Abstract
Secondhand smoke or environmental tobacco smoke is a combination of smoke from a burning cigarette and exhaled smoke from a smoker. This substance is an involuntarily inhaled mix of compounds that causes or contributes to a wide range of adverse health effects, including cancer, cardiovascular diseases, respiratory infections, adverse reproductive effects, and asthma. This paper presents findings from Global Youth Tobacco Surveys (GYTS) conducted in 132 countries between 1999 and 2005. GYTS data indicate that a large proportion of students in every World Health Organization Region are exposed to secondhand smoke at home (43.9%) and in public places (55.8%), and many have parents (46.5%) or best friends who smoke (17.9%). GYTS data have shown widespread and strong support among students for bans on smoking in public areas all over the world (76.1%). Countries should engage this positive public health attitude among youth to promote and enforce policies for smoke‐free public places and workplaces, including restaurants and bars.
Keywords: secondhand smoke, youth, school, surveillance
Secondhand smoke (SHS) includes smoke produced by the burning of a cigarette, pipe, cigar, or other smoked tobacco and the smoke exhaled from the lungs of smokers. SHS is involuntarily inhaled by non‐smokers, lingers in the air for hours after smoked tobacco has been extinguished, and can cause or contribute to a wide range of negative health effects, including adverse reproductive effects, cancer, cardiovascular disease, respiratory infections, and asthma.1,2,3,4,5 SHS chemicals include irritants and systemic toxicants, mutagens, and carcinogens, and reproductive and developmental toxicants.1 More than 60 compounds in tobacco smoke are known carcinogens, and the US Environmental Protection Agency and the International Agency for Research on Cancer have classified SHS as a group A and group 1 carcinogen, respectively, a category indicating the most dangerous cancer‐causing compounds.2,6 SHS exposure causes lung cancer, acute and chronic coronary heart disease (CHD), and eye and nasal irritation in adults.2,6 Serious effects of SHS on children include asthma exacerbation, bronchitis and pneumonia, chronic middle ear infection, chronic respiratory symptoms, low birth weight, and sudden infant death syndrome.7 Studies have concluded that high levels of particulate matter exposure from SHS may account for frequent episodes of short‐term respiratory damage in non‐smokers8 and the risks for CHD from passive smoking are virtually indistinguishable from active smoking.5,9 Smoke‐free policies, as part of a comprehensive tobacco control programme, reduce exposure to SHS and may reduce tobacco users' daily tobacco consumption and support cessation.10
The purpose of this paper is to show levels of self‐reported exposure to SHS among youth aged 13–15 years using data from the Global Youth Tobacco Survey (GYTS) from 132 World Health Organization (WHO) Member States, territories, or other autonomous regions. For the purposes of this paper, we shall refer to all of these units as “countries” although some samples are drawn from subnational areas, non‐Member States, or territories of other countries. Differences in several indicators of SHS exposure among countries in the six WHO Regions are described. The following data are presented: exposure to SHS at home, exposure to SHS in public places, percentage of students who had one or more parents who smoke, percentage of students who had most or all best friends who smoke, and percentage of students who think smoking should be banned in public places.
The Global Youth Tobacco Survey (GYTS)
In 1999, 11 countries (Barbados, China, Fiji, Jordan, Poland, Russian Federation, South Africa, Sri Lanka, Ukraine, Venezuela, and Zimbabwe) pilot‐tested the first GYTS. All 11 countries completed successful surveys during 1999. After this initial success, many countries asked WHO and the US Centers for Disease Control and Prevention (CDC) for assistance in participating in GYTS. Data from 132 countries were available for analyses in this report. For countries that have repeated the GYTS, only the most recent data are analysed. The GYTS data in this report include: 37 sites in 25 countries in the African Region; 98 sites in 37 countries in the Region of the Americas; 25 sites in 21 countries in the Eastern Mediterranean Region; 29 sites in 26 countries in the European Region; 11 sites in 7 countries in the South‐East Asia Region; and 30 sites in 16 countries in the Western Pacific Region.Tables 1 and 2 list sites that completed the GYTS by WHO Region and indicate whether the survey was representative of the entire country or subnational areas within the country. The median student response rate was 88.6% (ranging from 55.8–100.0%); only four of the sites reported a school response rate less than 80% and, in total, over two million students in more than 18 000 schools have completed the GYTS.11,12
Table 1 Percentage of students exposed to smoke at home and exposed to smoke outside home, Global Youth Tobacco Survey, 1999–2005*.
| Country | Region name | Exposed to smoke in home | 95% CI | Exposed to smoke outside home | 95% CI |
|---|---|---|---|---|---|
| TOTAL | 43.9 | (±2.5) | 55.8 | (±2.5) | |
| African Region | 30.4 | (±3.8) | 46.3 | (±4.0) | |
| Benin | |||||
| Atlantique Littoral, 2003 | 21.5 | (±3.0) | 38.0 | (±3.4) | |
| Borgou Alibori, 2003 | 30.7 | (±3.7) | 41.4 | (±4.3) | |
| Botswana | |||||
| Country, 2001 | 33.0 | (±3.1) | 52.5 | (±4.1) | |
| Burkina Faso | |||||
| Ouagadougou, 2001 | 38.4 | (±5.6) | 69.3 | (±5.3) | |
| Côte D'Ivoire (Ivory Coast) | |||||
| Ville Sud, 2003 | 39.6 | (±3.1) | 66.7 | (±2.8) | |
| Abidjan, 2003 | 44.2 | (±2.9) | 69.7 | (±3.4) | |
| Ethiopia | |||||
| Addis Ababa, 2003 | 14.9 | (±3.6) | 41.2 | (±3.4) | |
| Ghana | |||||
| Country, 2002 | 22.2 | (±3.8) | 41.4 | (±4.5) | |
| Kenya | |||||
| Country, 2001 | 27.2 | (±4.1) | 43.2 | (±3.7) | |
| Lesotho | |||||
| Country, 2002 | 39.5 | (±2.7) | 60.4 | (±2.6) | |
| Malawi | |||||
| Blantyre, 2000 | 19.0 | (±4.5) | 30.4 | (±7.1) | |
| Lilongwe, 2000 | 16.0 | (±2.3) | 35.5 | (±2.1) | |
| Mali | |||||
| Bamako, 2001 | 59.9 | (±4.6) | 75.9 | (±5.8) | |
| Mauritania | |||||
| Country, 2001 | 46.3 | (±2.9) | 53.8 | (±3.7) | |
| Mauritius | |||||
| Country, 2003 | 42.0 | (±4.7) | 68.2 | (±5.1) | |
| Mozambique | |||||
| Maputo, 2002 | 24.8 | (±5.5) | 39.4 | (±4.7) | |
| Gaza Inhambane, 2002 | 21.3 | (±3.1) | 34.3 | (±4.4) | |
| Namibia | |||||
| Country, 2004 | 40.3 | (±3.3) | 58.5 | (±2.6) | |
| Niger | |||||
| Country, 2001 | 43.2 | (±4.9) | 71.3 | (±5.1) | |
| Nigeria | |||||
| Cross River State, 2000 | 34.3 | (±5.1) | 49.6 | (±5.5) | |
| Senegal | |||||
| Country, 2002 | 45.8 | (±3.9) | 62.6 | (±3.9) | |
| Seychelles | |||||
| Country, 2002 | 43.3 | (±3.3) | 60.9 | (±3.9) | |
| South Africa | |||||
| Country, 2002 | 34.9 | (±3.6) | 43.4 | (±3.1) | |
| Swaziland | |||||
| Country, 2001 | 29.1 | (±2.0) | 58.8 | (±2.5) | |
| Togo | |||||
| Country, 2002 | 28.2 | (±3.9) | 59.8 | (±6.1) | |
