S0140-6736(21)01169-7","article-title":"Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the global burden of disease study 2019","volume":"397","author":"Collaborators","year":"2021","journal-title":"Lancet."},{"key":"B5","doi-asserted-by":"publisher","first-page":"a012120","DOI":"10.1101\/cshperspect.a012120","article-title":"Short- and long-term consequences of nicotine exposure during adolescence for prefrontal cortex neuronal network function","volume":"2","author":"Goriounova","year":"2012","journal-title":"Cold Spring Harb Perspect Med."},{"key":"B6","unstructured":"27021149\n          WHO Reports Progress in the Fight Against Tobacco Epidemic"},{"key":"B7","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/S2352-4642(20)30390-4","article-title":"Prevalence and trends in tobacco use among adolescents aged 13-15 years in 143 countries, 1999-2018: findings from the global youth tobacco surveys","volume":"5","author":"Ma","year":"2021","journal-title":"Lancet Child Adolesc Health."},{"key":"B8","doi-asserted-by":"publisher","first-page":"650","DOI":"10.2105\/AJPH.2021.306686","article-title":"Prevalence of e-cigarette use and its associated factors among youths aged 12 to 16 years in 68 countries and territories: global youth tobacco survey, 2012\u20132019","volume":"112","author":"Sun","year":"2022","journal-title":"Am J Public Health."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e1667","DOI":"10.1016\/S2214-109X(21)00365-X","article-title":"Global trends in the prevalence of secondhand smoke exposure among adolescents aged 12-16 years from 1999 to 2018: an analysis of repeated cross-sectional surveys","volume":"9","author":"Ma","year":"2021","journal-title":"Lancet Global Health."},{"key":"B10","doi-asserted-by":"publisher","first-page":"i18","DOI":"10.1136\/tc.2009.029710","article-title":"Health knowledge and perception of risks among Chinese smokers and non-smokers: findings from the wave 1 ITC China survey","volume":"19","author":"Yang","year":"2010","journal-title":"Tob Control"},{"key":"B11","doi-asserted-by":"publisher","first-page":"E82","DOI":"10.1542\/peds.106.6.e82","article-title":"Attitudes toward secondhand smoke, smoking, and quitting among young people","volume":"106","author":"Glantz","year":"2000","journal-title":"Pediatrics."},{"key":"B12","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/S0749-3797(97)00071-8","article-title":"Tobacco advertisements: one of the strongest risk factors for smoking in Hong Kong students","volume":"14","author":"Lam","year":"1998","journal-title":"Am J Prev Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"487","DOI":"10.2105\/AJPH.2008.137679","article-title":"Perceptions of smoking-related risks and benefits as predictors of adolescent smoking initiation","volume":"99","author":"Song","year":"2009","journal-title":"Am J Public Health."},{"key":"B14","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.addbeh.2018.12.005","article-title":"Youth perception of harm and addictiveness of tobacco products: findings from the population assessment of tobacco and health study (wave 1)","volume":"92","author":"Strong","year":"2019","journal-title":"Addict Behav."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e0233462","DOI":"10.1371\/journal.pone.0233462","article-title":"The theory of planned behavior as a behavior change model for tobacco control strategies among adolescents in Botswana","volume":"15","author":"Tapera","year":"2020","journal-title":"PLoS ONE."},{"key":"B16","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1016\/j.ypmed.2009.01.003","article-title":"Main determinants of cigarette smoking in youth based on the 2006 cyprus GYTS","volume":"48","author":"Christophi","year":"2009","journal-title":"Prev Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1093\/ntr\/ntt201","article-title":"Knowledge, attitudes, and normative beliefs as predictors of hookah smoking initiation: a longitudinal study of university students","volume":"16","author":"Sidani","year":"2014","journal-title":"Nicotine Tob Res."},{"key":"B18","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1186\/s12889-020-8381-x","article-title":"Knowledge and attitudes towards e-cigarette use in Lebanon and their associated factors","volume":"20","author":"Aghar","year":"2020","journal-title":"BMC Public Health."