| Uganda | |||||
| Arua, 2002 | 42.9 | (±6.2) | 64.0 | (±3.3) | |
| Kampala, 2002 | 16.6 | (±2.1) | 46.2 | (±6.8) | |
| Mpigi, 2002 | 17.0 | (±2.8) | 39.5 | (±4.1) | |
| United Republic of Tanzania | |||||
| Arusha, 2003 | 18.2 | (±3.3) | 23.3 | (±5.1) | |
| Kilimanjaro, 2003 | 19.0 | (±2.7) | 26.0 | (±3.1) | |
| Dar Es Salaam, 2003 | 28.3 | (±3.2) | 37.1 | (±4.8) | |
| Zambia | |||||
| Chongwe Luangwa, 2002 | 31.3 | (±4.3) | 43.8 | (±5.4) | |
| Lusaka, 2002 | 29.4 | (±3.9) | 40.9 | (±3.3) | |
| Kafue, 2002 | 23.7 | (±3.5) | 34.1 | (±4.2) | |
| Zimbabwe | |||||
| Harare, 2003 | 27.4 | (±2.7) | 56.4 | (±2.5) | |
| Manicaland, 2003 | 31.2 | (±5.2) | 50.3 | (±5.9) | |
| Matebeleland & Bulawayo, 2003 | 29.9 | (±4.5) | 56.9 | (±3.2) | |
| Region of the Americas | 41.6 | (±2.6) | 63.0 | (±2.6) | |
| Antigua and Barbuda | |||||
| Country, 2004 | 18.0 | (±2.8) | 40.3 | (±4.2) | |
| Argentina | |||||
| Buenos Aires, 2003 | 71.0 | (±1.9) | 82.0 | (±3.6) | |
| Capital Federal, 2003 | 61.1 | (±3.2) | 82.7 | (±2.4) | |
| Bahamas | |||||
| Country, 2004 | 21.6 | (±4.2) | 51.1 | (±5.1) | |
| Barbados | |||||
| Country, 2002 | 22.4 | (±3.0) | 51.3 | (±2.9) | |
| Belize | |||||
| Country, 2002 | 32.6 | (±4.4) | 60.3 | (±3.7) | |
| Bolivia | |||||
| Cochabamba, 2003 | 42.7 | (±4.1) | 60.9 | (±4.1) | |
| El Alto, 2003 | 33.8 | (±1.9) | 47.5 | (±2.6) | |
| La Paz, 2003 | 34.3 | (±3.2) | 52.9 | (±3.2) | |
| Oruro, 2003 | 38.6 | (±4.6) | 55.1 | (±4.2) | |
| Santa Cruz, 2003 | 51.4 | (±2.6) | 62.6 | (±3.2) | |
| Brazil | |||||
| Alagoas, 2004 | 37.4 | (±3.3) | 50.6 | (±5.2) | |
| Aracaju, 2002 | 31.1 | (±3.9) | 51.3 | (±3.6) | |
| Boa Vista, 2004 | 34.8 | (±4.6) | 46.0 | (±5.5) | |
| Curitiba, 2002 | 40.4 | (±4.2) | 60.3 | (±4.6) | |
| Espirito Santo Vitoria, 2004 | 27.8 | (±3.8) | 49.5 | (±3.0) | |
| Florianopolis, 2004 | 38.4 | (±3.7) | 53.6 | (±2.9) | |
| Fortaleza, 2002 | 44.9 | (±6.1) | 61.0 | (±4.6) | |
| Goiania, 2002 | 34.7 | (±4.9) | 50.7 | (±3.8) | |
| Matto Grosso do Sul, 2002 | 40.6 | (±5.0) | 53.3 | (±4.2) | |
| Paraiba, 2002 | 33.6 | (±4.1) | 47.8 | (±4.8) | |
| Rio de Janeiro Public, 2005 | 37.0 | (±5.6) | 51.8 | (±3.9) | |
| Rio Grande do Norte, 2002 | 36.9 | (±4.9) | 43.0 | (±3.5) | |
| Rio Grande do Sul, 2002 | 48.2 | (±4.1) | 62.2 | (±4.3) | |
| Salvador, 2005 | 20.4 | (±3.9) | 41.9 | (±5.8) | |
| Sao Luis, 2004 | 29.6 | (±3.8) | 46.0 | (±2.3) | |
| Tocantins, 2002 | 36.5 | (±7.3) | 49.8 | (±6.7) | |
| Chile | |||||
| Concepcion, 2003 | 50.0 | (±4.3) | 64.2 | (±6.0) | |
| Coquimbo, 2003 | 43.8 | (±4.3) | 54.9 | (±2.0) | |
| Santiago, 2003 | 60.6 | (±3.3) | 69.8 | (±2.3) | |
| Valparaiso, 2003 | 50.7 | (±4.4) | 63.3 | (±4.2) | |
| Colombia | |||||
| Bogota, 2001 | 43.6 | (±2.4) | 60.6 | (±2.4) | |
| Costa Rica | |||||
| Country, 2002 | 29.4 | (±2.2) | 51.0 | (±2.4) | |
| Cuba | |||||
| Havana, 2004 | 62.4 | (±3.9) | 65.0 | (±4.2) | |
| 4 Additional Provinces, 2004 | 52.0 | (±4.0) | 56.7 | (±4.5) | |
| Dominica | |||||
| Country, 2004 | 26.3 | (±3.3) | 60.2 | (±3.3) | |
| Dominican Republic | |||||
| Country, 2004 | 33.1 | (±3.1) | 41.9 | (±3.1) | |
| Ecuador | |||||
| Guayaquil, 2001 | 31.3 | (±2.8) | 46.0 | (±3.1) | |
| Quito, 2001 | 36.1 | (±4.0) | 56.9 | (±3.6) | |
| Zamora, 2001 | 41.8 | (±3.2) | 61.7 | (±3.8) | |
| El Salvador | |||||
| Country, 2003 | 14.8 | (±4.2) | 39.5 | (±11.6) | |
| Grenada | |||||
| Country, 2004 | 27.3 | (±2.6) | 61.8 | (±3.6) | |
| Guatemala | |||||
| Chimal Tenago, 2002 | 24.9 | (±4.7) | 42.9 | (±5.3) | |
| Guatemala City, 2002 | 36.3 | (±4.1) | 49.4 | (±3.3) | |
| Guyana | |||||
| Country, 2004 | 33.4 | (±4.0) | 61.1 | (±4.2) | |
| Haiti | |||||
| Port au Prince, 2000 | 31.3 | (±7.8) | 51.8 | (±5.2) | |
| Honduras | |||||
| San Pedro Sula La Ceiba, 2003 | 29.7 | (±3.7) | 41.8 | (±8.8) | |
| Tegucigalpa, 2003 | 29.6 | (±3.3 | 42.2 | (±5.4) | |
| Jamaica | |||||
| Country, 2000 | 30.7 | (±3.2) | 59.2 | (±3.5) | |
| Mexico | |||||
| Chetumal, 2003 | 34.8 | (±3.2) | 48.7 | (±3.0) | |
| Chilpancingo, 2005 | 30.3 | (±2.5) | 42.9 | (±3.7) | |
| Cuernavaca, 2003 | 41.7 | (±2.5) | 56.5 | (±2.9) | |
| Culican, 2005 | 34.3 | (±4.6) | 47.1 | (±3.1) | |
| Durango, 2005 | 40.7 | (±4.4) | 52.0 | (±2.4) | |
| Guadalajara, 2003 | 46.2 | (±2.4) | 60.4 | (±3.1) | |
| Hermosillo, 2005 | 43.3 | (±3.8) | 58.3 | (±4.5) | |
| Juarez, 2003 | 48.7 | (±3.7) | 58.1 | (±3.4) | |
| Leon, 2005 | 49.7 | (±3.0) | 58.9 | (±2.6) | |
| Merida, 2005 | 36.6 | (±3.3) | 51.6 | (±3.9) | |
| Mexico City, 2003 | 51.6 | (±2.6) | 60.4 | (±3.1) | |
| Monterrey, 2005 | 44.2 | (±3.6) | 54.9 | (±2.8) | |
| Nuevo Laredo, 2003 | 42.9 | (±3.2) | 54.1 | (±4.0) | |
| Oaxaca, 2003 | 23.0 | (±2.8) | 41.9 | (±3.9) | |
| Puebla, 2003 | 41.7 | (±4.2) | 50.0 | (±3.4) | |
| Tapachula, 2003 | 29.2 | (±3.7) | 38.1 | (±3.4) | |
| Tepic, 2005 | 32.4 | (±2.4) | 51.5 | (±3.1) | |
| Tijuana, 2003 | 36.8 | (±2.2) | 51.1 | (±2.7) | |
| Toluca, 2005 | 39.8 | (±2.8) | 53.0 | (±2.5) | |
| Veracruz, 2005 | 35.3 | (±2.6) | 48.2 | (±4.2) | |
| Zacatecas, 2005 | 43.8 | (±3.8) | 55.2 | (±2.8) | |
| Montserrat | |||||
| Country, 2000 | 18.1 | ** | 43.4 | ** | |
| Nicaragua | |||||
| Country, 2003 | 41.5 | (±2.7) | 50.8 | (±2.5) | |
| Panama | |||||
| Country, 2002 | 32.0 | (±2.8) | 51.8 | (±2.7) | |
| Peru | |||||
| Country, 2003 | 28.7 | (±2.1) | 40.4 | (±3.0) | |
| Saint Kitts and Nevis | |||||
| Country, 2002 | 16.5 | (±3.3) | 48.8 | (±4.0) | |
| Saint Lucia | |||||
| Country, 2000 | 26.9 | (±2.5) | 58.1 | (±3.5) | |
| Saint Vincent and The Grenadines | |||||
| Country, 2000 | 32.5 | (±2.9) | 64.1 | (±3.4) | |
| Suriname | |||||
| Country, 2004 | 49.7 | (±3.8) | 64.2 | (±4.5) | |
| Trinidad and Tobago | |||||
| Country, 2000 | 37.2 | (±2.5) | 68.7 | (±2.3) | |
| United States | |||||
| Country, 2000 | 42.1 | (±2.1) | 69.7 | (±1.8) | |
| Uruguay | |||||
| Colonia, 2000 | 58.3 | (±4.1) | 72.1 | (±4.1) | |
| Maldonado, 2000 | 64.2 | (±3.6) | 79.3 | (±3.9) | |
| Montevideo, 2000 | 64.6 | (±2.8) | 82.2 | (±2.3) | |
| Rivera, 2000 | 67.1 | (±3.1) | 80.8 | (±3.1) | |
| US Virgin Islands | |||||
| Country, 2004 | 22.2 | (±2.4) | 37.5 | (±3.0) | |
| Paraguay | |||||
| Alto Parana, 2003 | 41.6 | (±3.2) | 60.4 | (±3.5) | |
| Amambay, 2003 | 36.0 | (±3.2) | 54.0 | (±2.8) | |
| Asuncion, 2003 | 42.4 | (±2.2) | 66.3 | (±2.3) | |
| Central, 2003 | 38.6 | (±3.1) | 56.2 | (±3.6) | |
| Venezuela | |||||
| Barinas, 2003 | 34.4 | (±2.9) | 41.5 | (±2.9) | |
| Cojedes, 2003 | 40.4 | (±4.8) | 51.3 | (±2.9) | |
| Lara, 2003 | 44.4 | (±3.1) | 54.4 | (±3.0) | |
| Monagas, 2003 | 39.3 | (±3.5) | 45.4 | (±2.6) | |
| Nueva Esparta, 2001 | 42.8 | (±2.4) | 50.5 | (±4.4) | |
| Tachira, 2001 | 41.8 | (±3.5) | 49.6 | (±4.0) | |
| Yaracuy state, 2001 | 39.2 | (±2.7) | 46.3 | (±3.7) | |
| Zulia, 2001 | 43.8 | (±6.2) | 45.0 | (±5.4) | |
| Virgin Islands (British) | |||||
| Country, 2001 | 10.4 | (±3.4) | 43.3 | (±5.4) | |
| Eastern Mediterranean Region | 37.6 | (±3.5) | 46.3 | (±4.4) | |
| Afghanistan | |||||
| Kabul, 2004 | 38.8 | (±5.6) | 45.0 | (±12.1) | |
| Other Provinces, 2004 | 31.8 | (±5.4) | 49.5 | (±8.9) | |
| Bahrain | |||||
| Country, 2002 | 38.7 | (±3.3) | 45.3 | (±3.8) | |
| Djibouti | |||||
| Country, 2003 | 39.5 | (±5.1) | 43.2 | (±6.3) | |
| Egypt | |||||
| Country, 2001 | 32.1 | (±3.1) | 44.0 | (±5.7) | |
| Gaza Strip‐West Bank | |||||
| Gaza Strip, 2000 | 87.0 | (±2.5) | 50.9 | (±3.2) | |
| West Bank, 2000 | 66.8 | (±2.2) | 59.9 | (±3.7) | |
| Iran, Islamic Republic of | |||||
| Country, 2003 | 41.7 | (±2.4) | 50.6 | (±2.6) | |
| Jordan | |||||
| Country, 2003 | 63.0 | (±3.6) | 63.8 | (±2.8) | |
| Kuwait | |||||
| Country, 2001 | 42.9 | (±2.0) | 59.1 | (±2.3) | |
| Lebanon | |||||
| Country, 2001 | 77.3 | (±2.9) | 67.1 | (±1.6) | |
| Libyan Arab Jamahiriya | |||||
| Country, 2003 | 40.4 | (±4.1) | 38.6 | (±3.4) | |
| Morocco | |||||
| Country, 2001 | 25.1 | (±3.2) | 37.6 | (±3.0) | |
| Oman | |||||
| Country, 2002 | 21.0 | (±5.2) | 30.3 | (±5.6) | |
| Pakistan | |||||
| Islamabad, 2003 | 26.6 | (±3.9) | 33.9 | (±4.9) | |
| Lahore, 2003 | 22.2 | (±8.3) | 27.7 | (±8.2) | |
| Quetta, 2004 | 33.5 | (±5.3) | 34.3 | (±7.1) | |
| Qatar | |||||
| Country, 2004 | 30.2 | (±2.3) | 46.8 | (±3.4) | |
| Saudi Arabia | |||||
| Riyadh, 2001 | 25.9 | (±3.0) | 33.3 | (±3.7) | |
| Somalia | |||||
| Somaliland, 2004 | 56.9 | (±11.9) | 63.9 | (±8.8) | |
| Sudan | |||||
| Country, 2001 | 29.2 | (±2.9) | 41.0 | (±3.2) | |
| Syrian Arab Republic | |||||
| Country, 2002 | 54.5 | (±6.5) | 49.7 | (±5.5) | |
| Tunisia | |||||
| Country, 2001 | 62.4 | (±2.7) | 65.3 | (±2.4) | |
| United Arab Emirates | |||||
| Country, 2002 | 30.8 | (±2.5) | 36.0 | (±3.3) | |
| Yemen | |||||
| Country, 2003 | 44.0 | (±2.1) | 47.6 | (±2.4) | |
| European Region | 78.0 | (±2.6) | 84.8 | (±2.2) | |
| Albania | |||||
| Country, 2004 | 84.8 | (±2.6) | 80.6 | (±2.4) | |
| Armenia | |||||
| Country, 2004 | 89.8 | (±1.8) | 85.1 | (±3.2) | |
| Belarus | |||||
| Country, 2004 | 75.3 | (±1.9) | 90.1 | (±1.2) | |
| Bosnia and Herzegovina | |||||
| Federation of Bosnia and Herzegovina, 2003 | 96.7 | (±0.7) | 91.5 | (±1.1) | |
| Republic of Srpska, 2003 | 96.2 | (±1.1) | 91.1 | (±1.3) | |
| Bulgaria | |||||
| Country, 2002 | 67.7 | (±2.6) | 75.7 | (±2.5) | |
| Croatia (Hrvatska) | |||||
| Country, 2003 | 94.9 | (±1.2) | 91.1 | (±1.0) | |
| Czech Republic | |||||
| Country, 2002 | 41.1 | (±2.8) | 74.5 | (±2.2) | |
| Estonia | |||||
| Country, 2003 | 80.6 | (±1.6) | 90.7 | (±0.9) | |
| Georgia | |||||
| Country, 2003 | 95.0 | (±0.9) | 93.8 | (±1.1) | |
| Greece | |||||
| Athens, 2004 | 91.1 | (±2.8) | 94.3 | (±1.1) | |
| Hungary | |||||
| Country, 2003 | 84.0 | (±1.6) | 92.8 | (±1.7) | |
| Kazakhstan | |||||
| Country, 2004 | 72.7 | (±2.7) | 71.8 | (±3.1) | |
| Kyrgyzstan | |||||
| Country, 2004 | 64.4 | (±4.7) | 64.9 | (±4.1) | |
| Latvia | |||||
| Country, 2002 | 59.0 | (±2.7) | 71.3 | (±1.9) | |
| Lithuania | |||||
| Country, 2005 | 43.1 | (±3.0) | 64.6 | (±2.0) | |
| Macedonia | |||||
| Country, 2003 | 91.9 | (±1.4) | 80.2 | (±2.9) | |
| Poland | |||||
| Country, 2003 | 86.7 | (±2.5) | 90.4 | (±1.7) | |
| Republic of Moldova | |||||
| Country, 2004 | 62.3 | (±2.8) | 96.7 | (±1.5) | |
| Romania | |||||
| Country, 2004 | 90.4 | (±1.9) | 81.5 | (±2.7) | |
| Russian Federation | |||||
| Moscow, 1999 | 55.3 | (±2.2) | 72.5 | (±2.1) | |
| Sarov, 2002 | 36.5 | (±2.9) | 73.6 | (±2.9) | |
| Serbia and Montenegro | |||||
| Montenegro, 2004 | 95.0 | (±1.1) | 84.6 | (±2.4) | |
| Republic of Serbia, 2003 | 97.7 | (±0.5 | 90.6 | (±1.2) | |
| Slovakia | |||||
| Country, 2003 | 79.5 | (±2.2) | 85.7 | (±1.2) | |
| Slovenia | |||||
| Country, 2003 | 65.9 | (±2.5) | 89.0 | (±1.3) | |
| Tajikistan | |||||
| Country, 2004 | 51.5 | (±6.9) | 69.7 | (±5.4) | |
| Turkey | |||||
| Country, 2003 | 81.6 | (±0.9) | 85.9 | (±1.1) | |
| Ukraine | |||||
| Country, 2005 | 70.1 | (±2.8) | 84.4 | (±2.5) | |
| South‐East Asia Region | 37.0 | (±1.6) | 49.4 | (±1.7) | |
| Bangladesh | |||||
| Dhaka, 2004 | 33.8 | (±2.1) | 46.7 | (±3.8) | |
| Bhutan | |||||
| Country, 2004 | 29.2 | (±3.8) | 47.4 | (±6.2) | |
| India | |||||
| Country, 2004 | 36.4 | (±1.6) | 48.7 | (±1.6) | |
| Indonesia | |||||
| Bekasi, 2004 | 69.0 | (±2.1) | 77.4 | (±2.4) | |
| Jakarta, 2004 | 68.8 | (±3.9) | 82.7 | (±3.5) | |
| Medan, 2004 | 69.6 | (±2.8) | 79.9 | (±4.0) | |
| Maldives | |||||
| Rural, 2004 | 51.2 | (±4.6) | 77.1 | (±2.5) | |
| Urban, 2003 | 45.4 | (±3.8) | 69.2 | (±4.1) | |
| Nepal | |||||
| Biratnagar, 2004 | 84.7 | (±6.8) | 61.5 | (±7.7) | |
| Mahendranagar and Dhangad, 2004 | 42.3 | (±4.7) | 55.3 | (±3.3) | |
| Sri Lanka | |||||
| Country, 2003 | 50.9 | (±3.2) | 68.3 | (±3.1) | |
| Western Pacific Region | 50.5 | (±3.2) | 53.6 | (±2.8) | |
| American Samoa | |||||
| Country, 2005 | 61.9 | (±3.4) | † | † | |
| Cambodia | |||||
| Country, 2003 | 47.0 | (±5.8) | 58.5 | (±5.5) | |
| China | |||||
| Chongqing, 1999 | 56.8 | (±3.7) | 59.6 | (±3.2) | |
| Guangdong, 1999 | 49.4 | (±2.8) | 48.4 | (±2.8) | |
| Puyang, 2005 | 32.6 | (±5.4) | 34.3 | (±4.2) | |
| Shandong, 1999 | 48.9 | (±3.8) | 42.9 | (±2.7) | |
| Shanghai, 2005 | 47.0 | (±2.8) | 35.2 | (±3.2) | |
| Tianjin, 2005 | 45.2 | (±4.1) | 38.5 | (±3.7) | |
| Zhuhai, 2005 | 44.2 | (±3.1) | 40.2 | (±2.6) | |
| Cook Islands | |||||
| Country, 2003 | 57.6 | (±4.2) | 73.0 | (±3.0) | |
| Fiji | |||||
| Country, 1999 | 49.4 | (±4.8) | 68.6 | (±3.4) | |
| Guam | |||||
| Country, 2002 | 59.4 | (±2.8) | † | † | |
| Lao People's Democratic Republic | |||||
| Luang Prabang Province, 2003 | 35.7 | (±4.5) | 45.5 | (±4.7) | |
| Savannakhet, 2003 | 45.5 | (±3.8) | 60.6 | (±3.9) | |
| Vientiane Municipality, 2003 | 43.2 | (±2.2) | 57.0 | (±3.3) | |
| Vientiane Province, 2003 | 42.9 | (±5.7) | 57.2 | (±8.1) | |
| Macau | |||||
| Macau, 2001 | 39.0 | (±3.9) | † | † | |
| Malaysia | |||||
| Country, 2004 | 59.0 | (±4.1) | 75.7 | (±2.5) | |
| Micronesia | |||||
| Kosrae, 2000 | 53.2 | (±3.5) | † | † | |
| Pohnpei, 2000 | 51.2 | (±3.0) | † | † | |
| Mongolia | |||||
| Country, 2003 | 63.7 | (±3.2) | 48.4 | (±2.7) | |
| Northern Mariana | |||||
| Country, 2000 | 64.9 | (±3.7) | 80.2 | (±4.5) | |
| Palau | |||||
| Country, 2000 | 46.0 | (±3.7) | 49.1 | (±3.9) | |
| Philippines | |||||
| Country, 2004 | 56.4 | (±2.9) | 58.6 | (±2.7) | |
| Singapore | |||||
| Country, 2000 | 35.1 | (±1.5) | 65.1 | (±1.3) | |
| Viet Nam | |||||
| Denang, 2003 | 65.8 | (±3.4) | † | † | |
| Haiphong, 2003 | 56.5 | (±6.6) | † | † | |
| Hanoi, 2003 | 57.7 | (±10.4) | † | † | |
| Hochiminh, 2003 | 64.7 | (±6.1) | † | † | |
| Tuenquang, 2003 | 57.3 | (±8.5) | † | † | |
*Data from 131 countries are included in this report. Notable countries, by WHO Region, that have not completed the GYTS include: Region of the Americas (Canada), European Region (most Western European countries), and Western Pacific Region (Australia, Japan, and New Zealand).
**No confidence interval calculated because the survey was conducted among a census of students.
†Not available.
Table 2 Percentage of students who had one or more parents who smoke, had most or all best friends who smoke, and supported ban on smoking in public places, Global Youth Tobacco Survey, 1999–2005*.