},{"key":"B19","doi-asserted-by":"publisher","first-page":"230","DOI":"10.11604\/pamj.2020.37.230.24174","article-title":"Prevalence and predictors of susceptibility and future intention to smoke cigarettes among school-going adolescents in Ibadan, Nigeria","volume":"37","author":"Osuh","year":"2020","journal-title":"Pan Afr Med J."},{"key":"B20","doi-asserted-by":"publisher","first-page":"37","DOI":"10.7314\/APJCP.2016.17.S1.37","article-title":"Knowledge and attitude towards tobacco smoking among 13-15 year-old school children in Viet Nam - findings from GYTS 2014","volume":"17","author":"Huong","year":"2016","journal-title":"Asian Pac J Cancer Prev"},{"key":"B21","unstructured":"Global Tobacco Surveillance System Data (GTSSData)"},{"key":"B22","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.jadohealth.2014.09.014","article-title":"Secondhand smoke exposure among never-smoking youth in 168 countries","volume":"56","author":"Veeranki","year":"2015","journal-title":"J Adolesc Health."},{"key":"B23","unstructured":"Bank\n              W\n            \n          \n          World Bank Country and Lending Groups"},{"key":"B24","unstructured":"32289497\n          WHO Report on the Global Tobacco Epidemic, 2019: Offer Help to Quit Tobacco Use"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss6812a1","article-title":"Tobacco product use and associated factors among middle and high school students - United States, 2019","volume":"68","author":"Wang","year":"2019","journal-title":"MMWR Surveill Summ."},{"key":"B26","doi-asserted-by":"publisher","first-page":"502","DOI":"10.3390\/medicina58040502","article-title":"Prevalence of cigarette smoking and influence of associated factors among students of the university of Banja Luka: a cross-sectional study","volume":"58","author":"Todorovi\u0107","year":"2022","journal-title":"Medicina."},{"key":"B27","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.amepre.2018.04.043","article-title":"Electronic cigarette harm and benefit perceptions and use among youth","volume":"55","author":"Bernat","year":"2018","journal-title":"Am J Prev Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1016\/j.jadohealth.2015.11.008","article-title":"Prevalence and correlates of e-cigarette perceptions and trial among early adolescents in Mexico","volume":"58","author":"Thrasher","year":"2016","journal-title":"J Adolesc Health."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1186\/1471-2458-14-1296","article-title":"Predictors of smoking among Swedish adolescents","volume":"14","author":"Joffer","year":"2014","journal-title":"BMC Public Health."},{"key":"B30","doi-asserted-by":"publisher","first-page":"S40","DOI":"10.4103\/ijph.IJPH_234_17","article-title":"Tobacco use among thai students: results from the 2015 global youth tobacco survey","volume":"61","author":"Chotbenjamaporn","year":"2017","journal-title":"Indian J Public Health."},{"key":"B31","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.ypmed.2016.10.019","article-title":"Adolescents' attitudes towards e-cigarette ingredients, safety, addictive properties, social norms, and regulation","volume":"94","author":"Gorukanti","year":"2017","journal-title":"Prev Med."},{"key":"B32","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1001\/jamapediatrics.2017.4173","article-title":"Association of noncigarette tobacco product use with future cigarette smoking among youth in the population assessment of tobacco and health (PATH) study, 2013-2015","volume":"172","author":"Watkins","year":"2018","journal-title":"JAMA Pediatr."},{"key":"B33","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1007\/s00038-016-0796-x","article-title":"Waterpipe smoking among secondary school students in Hong Kong","volume":"61","author":"Jiang","year":"2016","journal-title":"Int J Public Health."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e795","DOI":"10.1016\/S2214-109X(16)30187-5","article-title":"Tobacco use and second-hand smoke exposure in young adolescents aged 12-15 years: data from 68 low-income and middle-income countries","volume":"4","author":"Xi","year":"2016","journal-title":"Lancet Global Health."},{"key":"B35","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.addbeh.2013.09.026","article-title":"Effectiveness of school-based smoking intervention in middle school students of Linzhi Tibetan and Guangzhou Han ethnicity in China","volume":"39","author":"Chen","year":"2014","journal-title":"Addict Behav."