| Country | Region name | Had one or more parents who smoke | 95% CI | Had most or all best friends who smoke | 95% CI | Supported ban on smoking in public places | 95% CI |
|---|---|---|---|---|---|---|---|
| TOTAL | 46.5 | (±3.2) | 17.9 | (±2.0) | 76.1 | (±2.2) | |
| African Region | 22.7 | (±3.7) | 7.2 | (±1.9) | 60.2 | (±5.9) | |
| Benin | |||||||
| Atlantique Littoral, 2003 | 6.6 | (±1.7) | 5.6 | (±2.0) | 76.5 | (±4.3) | |
| Borgou Alibori, 2003 | 19.4 | (±2.2) | 7.3 | (±3.0) | 61.2 | (±5.3) | |
| Botswana | |||||||
| Country, 2001 | 26.0 | (±2.6) | 7.0 | (±2.1) | 70.3 | (±4.5) | |
| Burkina Faso | |||||||
| Ouagadougou, 2001 | 15.3 | (±1.9) | 7.0 | (±1.7) | 80.3 | (±6.3) | |
| Côte D'Ivoire (Ivory Coast) | |||||||
| Ville Sud, 2003 | 17.9 | (±1.6) | † | † | 84.7 | (±2.1) | |
| Abidjan, 2003 | 17.4 | (±1.7) | † | † | 84.9 | (±2.3) | |
| Ethiopia | |||||||
| Addis Ababa,2003 | 8.8 | (±1.9) | 3.0 | (±1.5) | 95.7 | (±1.7) | |
| Ghana | |||||||
| Country, 2002 | 13.6 | (±4.0) | 4.1 | (±1.9) | 58.1 | (±8.8) | |
| Kenya | |||||||
| Country, 2001 | 19.4 | (±6.0) | 7.0 | (±2.2) | 39.8 | (±8.2) | |
| Lesotho | |||||||
| Country, 2002 | 31.7 | (±2.7) | 10.6 | (±2.0) | 32.9 | (±7.5) | |
| Malawi | |||||||
| Blantyre, 2000 | 10.2 | (±4.0) | 4.8 | (±1.1) | 90.1 | (±3.0) | |
| Lilongwe, 2000 | 8.3 | (±2.4) | 4.2 | (±1.5) | 85.1 | (±6.8) | |
| Mali | |||||||
| Bamako, 2001 | 19.1 | (±3.2) | 15.3 | (±2.3) | 77.0 | (±7.0) | |
| Mauritania | |||||||
| Country, 2001 | 26.2 | (±2.6) | 12.2 | (±1.7) | 61.9 | (±4.0) | |
| Mauritius | |||||||
| Country, 2003 | 42.7 | (±2.6) | 10.2 | (±3.4) | 61.8 | (±5.1) | |
| Mozambique | |||||||
| Maputo, 2002 | 21.3 | (±3.0) | 1.5 | (±0.9) | 77.4 | (±3.9) | |
| Gaza Inhambane, 2002 | 16.6 | (±2.8) | 1.0 | (±0.9) | 73.3 | (±7.4) | |
| Namibia | |||||||
| Country, 2004 | 28.1 | (±2.9) | 12.6 | (±2.3) | 34.1 | (±3.6) | |
| Niger | |||||||
| Country, 2001 | 16.3 | (±2.3) | 11.7 | (±2.1) | 56.7 | (±5.7) | |
| Nigeria | |||||||
| Cross River State, 2000 | 14.1 | (±3.6) | 7.3 | (±2.2) | 60.2 | (±4.6) | |
| Senegal | |||||||
| Country, 2002 | 21.6 | (±2.9) | † | † | 89.5 | (±1.5) | |
| Seychelles | |||||||
| Country, 2002 | 31.4 | (±2.7) | 12.1 | (±2.7) | 64.8 | (±7.6) | |
| South Africa | |||||||
| Country, 2002 | 36.9 | (±3.7) | 10.6 | (±2.1) | 59.4 | (±4.1) | |
| Swaziland | |||||||
| Country, 2001 | 21.0 | (±1.5) | 4.4 | (±1.1) | 26.5 | (±4.2) | |
| Togo | |||||||
| Country, 2002 | 14.8 | (±2.1) | 3.7 | (±1.3) | 85.1 | (±4.3) | |
| Uganda | |||||||
| Arua, 2002 | 32.7 | (±6.2) | 8.4 | (±2.6) | 32.0 | (±4.3) | |
| Kampala, 2002 | 14.9 | (±2.5) | 2.0 | (±0.8) | 67.1 | (±5.7) | |
| Mpigi, 2002 | 12.9 | (±3.4) | 3.0 | (±1.0) | 58.7 | (±5.9) | |
| United Republic of Tanzania | |||||||
| Arusha, 2003 | 11.5 | (±2.4) | 3.3 | (±1.8) | 70.2 | (±4.8) | |
| Kilimanjaro, 2003 | 22.5 | (±3.2) | 7.3 | (±2.8) | 66.8 | (±3.6) | |
| Dar Es Salaam, 2003 | 13.4 | (±2.0) | 3.3 | (±1.4) | 79.5 | (±3.1) | |
| Zambia | |||||||
| Chongwe Luangwa, 2002 | 28.6 | (±3.3) | 11.7 | (±2.7) | 40.5 | (±6.1) | |
| Lusaka, 2002 | 23.2 | (±3.7) | 11.5 | (±2.8) | 49.8 | (±6.6) | |
| Kafue, 2002 | 22.8 | (±3.3) | 10.5 | (±2.8) | 34.9 | (±4.0) | |
| Zimbabwe | |||||||
| Harare, 2003 | 27.9 | (±3.5) | 5.5 | (±1.4) | 43.7 | (±6.8) | |
| Manicaland, 2003 | 33.7 | (±3.9) | 11.1 | (±3.5) | 34.8 | (±9.8 | |
| Matebeleland & Bulawayo, 2003 | 29.7 | (±4.1) | 8.0 | (±2.8) | 50.7 | (±11.7) | |
| Region of the Americas | 41.0 | (±3.5) | 39.3 | (±2.6) | 80.4 | (±2.9) | |
| Antigua and Barbuda | |||||||
| Country, 2004 | 18.6 | (±2.6) | 5.5 | (±1.5) | 72.3 | (±3.5) | |
| Argentina | |||||||
| Buenos Aires, 2003 | 56.6 | (±2.3) | 28.0 | (±4.2) | 68.0 | (±4.3) | |
| Capital Federal, 2003 | 56.8 | (±3.7) | 21.6 | (±3.5) | 65.8 | (±1.5) | |
| Bahamas | |||||||
| Country, 2004 | 24.8 | (±3.6) | 4.3 | (±0.9) | 71.6 | (±6.5) | |
| Barbados | |||||||
| Country, 2002 | 21.9 | (±3.0) | 6.8 | (±1.5) | 77.2 | (±4.8) | |
| Belize | |||||||
| Country, 2002 | 31.8 | (±3.5) | 9.2 | (±2.1) | 52.2 | (±8.8) | |
| Bolivia | |||||||
| Cochabamba, 2003 | 44.8 | (±2.0) | 15.7 | (±2.5) | 80.4 | (±3.1) | |
| El Alto, 2003 | 40.2 | (±3.1) | 11.0 | (±1.3) | 77.6 | (±3.0) | |
| La Paz, 2003 | 42.5 | (±2.6) | 10.9 | (±2.1) | 82.0 | (±3.2) | |
| Oruro, 2003 | 41.4 | (±3.3) | 13.8 | (±4.0) | 79.1 | (±3.7) | |
| Santa Cruz, 2003 | 47.1 | (±2.5) | 12.9 | (±2.4) | 80.7 | (±2.2) | |
| Brazil | |||||||
| Alagoas, 2004 | 34.7 | (±4.2) | 9.4 | (±3.3) | 88.8 | (±2.7) | |
| Aracaju, 2002 | 29.0 | (±4.2) | 7.6 | (±3.0) | 87.1 | (±2.8) | |
| Boa Vista, 2004 | 36.5 | (±3.3) | 8.8 | (±3.5) | 84.2 | (±2.9) | |
| Curitiba, 2002 | 38.0 | (±3.5) | 10.8 | (±3.0) | 84.2 | (±3.1) | |
| Espirito Santo Vitoria, 2004 | 30.9 | (±4.2) | 6.9 | (±2.4) | 86.8 | (±2.5) | |
| Florianopolis, 2004 | 40.0 | (±3.7) | 7.1 | (±1.4) | 85.3 | (±1.9) | |
| Fortaleza, 2002 | 44.8 | (±6.4) | 10.8 | (±4.8) | 87.1 | (±3.9) | |
| Goiania, 2002 | 34.5 | (±4.1) | 7.1 | (±2.9) | 86.2 | (±3.5) | |
| Matto Grosso do Sul, 2002 | 36.9 | (±3.6) | 10.8 | (±2.9) | 88.1 | (±2.6) | |
| Paraiba, 2002 | 33.1 | (±3.6) | 5.6 | (±2.1) | 88.3 | (±4.0) | |
| Rio de Janeiro Public, 2005 | 39.0 | (±3.9) | 9.5 | (±2.9) | 86.4 | (±3.6) | |
| Rio Grande do Norte, 2002 | 35.7 | (±4.4) | 6.9 | (±2.0) | 87.7 | (±2.6) | |
| Rio Grande do Sul, 2002 | 47.7 | (±4.5) | 15.5 | (±4.3) | 83.3 | (±2.0) | |
| Salvador, 2005 | 18.9 | (±3.4) | 3.9 | (±2.0) | 92.7 | (±2.4) | |
| Sao Luis, 2004 | 35.0 | (±2.9) | 11.5 | (±2.8) | 85.5 | (±3.7) | |
| Tocantins, 2002 | 35.0 | (±8.3) | 8.9 | (±3.0) | 89.6 | (±3.4) | |
| Chile | |||||||
| Concepcion, 2003 | 56.6 | (±3.0) | 23.2 | (±6.6) | 76.0 | (±2.8) | |
| Coquimbo, 2003 | 55.0 | (±4.2) | 18.7 | (±3.9) | 79.2 | (±3.4) | |
| Santiago, 2003 | 67.2 | (±2.2) | 26.5 | (±4.1) | 71.1 | (±3.4) | |
| Valparaiso, 2003 | 60.6 | (±2.8) | 23.0 | (±4.3) | 75.9 | (±3.1) | |
| Colombia | |||||||
| Bogota, 2001 | 42.2 | (±2.2) | 24.2 | (±2.5) | 78.9 | (±2.1) | |
| Costa Rica | |||||||
| Country, 2002 | 28.1 | (±2.0) | † | † | 81.6 | (±2.5) | |
| Cuba | |||||||
| Havana, 2004 | 54.5 | (±3.7) | 10.8 | (±2.3) | 84.5 | (±2.6) | |
| 4 Additional Provinces, 2004 | 47.0 | (±5.2) | 7.3 | (±2.1) | 85.9 | (±4.4) | |
| Dominica | |||||||
| Country, 2004 | 25.6 | (±3.3) | 9.5 | (±1.9) | 73.0 | (±4.2) | |
| Dominican Republic | |||||||
| Country, 2004 | 24.0 | (±2.2) | 3.5 | (±1.0) | 85.8 | (±1.7) | |
| Ecuador | |||||||
| Guayaquil, 2001 | 38.6 | (±2.4) | 8.5 | (±1.8) | 83.3 | (±2.7) | |
| Quito, 2001 | 49.3 | (±2.7) | 15.8 | (±2.7) | 80.1 | (±3.5) | |
| Zamora, 2001 | 46.3 | (±3.8) | 19.3 | (±4.2) | 81.5 | (±4.0) | |
| El Salvador | |||||||
| Country, 2003 | 19.7 | (±5.2) | 11.4 | (±2.7) | 88.3 | (±3.0) | |
| Grenada | |||||||
| Country, 2004 | 30.4 | (±3.3) | 6.8 | (±1.5) | 77.7 | (±3.7) | |
| Guatemala | |||||||
| Chimal Tenago, 2002 | 18.3 | (±2.8) | 11.4 | (±3.6) | 83.5 | (±2.8) | |
| Guatemala City, 2002 | 30.4 | (±3.1) | 13.3 | (±3.1) | 78.2 | (±3.3) | |
| Guyana | |||||||
| Country, 2004 | 33.7 | (±3.6) | 4.6 | (±1.7) | 70.9 | (±6.2) | |
| Haiti | |||||||
| Port au Prince, 2000 | 22.4 | (±7.1) | 13.4 | (±4.2) | 74.9 | (±6.2) | |
| Honduras | |||||||
| San Pedro Sula La Ceiba, 2003 | 21.0 | (±5.9) | 15.4 | (±5.3) | 81.5 | (±4.1) | |
| Tegucigalpa, 2003 | 26.0 | (±3.3) | 15.4 | (±4.1) | 82.1 | (±3.2) | |
| Jamaica | |||||||
| Country, 2000 | † | † | 7.8 | (±2.0) | 70.6 | (±7.6) | |
| Mexico | |||||||
| Chetumal, 2003 | 32.6 | (±3.2) | 61.7 | (±3.2) | 87.4 | (±2.7) | |
| Chilpancingo, 2005 | 28.7 | (±2.6) | 48.5 | (±3.0) | 91.0 | (±1.8) | |
| Cuernavaca, 2003 | 42.1 | (±3.1) | 63.6 | (±3.0) | 80.3 | (±2.7) | |
| Culican, 2005 | 32.2 | (±3.3) | 48.0 | (±3.0) | 93.4 | (±1.9) | |
| Durango, 2005 | 42.6 | (±4.3) | 51.9 | (±4.4) | 87.6 | (±2.5) | |
| Guadalajara, 2003 | 42.7 | (±3.1) | 59.4 | (±3.5) | 84.4 | (±2.5) | |
| Hermosillo, 2005 | 41.1 | (±3.2) | 50.2 | (±3.1) | 88.7 | (±2.4) | |
| Juarez, 2003 | 50.1 | (±4.0) | 60.4 | (±3.0) | 86.6 | (±2.5) | |
| Leon, 2005 | 48.5 | (±2.3) | 58.4 | (±3.2) | 88.8 | (±2.3) | |
| Merida, 2005 | 36.9 | (±2.5) | 59.7 | (±3.7) | 85.9 | (±3.2) | |
| Mexico City, 2003 | 54.1 | (±2.8) | 66.8 | (±4.3) | 43.5 | (±3.2) | |
| Monterrey, 2005 | 47.4 | (±4.3) | 60.4 | (±4.2) | 84.7 | (±2.5) | |
| Nuevo Laredo, 2003 | 44.0 | (±3.3) | 64.8 | (±4.1) | 87.2 | (±2.5) | |
| Oaxaca, 2003 | 27.1 | (±3.2) | 53.3 | (±4.9) | 90.3 | (±2.0) | |
| Puebla, 2003 | 47.8 | (±4.3) | 60.5 | (±5.4) | 82.4 | (±3.3) | |
| Tapachula, 2003 | 23.7 | (±4.1) | 43.9 | (±4.7) | 91.5 | (±2.0) | |
| Tepic, 2005 | 33.0 | (±2.7) | 49.1 | (±2.1) | 91.8 | (±1.4) | |
| Tijuana, 2003 | 41.4 | (±2.5) | 55.1 | (±3.0) | 90.8 | (±1.6) | |
| Toluca, 2005 | 43.4 | (±2.4) | 58.1 | (±4.1) | 84.7 | (±2.0) | |
| Veracruz, 2005 | 35.2 | (±2.3) | 62.4 | (±3.1) | 88.5 | (±1.5) | |
| Zacatecas, 2005 | 46.9 | (±3.7) | 53.8 | (±3.8) | 87.4 | (±2.2) | |
| Montserrat | |||||||
| Country, 2000 | 13.3 | ** | 3.1 | ** | 88.3 | ** | |
| Nicaragua | |||||||
| Country, 2003 | 34.1 | (±2.2) | 16.4 | (±2.6) | 85.2 | (±1.5) | |
| Panama | |||||||
| Country, 2002 | 25.5 | (±3.7) | 14.5 | (±3.4) | 80.5 | (±3.6) | |
| Peru | |||||||
| Country, 2003 | 39.2 | (±3.6) | 14.3 | (±2.5) | 86.3 | (±2.2) | |
| Saint Kitts and Nevis | |||||||
| Country, 2002 | 16.3 | (±2.4) | 5.7 | (±1.8) | 77.1 | (±4.9) | |
| Saint Lucia | |||||||
| Country, 2000 | 31.4 | (±2.5) | 7.6 | (±1.7) | 79.5 | (±3.8) | |
| Saint Vincent and The Grenadines | |||||||
| Country, 2000 | 30.8 | (±2.6 | 6.6 | (±1.1) | 70.5 | (±3.8) | |
| Suriname | |||||||
| Country, 2004 | 49.5 | (±4.5) | 4.9 | (±1.6) | 91.0 | (±2.6) | |
| Trinidad and Tobago | |||||||
| Country, 2000 | 38.4 | (±2.9) | 6.7 | (±1.3) | 84.7 | (±2.0) | |
| United States | |||||||
| Country, 2000 | † | † | 51.2 | (±2.2) | † | † | |
| Uruguay | |||||||
| Colonia, 2000 | 49.2 | (±4.7) | 12.9 | (±3.7) | 79.5 | (±6.4) | |
| Maldonado, 2000 | 53.6 | (±4.1) | 20.2 | (±3.6) | 76.3 | (±4.2) | |
| Montevideo, 2000 | 56.7 | (±3.7) | 25.4 | (±3.2) | 72.6 | (±2.8) | |
| Rivera, 2000 | 51.9 | (±3.9) | 18.2 | (±3.7) | 81.9 | (±3.1) | |
| US Virgin Islands | |||||||
| Country, 2004 | † | † | 24.9 | (±2.6) | † | † | |
| Paraguay | |||||||
| Alto Parana, 2003 | 35.8 | (±3.4) | 10.5 | (±2.8) | 83.7 | (±2.5) | |
| Amambay, 2003 | 35.6 | (±3.7) | 8.2 | (±1.5) | 86.1 | (±2.8) | |
| Asuncion, 2003 | 35.6 | (±3.2) | 15.8 | (±2.1) | 78.0 | (±3.1) | |
| Central, 2003 | 33.2 | (±1.9) | 9.8 | (±1.7) | 84.7 | (±2.2) | |
| Venezuela | |||||||
| Barinas, 2003 | 32.1 | (±3.2) | 6.8 | (±1.5) | 90.3 | (±2.6) | |
| Cojedes, 2003 | 37.9 | (±4.6) | 8.3 | (±3.1) | 89.4 | (±2.3) | |
| Lara, 2003 | 39.4 | (±4.5) | 10.5 | (±2.7) | 85.5 | (±2.0) | |
| Monagas, 2003 | 38.6 | (±3.7) | 7.4 | (±2.1) | 88.0 | (±3.0) | |
| Nueva Esparta, 2001 | 41.7 | (±4.3) | 6.8 | (±2.1) | 85.9 | (±2.8) | |
| Tachira, 2001 | 39.4 | (±3.1) | 10.2 | (±2.6) | 92.1 | (±2.9) | |
| Yaracuy state, 2001 | 36.7 | (±3.3) | 10.8 | (±2.2) | 88.1 | (±1.6 | |
| Zulia, 2001 | 40.7 | (±6.1) | 12.5 | (±2.9) | 85.0 | (±4.6) | |
| Virgin Islands (British) | |||||||
| Country, 2001 | 13.4 | (±3.9) | 3.6 | (±1.9) | 79.5 | (±6.9) | |
| Eastern Mediterranean Region | 35.6 | (±3.7) | 6.9 | (±1.9) | 82.8 | (±2.8) | |
| Afghanistan | |||||||
| Kabul, 2004 | 29.7 | (±5.7) | 21.8 | (±6.5) | 83.9 | (±3.5) | |
| Other Provinces, 2004 | 23.7 | (±5.2) | 16.7 | (±4.1) | 68.6 | (±7.1) | |
| Bahrain | |||||||
| Country, 2002 | 31.7 | (±2.0) | 7.3 | (±2.2) | 82.7 | (±2.2) | |
| Djibouti | |||||||
| Country, 2003 | 37.4 | (±4.2) | 10.9 | (±2.3) | 72.1 | (±4.4) | |
| Egypt | |||||||
| Country, 2001 | 43.3 | (±5.4) | 4.6 | (±1.4) | 88.5 | (±3.2) | |
| Gaza Strip‐West Bank | |||||||
| Gaza Strip, 2000 | † | † | † | † | 47.1 | (±3.2) | |
| West Bank, 2000 | 57.2 | (±2.3) | 17.0 | (±2.0) | 82.5 | (±1.9) | |
| Iran, Islamic Republic of | |||||||
| Country, 2003 | 33.3 | (±2.1) | 4.6 | (±1.1) | 89.5 | (±1.5) | |
| Jordan | |||||||
| Country, 2003 | 53.3 | (±2.2) | 20.6 | (±2.3) | 75.5 | (±2.7) | |
| Kuwait | |||||||
| Country, 2001 | 36.0 | (±1.9) | 8.7 | (±1.4) | 83.2 | (±1.5) | |
| Lebanon | |||||||
| Country, 2001 | 67.7 | (±4.3) | 12.9 | (±1.5) | 85.8 | (±1.9) | |
| Libyan Arab Jamahiriya | |||||||
| Country, 2003 | 31.4 | (±4.0) | 4.7 | (±1.5) | 77.3 | (±3.5) | |
| Morocco | |||||||
| Country, 2001 | 25.2 | (±2.2) | 4.9 | (±1.0) | 78.0 | (±2.3) | |
| Oman | |||||||
| Country, 2002 | 20.4 | (±5.1) | 6.5 | (±5.1) | 88.0 | (±2.7) | |
| Pakistan | |||||||
| Islamabad, 2003 | 20.3 | (±3.6) | 3.9 | (±3.0) | 94.5 | (±1.9) | |
| Lahore, 2003 | 30.4 | (±9.1) | 6.7 | (±9.4) | 96.9 | (±1.2) | |
| Quetta, 2004 | 37.0 | (±5.6) | 4.5 | (±2.0) | 93.4 | (±2.3) | |
| Qatar | |||||||
| Country, 2004 | 26.6 | (±2.3) | 7.7 | (±1.1) | 84.8 | (±1.5) | |
| Saudi Arabia | |||||||
| Riyadh, 2001 | 17.6 | (±3.8) | 7.0 | (±1.1) | 76.6 | (±2.4) | |
| Somalia | |||||||
| Somaliland, 2004 | 48.8 | (±12.1) | 24.0 | (±11.2) | 78.0 | (±7.8) | |
| Sudan | |||||||
| Country, 2001 | 22.5 | (±2.9) | 4.6 | (±2.2) | 78.0 | (±3.0) | |
| Syrian Arab Republic | |||||||
| Country, 2002 | 52.1 | (±3.4) | 5.1 | (±1.0) | 80.0 | (±3.9) | |
| Tunisia | |||||||
| Country, 2001 | 51.2 | (±3.2) | 10.3 | (±1.8) | 87.0 | (±1.0) | |
| United Arab Emirates | |||||||
| Country, 2002 | 28.0 | (±2.2) | 6.9 | (±1.6) | 72.1 | (±2.6) | |
| Yemen | |||||||
| Country, 2003 | 43.1 | (±2.0) | 6.3 | (±0.8) | 78.1 | (±1.2) | |
| European Region | 59.6 | (±2.7) | 17.5 | (±2.6) | 82.1 | (±2.0) | |
| Albania | |||||||
| Country, 2004 | 46.3 | (±3.3) | 3.7 | (±1.0) | 93.7 | (±0.7) | |
| Armenia | |||||||
| Country, 2004 | 67.8 | (±3.3) | 7.2 | (±1.8) | 90.3 | (±2.2) | |
| Belarus | |||||||
| Country, 2004 | 59.8 | (±2.1) | 23.5 | (±1.8) | 86.4 | (±1.3) | |
| Bosnia and Herzegovina | |||||||
| Federation of Bosnia and Herzegovina, 2003 | 68.8 | (±2.5) | 13.5 | (±3.1) | 86.1 | (±2.3) | |
| Republic of Srpska, 2003 | 60.5 | (±2.1) | 13.3 | (±3.5) | 87.7 | (±2.7) | |
| Bulgaria | |||||||
| Country, 2002 | 75.5 | (±2.4) | 41.6 | (±4.2) | 62.5 | (±2.6) | |
| Croatia (Hrvatska) | |||||||
| Country, 2003 | 59.6 | (±3.5) | 15.2 | (±2.1) | 73.5 | (±3.2) | |
| Czech Republic | |||||||
| Country, 2002 | 53.7 | (±2.7) | 32.9 | (±3.7) | 68.0 | (±2.0) | |
| Estonia | |||||||
| Country, 2003 | 58.7 | (±2.4) | 27.6 | (±3.2) | 78.3 | (±2.1) | |
| Georgia | |||||||
| Country, 2003 | 73.0 | (±2.4) | 9.5 | (±1.5) | 76.1 | (±2.1) | |
| Greece | |||||||
| Athens, 2004 | 69.8 | (±4.0) | 11.2 | (±1.6) | 83.1 | (±2.7) | |
| Hungary | |||||||
| Country, 2003 | 57.4 | (±2.9) | 25.8 | (±3.8) | 69.7 | (±2.9) | |
| Kazakhstan | |||||||
| Country, 2004 | 53.8 | (±2.4) | 9.4 | (±1.8) | 89.9 | (±1.1) | |
| Kyrgyzstan | |||||||
| Country, 2004 | 37.1 | (±5.9) | 5.7 | (±2.0) | 91.1 | (±1.8) | |
| Latvia | |||||||
| Country, 2002 | 63.4 | (±3.5) | 30.5 | (±2.9) | 77.3 | (±2.9) | |
| Lithuania | |||||||
| Country, 2005 | 58.1 | (±3.0) | 27.6 | (±3.4) | 66.1 | (±2.5) | |
| Macedonia | |||||||
| Country, 2003 | 65.9 | (±3.5) | 13.1 | (±3.3) | 86.7 | (±3.3) | |
| Poland | |||||||
| Country, 2003 | 58.5 | (±2.6) | 17.0 | (±2.7) | 75.0 | (±2.1) | |
| Republic of Moldova | |||||||
| Country, 2004 | 50.2 | (±2.5) | 10.7 | (±2.3) | 92.4 | (±1.2) | |
| Romania | |||||||
| Country, 2004 | 63.7 | (±2.6) | 14.0 | (±1.8) | 86.1 | (±2.7) | |
| Russian Federation | |||||||
| Moscow, 1999 | 62.5 | (±1.8) | 34.9 | (±2.7) | 71.0 | (±2.1) | |
| Sarov, 2002 | 56.4 | (±3.2) | 37.5 | (±4.4) | 77.6 | (±2.8) | |
| Serbia and Montenegro | |||||||
| Montenegro, 2004 | 64.5 | (±3.0) | 11.0 | (±2.1) | 87.7 | (±2.6) | |
| Republic of Serbia, 2003 | 70.8 | (±2.1) | 16.9 | (±2.7) | 79.0 | (±2.6) | |