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1007\/s10900-019-00689-8","article-title":"Effectiveness of a school based smokeless tobacco intervention: a cluster randomized trial","volume":"44","author":"Rozi","year":"2019","journal-title":"J Community Health."},{"key":"B37","doi-asserted-by":"publisher","first-page":"Cd001291","DOI":"10.1002\/14651858.CD001291.pub2","article-title":"Community interventions for preventing smoking in young people","volume":"2011","author":"Carson","year":"2011","journal-title":"Cochrane Database Syst Rev."},{"key":"B38","doi-asserted-by":"publisher","first-page":"s119","DOI":"10.1136\/tobaccocontrol-2018-054389","article-title":"Impact of the WHO FCTC over the first decade: a global evidence review prepared for the impact assessment expert group","volume":"28","author":"Chung-Hall","year":"2019","journal-title":"Tob Control."},{"key":"B39","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1136\/tobaccocontrol-2021-056857","article-title":"Tobacco control in Europe: progress and key challenges","volume":"31","author":"Willemsen","year":"2022","journal-title":"Tob Control."},{"key":"B40","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1136\/tobaccocontrol-2018-054372","article-title":"Tobacco control and healthy China 2030","volume":"28","author":"Goodchild","year":"2019","journal-title":"Tob Control."},{"key":"B41","doi-asserted-by":"publisher","first-page":"856","DOI":"10.5588\/ijtld.13.0906","article-title":"Knowledge, attitude and perception of second-hand smoke and factors promoting smoking in Malaysian adolescents","volume":"18","author":"Abidin","year":"2014","journal-title":"Int J Tuberc Lung Dis."},{"key":"B42","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1186\/s12889-022-12493-6","article-title":"Susceptibility to tobacco use and associated factors among youth in five central and eastern European countries","volume":"22","author":"Polanska","year":"2022","journal-title":"BMC Public Health."},{"key":"B43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss7105a1","article-title":"Tobacco product use and associated factors among middle and high school students - national youth tobacco survey, United States, 2021","volume":"71","author":"Gentzke","year":"2022","journal-title":"MMWR Surveill Summ."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.3390\/ijerph13121183","article-title":"Association between family and friend smoking status and adolescent smoking behavior and e-cigarette use in Korea","volume":"13","author":"Joung","year":"2016","journal-title":"Int J Environ Res Public Health."},{"key":"B45","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1159\/000446022","article-title":"Parental smoking and smoking cognitions among youth: a systematic review of the literature","volume":"22","author":"Lochbuehler","year":"2016","journal-title":"Eur Addict Res."},{"key":"B46","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1111\/nyas.12609","article-title":"Are e-cigarettes a safe and good alternative to cigarette smoking?","volume":"1340","author":"Rom","year":"2015","journal-title":"Ann N Y Acad Sci."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1052519","DOI":"10.3389\/fpubh.2022.1052519","article-title":"Prevalence of waterpipe smoking and its associated factors among adolescents aged 12-16 years in 73 countries\/territories","volume":"10","author":"Ma","year":"2022","journal-title":"Front Public Health."},{"key":"B48","doi-asserted-by":"publisher","first-page":"04101","DOI":"10.7189\/jogh.12.04101","article-title":"Cigarette access and purchase patterns among adolescent smokers aged 12-16 years in 140 countries\/territories, global youth tobacco survey 2010-2018","volume":"12","author":"Sun","year":"2022","journal-title":"J Glob Health."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1546867\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T05:29:05Z","timestamp":1755494945000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1546867\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,18]]},"references-count":48,"alternative-id":["10.3389\/fpubh.2025.1546867"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1546867","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,18]]},"article-number":"1546867"}}