| Slovakia | |||||||
| Country, 2003 | 55.1 | (±2.3) | 24.1 | (±2.1) | 75.6 | (±2.0) | |
| Slovenia | |||||||
| Country, 2003 | 46.5 | (±2.2) | 18.0 | (±2.8) | 71.5 | (±3.0) | |
| Tajikistan | |||||||
| Country, 2004 | 29.4 | (±3.8) | 2.6 | (±1.4) | 93.2 | (±2.9) | |
| Turkey | |||||||
| Country, 2003 | 59.8 | (±1.2) | 5.4 | (±0.7) | 91.4 | (±0.7) | |
| Ukraine | |||||||
| Country, 2005 | 62.1 | (±2.0) | 24.3 | (±2.5) | 83.1 | (±1.5) | |
| South East Asia Region | 43.5 | (±3.5) | 7.0 | (±1.7) | 75.3 | (±1.2) | |
| Bangladesh | |||||||
| Dhaka, 2004 | 33.5 | (±3.0) | 3.1 | (±1.2) | 94.4 | (±1.3) | |
| Bhutan | |||||||
| Country, 2004 | 17.8 | (±2.5) | 4.5 | (±1.9) | 19.8 | (±7.9) | |
| India | |||||||
| Country, 2004 | † | † | † | † | 74.8 | (±1.2) | |
| Indonesia | |||||||
| Bekasi, 2004 | 7.9 | (±1.4) | 20.4 | (±2.6) | 87.0 | (±2.2) | |
| Jakarta, 2004 | 66.7 | (±3.8) | 15.7 | (±3.2) | 84.8 | (±3.4) | |
| Medan, 2004 | 74.5 | (±3.4) | 17.8 | (±3.0) | 85.9 | (±2.7) | |
| Maldives | |||||||
| Rural, 2004 | 52.2 | (±4.7) | 6.7 | (±1.8) | 92.8 | (±2.0) | |
| Urban, 2003 | 40.3 | (±4.0) | 13.2 | (±3.5) | 89.5 | (±2.8) | |
| Nepal | |||||||
| Biratnagar, 2004 | 52.0 | (±7.2) | † | † | 64.7 | (±5.5) | |
| Mahendranagar and Dhangad, 2004 | 56.7 | (±3.3) | † | † | 68.1 | (±5.3) | |
| Sri Lanka | |||||||
| Country, 2003 | 41.2 | (±3.9) | 3.6 | (±1.0) | 93.0 | (±1.8) | |
| Western Pacific Region | 59.7 | (±2.9) | 5.1 | (±1.1) | 72.9 | (±2.2) | |
| American Samoa | |||||||
| Country, 2005 | † | † | 43.2 | (±4.0) | † | † | |
| Cambodia | |||||||
| Country, 2003 | 43.9 | (±6.6) | 2.9 | (±1.8) | 82.9 | (±3.4) | |
| China | |||||||
| Chongqing, 1999 | 77.2 | (±4.0) | 5.7 | (±0.9) | 55.7 | (±2.7) | |
| Guangdong, 1999 | 60.0 | (±2.7) | 3.3 | (±0.6) | 64.3 | (±2.1) | |
| Puyang, 2005 | 68.1 | (±3.9) | 4.8 | (±1.6) | 64.2 | (±8.0) | |
| Shandong, 1999 | 60.2 | (±3.3) | 2.1 | (±0.6) | 63.1 | (±2.1) | |
| Shanghai, 2005 | 75.3 | (±2.5) | 2.1 | (±0.6) | 58.7 | (±2.6) | |
| Tianjin, 2005 | 69.6 | (±2.6) | 6.2 | (±1.3) | 61.3 | (±4.8) | |
| Zhuhai, 2005 | 64.2 | (±3.1) | 5.7 | (±1.2) | 57.2 | (±2.6) | |
| Cook Islands | |||||||
| Country, 2003 | 53.6 | (±4.3) | 26.0 | (±3.8) | 75.7 | (±4.8) | |
| Fiji | |||||||
| Country, 1999 | 45.1 | (±3.6) | 10.2 | (±3.5) | 54.0 | (±8.2) | |
| Guam | |||||||
| Country, 2002 | † | † | † | † | † | † | |
| Lao People's Democratic Republic | |||||||
| Luang Prabang Province, 2003 | 42.4 | (±4.6) | 2.2 | (±1.1) | 55.9 | (±4.3) | |
| Savannakhet, 2003 | 54.3 | (±3.0) | 5.1 | (±1.9) | 50.6 | (±3.8) | |
| Vientiane Municipality, 2003 | 46.3 | (±4.5) | 3.0 | (±1.1) | 60.2 | (±5.3) | |
| Vientiane Province, 2003 | 53.0 | (±6.7) | 5.4 | (±2.1) | 48.4 | (±5.8) | |
| Macau | |||||||
| Macau, 2001 | 55.4 | (±4.8) | 8.5 | (±2.2) | 58.1 | (±3.0) | |
| Malaysia | |||||||
| Country, 2004 | † | † | † | † | 79.5 | (±3.1) | |
| Micronesia | |||||||
| Kosrae, 2000 | † | † | 54.1 | (±6.0) | † | † | |
| Pohnpei, 2000 | † | † | 54.4 | (±3.7) | † | † | |
| Mongolia | |||||||
| Country, 2003 | 58.2 | (±2.7) | 8.9 | (±2.2) | 83.2 | (±1.7) | |
| Northern Mariana | |||||||
| Country, 2004 | † | † | 60.3 | (±2.8) | † | † | |
| Palau | |||||||
| Country, 2000 | † | † | 41.0 | (±4.9) | † | † | |
| Philippines | |||||||
| Country, 2004 | 55.1 | (±2.5) | 9.1 | (±2.0) | 90.5 | (±1.9) | |
| Singapore | |||||||
| Country, 2000 | 36.4 | (±1.4) | † | † | † | † | |
| Viet Nam | |||||||
| Denang, 2003 | 65.7 | (±4.9) | 4.6 | (±1.0) | 87.5 | (±2.6) | |
| Haiphong, 2003 | 53.7 | (±5.3) | 2.8 | (±1.2) | 86.2 | (±2.2) | |
| Hanoi, 2003 | 56.1 | (±11.0) | 3.0 | (±2.7) | 91.7 | (±2.2) | |
| Hochiminh, 2003 | 60.6 | (±4.8) | 3.4 | (±1.4) | 89.1 | (±3.2) | |
| Tuenquang, 2003 | 47.5 | (±5.8) | 5.3 | (±3.2) | 85.8 | (±4.2) | |
*Data from 131 countries are included in this report. Notable countries, by WHO Region, that have not completed the GYTS include: Region of the Americas (Canada), European Region (most Western European countries), and Western Pacific Region (Australia, Japan, and New Zealand).
**No confidence interval calculated because the survey was conducted among a census of students.
†Not available.
The GYTS provides systematic global surveillance of youth tobacco use. Countries can use GYTS data to enhance their capacity to monitor tobacco use among youth; guide development, implementation, and evaluation of their national tobacco prevention and control programmes; and compare tobacco‐related data at the national, regional, and global levels.
The GYTS uses a standardised methodology for constructing sampling frames, selecting schools and classes, preparing questionnaires, carrying out field procedures, and processing data. The GYTS includes data on prevalence of cigarette and other tobacco use, perceptions and attitudes about tobacco, access to and availability of tobacco products, exposure to secondhand smoke, school curricula, media and advertising, and smoking cessation.
The GYTS questionnaire is self‐administered in classrooms, and school, class, and student anonymity is maintained throughout the GYTS process. Country‐specific questionnaires consist of a core set of questions that all countries ask and unique country‐specific questions. The final country questionnaires are translated in‐country into local languages and back‐translated to check for accuracy. GYTS country research coordinators conduct focus groups of students aged 13–15 to further test the accuracy of the translation and student understanding of the questions.
Estimates presented in this study include exposure to smoke at home (defined as the percentage of students who answered “1 or more days” to the question, “During the past 7 days, on how many days have people smoked in your home, in your presence?”), exposure to smoke in public places (defined as the percentage of students who answered “1 or more days” to the question, “During the past 7 days, on how many days have people smoked in your presence, in places other than in your home?”), parental smoking (defined as the percentage of students who answered “both”, “mother only”, or “father only” to the question “Do your parents smoke?”), best friends who smoke (defined as the percentage of students who answered “most of them” or “all of them” to the question “Do any of your closest friends smoke cigarettes?”), and support for bans on smoking in public places (defined as the percentage of students who answered “yes” to the question “Are you in favour of banning smoking in public places (such as in restaurants, in buses, streetcars, and trains, in schools, on playgrounds, in gyms and sports arenas, in discos)?”).
METHODS
The GYTS is a school‐based survey of defined geographic sites that can be countries, provinces, cities, or any other sampling frame including subnational areas, non‐Member States, or territories. The GYTS uses a two‐stage cluster sample design that produces representative samples of students in grades associated with ages 13–15. The sampling frame includes all schools containing any of the identified grades. At the first stage, the probability of schools being selected is proportional to the number of students enrolled in the specified grades. At the second sampling stage, classes within the selected schools are randomly selected. All students in selected classes attending school the day the survey is administered are eligible to participate. Student participation is voluntary and anonymous using self‐administered data‐collection procedures. The GYTS sample design produces representative, independent, cross‐sectional estimates for each site. Respondents younger than 13 or older than 15 were excluded from these analyses because the objective of this paper is comparisons of same aged children 13–15 years old.
A weighting factor is applied to each student record to adjust for non‐response (by school, class, and student) and variation in the probability of selection at the school, class, and student levels. A final adjustment sums the weights by grade and sex to the population of school children in the selected grades in each sample site. We used SUDAAN, a software package for statistical analysis of correlated data, to compute standard errors of the estimates and produced 95% confidence intervals by multiplying the standard errors by 1.96.13
RESULTS
Exposed to smoke at home
Overall, more than four in 10 students (43.9%) were exposed to smoke at home (table 1). Among the six Regions, exposure to SHS at home was highest in the European Region (mean 78.0%) and lowest in the African Region (mean 30.4%). In the other four Regions, exposure at home ranged from 50.5% (Western Pacific Region) to 37.0% (South‐East Asia Region).
More than half the students were exposed to SHS at home in one of 37 sites in the African Region, 12 of 97 sites in the Region of the Americas, seven of 25 sites in the Eastern Mediterranean Region, 26 of 29 sites in the European Region, six of 11 sites in the South‐East Asia Region, and 15 of 30 sites in the Western Pacific Region.
Exposed to smoke in public places
More than half (55.8%) of all students were exposed to SHS in public places (table 1). Exposure to SHS in public places was highest in the European Region (mean 84.8%). For the other five Regions, exposure to SHS in public places ranged from 63.0% (Region of the Americas) to 46.3% (African Region and Eastern Mediterranean Region).
Across Regions, more than 50% of students were exposed to SHS in public places in 18 of 37 sites in the African Region, 65 of 96 sites in the Region of the Americas, eight of 25 sites in the Eastern Mediterranean Region, all sites in the European Region, eight of 11 sites in the South‐East Asia Region, and 10 of 18 sites in the Western Pacific Region.
Had one or more parents who smoke
Nearly half of all students (46.5%) said one or more of their parents smoke (table 2). Students in the Western Pacific Region (mean 59.7%) and the European Region (mean 59.6%) were most likely to have one or more parents who smoke. Students in the African Region were least likely to have one or more parents who smoke (mean 22.7%). For the other Regions, the prevalence of parents who smoke ranged from 43.5% (South‐East Asia Region) to 35.6% (Eastern Mediterranean Region).
More than half of students had at least one parent who smoked in none of 37 sites in the African Region, 12 of 95 sites in Region of the Americas, five of 24 sites in the Eastern Mediterranean Region, 25 of 29 sites in the European Region, five of 10 sites in the South‐East Asia Region, and 17 of 23 sites in the Western Pacific Region.
Had most or all best friends who smoke
Nearly one in five of all students (17.9%) reported that most or all of their best friends smoke (table 2). Students in the Region of the Americas were most likely to report that most or all of their best friends smoke (mean 39.3%). About one in seven students in the European Region (17.5%) reported that most or all of their best friends smoke. Less than one in 10 students reported most or all best friends who smoke in the other four Regions (means of 7.2%, 6.9%, 7.0%, and 5.1% in the African Region, Eastern Mediterranean Region, South‐East Asia Region, and Western Pacific Region, respectively).
More than 50% of students reported most or all best of their friends smoke in 17 of 95 sites in the Region of the Americas and 3 of 27 sites in the Western Pacific Region. The other four Regions did not have any sites in which more than 50% of students reported most or all their best friends smoke.
Thought smoking should be banned in public places
More than three quarters (76.1%) of all students in all Regions thought smoking should be banned in public places (table 2). However, there were differences among Regions. Only six in 10 students (mean 60.2%) in the African Region thought smoking should be banned in public places, compared with slightly over seven in 10 students in the South‐East Asia (75.3%) and Western Pacific (72.9%) Regions and more than eight in 10 students in the other three Regions (means of 80.4%, 82.8%, and 82.1%, in the Region of the Americas, the Eastern Mediterranean Region, and the European Region, respectively).
More than 80% of students support smoke‐free environments in eight of 37 sites in the African Region, 68 of 96 sites in the Region of the Americas, 13 of 25 sites in the Eastern Mediterranean Region, 15 of 29 sites in the European Region, seven of 11 sites in the South‐East Asia Region, and eight of 23 sites in the Western Pacific Region.
DISCUSSION
Exposure to SHS is a significant health risk for non‐smokers and smokers1,2,3,4,5,6,7,8,9; thus, reduction of SHS exposure should be a primary component of national comprehensive tobacco control programmes. This report shows that more than half of all students surveyed were exposed to smoke in public places. Also, nearly half of all students were exposed to smoke at home and had one or more parents who smoke. One fifth of all students said most or all of their best friends smoke. Changing these patterns to reduce the chronic disease burden associated with long‐term tobacco smoke exposure is a significant challenge to the tobacco control community. Fortunately, the majority of students surveyed by the GYTS between 1999 and 2005 support implementation of measures to reduce SHS exposure, including banning smoking in public areas.
Initiatives are under way in all six WHO Regions to reduce exposure to SHS. Many countries are making important policy and legislative advances to ban smoking in public places, especially hospitals, restaurants, and public transportation, and some have passed workplace smoking bans. Comprehensive bans on smoking in the workplace, including restaurants and bars, exist for the entire countries of Bermuda, Bhutan, Ireland, Italy, Malta, Norway, Sweden, Spain, New Zealand, and Uganda. In addition, 10 of 50 US states and 11 of 13 provinces and territories in Canada have enacted smoke‐free workplace legislation. See table 3 for examples of secondhand smoke policies and laws by Region and country.
Table 3 Secondhand smoke policies and laws by Region and country.
| African Region | |
| South Africa | Smoking is banned in all public places including the workplace |
| Tanzania | Effective 1 July 2003, smoking in public places was banned. Under the Tobacco Products (regulation) Act 2003 it is illegal to smoke inside public transport, hospitals, schools, and many other public places |
| Uganda | Effective March 2004, the environment minister imposed a smoking ban in all public places. Smoking in restaurants, educational institutions, and bars is an offence. Offenders will be fined between $10 and $50 if arrested by police, who have been instructed to enforce the law |
| Region of the Americas | |
| Argentina | Public education activities began in 2003 in some provinces and municipalities in Argentina. Argentina has programmes where businesses can officially register as being smoke‐free. The city of Buenos Aires has recently announced that restaurants and bars smaller than 100 square meters must be smoke‐free in October 2006 |
| Brazil | Significant public education activities began in 2003 in some municipalities of Brazil (for example Belo Horizonte, Rio de Janeiro, and the federal district of Brasilia) |
| Canada | Since 2003, three Canadian provinces and two territories have become smoke‐free (requiring 100% smoke‐free workplaces and public places including restaurants and bars). Most others will become smoke‐free in 2006, including Ontario and Quebec, which combined comprise more than half of Canada's population |
| Costa Rica | Laws governing public places require facilities to designate smoking areas |
| Mexico | Laws governing government and related federal facilities require facilities to designate smoking areas |
| Trinidad & Tobago | Trinidad's 100% smoke‐free policies apply only to government facilities |
| United States | As of October 2005, 14 states have laws that require 100% smoke‐free workplaces, restaurants, and bars |
| Uruguay | The Region's significant exception to weak policies is Uruguay, whose president announced in September 2005 that Uruguay would require all workplaces and public places to be smoke‐free beginning in March 2006. If the implementation of Uruguay's smoke‐free policy is successful it will provide a model that other Latin American countries may soon follow. In addition, public education activities began in 2003 in Uruguay |
| Eastern Mediterranean Region | |
| Iran | In 2004, Parliament passed a bill prohibiting smoking in public places—mosques, cinemas, restaurants, department stores, public transport, and stadiums. The antismoking bill states the government is obliged to fight smoking by campaigning against financial, health, and social hazards of the habit to prevent youth from becoming addicted |
| Gulf States | There is a leading movement in the seven Gulf states in the area of SHS legislation; a great example can be found in the initiative of tobacco‐free Mecca and Medina; which is based on tobacco‐free public places and now moving toward a total ban of tobacco sales in the two cities |
| The ban of smoking in public places is based on a plan of action that was designed and put in place by the Ministry of Health in the year 2001; fortunately, it was supported by the governors of the two cities and was therefore implemented immediately. On‐the‐spot fines are imposed on violators and if repeated, other penalties are sometimes enforced. The legislation is also supported by wide national media and advocacy campaigns | |
| In Bahrain, Kuwait, and Oman the enforcement of anti‐SHS legislation, in place since the nineties, is very strong, although the process of the WHO‐FCTC will strengthen it further. In this group of Member States, the involvement of the Gulf Cooperation Council for Ministries of Health supported coordinating their activities and unifying the SHS measures taken in all seven countries | |
| Egypt | A ban of tobacco use in public places existed in the 1980s, but it was reinforced in 2002 with the adoption of new legislation. However, the ban is not being enforced, and its implementation depends largely on the administration in each facility and public place. The national authorities are working to strengthen the ban, and the adoption of the WHO‐FCTC will support that process |
| European Region | |
| Austria | A 2003 law prohibits smoking in classes, conference rooms, school sports buildings, buildings open to the public, schools or similar institutions open to children and young people, but there are no sanctions in case of violation |
| Belgium | As of January 2006, smoking was banned in all enclosed workplaces and social facilities under the employer's authority and to which workers have access |
| Bulgaria | In 2005, a smoking ban for all public places took effect. Smokers are banned from lighting a cigarette at kindergartens, schools, cinemas, theatres, Internet clubs, and city transport. Taxi drivers and their clients can smoke only outside the taxi. Restaurants of more than 60‐people occupancy are now obliged to provide separate areas for smokers and non‐smokers. Smaller cafes must be equipped with air‐conditioning systems. Fines of BGN 50 up to BGN 150 will be imposed for violations |
| Czech Republic | In 2003, smoking was banned in public transport including indoor air spaces, during indoor work meetings, in workplaces where non‐smokers could be exposed to tobacco smoke, in schools, health care facilities, and indoor sport areas (except dedicated smoking areas) |
| Cyprus | A 2002 ban prohibited smoking in all public places including places of entertainment, in all government buildings, public transport, and in private cars with passengers younger than 16 |
| Estonia | The Tobacco Act of 2001 was amended in 2005 to impose a complete ban on smoking in health care, education, and government facilities; indoor offices and workplaces (including bars and restaurants); and theatres and cinemas. However, in all of these places special smoking areas are permitted |
| Finland | The Ministry of Social Affairs and Health is preparing amendments to smoking legislation aimed at curbing smoking in restaurants, to prevent employees being exposed to environmental tobacco smoke. This new tobacco law should take effect in summer 2006 |
| Germany | A 2002 non‐smokers protection act for workplaces excludes the hospitality industry and public areas. Smoking is not banned in trains, planes, public transportation, health care and government buildings, or schools. |
| Ireland | In 2004, Ireland banned smoking in a wide range of workplaces, including pubs, restaurants, offices, and shops. The law does not apply to hotel bedrooms, prisons, or psychiatric hospitals. Fines are foreseen for violators |
| Italy | A 2005 ban on smoking included all enclosed public places such as bars and restaurants. Businesses face a fine of up to €2000 if they fail to ensure their customers do not smoke, while smokers themselves could face a fine of up to €275 for repeatedly ignoring the new rules. The new rules allow smoking in special sealed‐off areas fitted with smoke extractors; however, many bar owners say fitting the automatic doors and forced ventilation systems required by law is too expensive |
| Latvia | Plans call for a complete ban on smoking in public places including bars and restaurants in 2006 |
| Malta | A 2004 law bans smoking in any enclosed private or public premises that is open to the public except in designated smoking rooms, including bars and restaurants. The present ban is a total ban because the smoking areas are enclosed and totally separated from non‐smoking areas |
| Netherlands | In 2002, the tobacco law was amended to restrict smoking in public places, workplaces, and public transport. In 2004, smoke‐free workplace legislation came into force but included exceptions: areas designated for the public in hotels, bars, and restaurants (hospitality industry), and entertainment facilities |
| Northern Ireland, UK | Workplace smoking legislation, similar to that in Ireland, was introduced in 2005 |
| Norway | A 2003 clean indoor air provision bans smoking in all workplaces including transportation, bars, and restaurants |
| Poland | A 1995 law on the protection of public health against the effects of tobacco use was amended in 1999 and 2003 and now includes a smoking ban in public places |
| Scotland, UK | A ban on smoking in public places in Scotland has been confirmed and is set to take effect in March 2006. The ban will prohibit smoking in pubs, bars, and restaurants. Licensees failing to enforce the ban will face fines up to £2500 and customers caught smoking could be fined £1000 |
| Sweden | A ban on smoking in public places including all restaurants, bars, and cafes was introduced in 2005. The law allows for the possibility of building a separately ventilated designated smoking room where no food or drink is served |
| Southeast Asia Region | |
| Bangladesh | Smoking was banned in public places under a high‐court verdict and other government regulations since the 1980s. The Bangladesh Tobacco Control Act 2005 made provisions to ban smoking in public places in a comprehensive manner. The law has identified educational institutes, government, semi‐government, and autonomous offices, libraries, lifts, hospitals and clinics, court buildings, airports, sea and naval port buildings, railways station buildings, bus terminal buildings, ferries, theatres, covered exhibition centres, public toilets, government and non‐government parks and other places as government‐designated smoke‐free public places. The law has also identified all public transport including motor, bus, train, tram, ship, launch or any motorised vehicle as government‐designated smoke‐free transport. Under this law, smoking places have also been designated |
| Bhutan | A smoking ban in public places was introduced 1 March 2005. The ban forbids people from lighting up at government offices, hospitals, schools, parks and shopping centres, among other places |
| DPR Korea | Laws and regulations ban smoking in restaurants, shops, and railway station waiting rooms |
| India | Under the India Tobacco Control Act 2003, smoking in public places and public transport has been banned. The law also defined public places and public transport where smoking has been banned. In addition, the state governments have even more stringent laws banning smoking in places like airports and other workplaces. Court orders also ban smoking in public places |
| Indonesia | A 1991 Presidential Decree declared that a Ministry has to designate, guide, and implement the availability of smoke‐free environments. It has also made provisions for banning smoking in public places and other areas such as health facilities, religious facilities, workplaces serving children, and public transportation. The Ministry of Internal Affairs in Indonesia in 1989 banned smoking in schools. The Ministry of Health in 1990 provided instructions on smoke‐free workplaces and in 1991 smoking was prohibited for land, sea, and air transportation. The Gubernatorial regulation in Jakarta province was issued in June 2005 to support regulation on air pollution control which will take effect from February 2006. The regulations are mostly aimed at those responsible for smoke‐free zones — owners of buildings, offices, schools, houses of worship, and operators of public transportation vehicles. Affected public places include government and private offices, bus terminals, train stations, malls, airports, shopping centres, hotels, and restaurants. Trains, taxis, buses, and public minivans have been declared smoke‐free. The law requires those responsible to either declare their premises a smoke‐free zone or designate at least one special smoking area located away from other rooms, and it mandates follow‐up on violations |
| Maldives | Legislation prohibits smoking in health facilities, educational institutes, government buildings, and other public places like sports complexes and stadiums, air conditioned restaurants, and public transportation |
| Myanmar | Smoking has been banned at hospitals, schools, sports stadiums, fields, training camps, and all types of health facilities. The Public Health Law protects the environment from air pollution arising from such factors as tobacco |
| Nepal | Smoking has been banned in government offices, health facilities, and some public places since June 1992. Smoking has also been banned on flights and in airports |
| Sri Lanka | A ban on smoking has been enforced in state institutions and state transports. Sale of tobacco in state canteens also has been prohibited since 1999 |
| Thailand | Globally, Thailand has been a pioneer in secondhand smoke legislation. The Non‐Smoker's Right to Protection Act (1992) prohibits smoking in public places, public buses, taxis, and air‐conditioned trains, and also states that smoke‐free areas in trains and restaurants must constitute at least 50% of the total area. The country has also banned smoking on flights and now the Acts and Regulations partially ban smoking in restaurants |
| Western Pacific Region | |
| Australia | Smoking is banned in most public places and workplaces throughout Australia |
| The governments of the Australian Capital Territory and the state of South Australia have announced their intention to introduce legislation to ban smoking in all restaurants and bars. The New South Wales government is considering a similar proposal. Smoking in Western Australia's nightclubs was limited to 20% of the venue from July 2004. A complete ban in all enclosed places is expected to be introduced by the end of 2006 | |
| China | A smoking ban in public transport is actively enforced in major city subways. National railways ban smoking on passenger trains and in waiting rooms at railway stations throughout the country. More than 500 railway stations have become smoke‐free |
| Fiji | Smoking is banned in government buildings, hospitals, health care facilities, and theatres, and the government has stepped up efforts to promote and enforce these bans. However, there are no bans on smoking in restaurants |
| Japan | A voluntary based restriction on smoking is being enforced in an increasing number of schools, hospitals, restaurants, municipal offices and workplaces under Health Promotion Act since May 2003. The national government has encouraged administrators of public places including workplaces to take the lead in implementing smoking restrictions |
| Mongolia | Smoking is banned in public places and workplaces, and restricted to separate smoking areas in all other indoor areas, with a system of fines. However, the ban and restrictions are widely ignored and unenforced |
| New Zealand | Smoking is banned in most workplaces. The law was extended to include restaurants and bars from December 2004 |
| Philippines | 2004 tobacco legislation bans smoking in all public places, enclosed buildings. Several cities have expanded the ban to all indoor areas |
| Samoa | Smoking is banned in all government buildings and hospitals, but enforcement is weak. The government has tried to promote voluntary smoke‐free policies for public transport such as taxis and buses |
| Singapore | Smoking is banned in most workplaces and public places. Plans for 2006 will extend bans to cover virtually all indoor areas and nature reserves |
| South Korea | As of March 2003, game rooms, internet cafes and restaurants with an area more than 150 square meters are required to designate non‐smoking sections, occupying at least half of their establishments. Owners must also ensure the non‐smoking sections remain absolutely smoke‐free by installing walls, screens, or ventilation facilities. In addition, smoking is completely banned in all hospitals and schools, as well as outdoor subway platforms, train passageways, and office hallways and bathrooms. These are some of the measures included in the revised regulations of the nation's health promotion law |
| Tonga | Smoking is banned in government buildings and health care facilities. The government plans to expand smoke‐free policies to all public places and workplaces, enclosed restaurants, and public transport |
| Tuvalu | Smoking is banned in government buildings and health care facilities. The government plans to expand smoke‐free policies to all public places and workplaces, enclosed restaurants, and public transport |
| Viet Nam | In January 2005, the Minister of Transport and Communications signed a directive prohibiting smoking in offices and reception rooms of the ministry and public places, including stations, airports, ports, and public transportation |
FCTC, Framework Convention on Tobacco Control; SHS, secondhand smoke; WHO, World Health Organization.
All six WHO Regions are using GYTS data to develop Regional Tobacco Action Plans to address the challenges of tobacco control and identify specific regional needs. These plans focus on implementing the most cost‐effective tobacco control measures, as called for in WHO's Framework Convention on Tobacco Control (WHO‐FCTC), including price and tax measures; comprehensive bans on advertising, promotion, and sponsorship by tobacco companies; smoke‐free environments in public places and workplaces; and graphic health warnings on tobacco packaging.14 With regard to SHS exposure, Regional plans provide examples of how WHO Member States in these regions can address related issues such as promoting awareness of SHS dangers, introducing and strengthening existing legislation to make public places smoke‐free, banning indoor and outdoor smoking on the premises of all educational institutions, and banning smoking on the premises of all health institutions and government facilities. The South‐East Asia Region developed a specific objective “to promote awareness on the dangers of exposure to secondhand smoke and to protect the youth from exposure to secondhand smoke by taking measures to ban smoking within educational facilities, in public places, and in public transport” after reviewing data gathered under the GYTS.15 The Western Pacific Region referred to the value of GYTS data in the most recent five‐year Regional Action Plan whose goal is to improve the comprehensiveness of tobacco control efforts.16 In the Region of the Americas, the PAHO Smoke Free Americas Initiative used GYTS data showing widespread exposure to secondhand smoke in students' homes to identify the need “to raise awareness about the harmful effect of exposure to secondhand tobacco and to support efforts to implement 100% smoke‐free environments in all public places and workplaces.”17
More than 30 countries have conducted a second GYTS, and public health officials are using these data to monitor and evaluate tobacco control efforts such as laws and policies that reduce exposure to SHS. For example, the Philippines introduced several high‐profile tobacco control and smoke‐free initiatives between 1999 and 2003. GYTS data showed that, over the same period, prevalence of current cigarette smoking declined significantly, exposure to smoke in public places declined significantly, and support for bans on smoking in public areas rose from 39.2% of students in 2000 to 88.7% in 2003.18
The WHO‐FCTC, signed by 168 countries and ratified by 116 as of January 2006, is the world's first public health treaty.14 Although the focus of the Convention is on a comprehensive approach to reducing tobacco use, Article 8 identifies tobacco smoke as harmful to public health and calls for parties to protect their populations from exposure:
Parties recognize that scientific evidence has unequivocally established that exposure to tobacco smoke causes death, disease, and disability. Each Party shall adopt and implement in the areas of existing national jurisdiction as determined by national law and actively promote at other jurisdictional levels the adoption and implementation of effective legislative, executive, and administrative and/or other measures, providing for protection from exposure to tobacco smoke in indoor workplaces, public transport, and, as appropriate, other public places.14
What this paper adds
Secondhand smoke or environmental tobacco smoke is a combination of smoke from a burning cigarette and exhaled smoke from a smoker. This paper presents findings from Global Youth Tobacco Surveys (GYTS) conducted in 132 countries between 1999 and 2005. GYTS data indicate that a large proportion of students in every World Health Organization Region are exposed to secondhand smoke at home and in public places, and many have parents or best friends who smoke. GYTS data have shown widespread and strong support among students for bans on smoking in public areas all over the world.
Full implementation of the principles and obligations contained in the WHO‐FCTC will likely limit tobacco use, initiation of smoking, and exposure to secondhand smoke, and will promote cessation.
The findings in this report are subject to at least three limitations. First, these data apply only to youth aged 13–15 years who attended school and therefore are not representative of all persons in this age group. However, in most countries, the majority of young people aged 13–15 attended regular, private, or technical schools.19 Second, these data apply only to youth who were in school the day the survey was administered and who participated in the survey. School response rates have been high throughout GYTS, and only 21 of 395 survey sites have recorded student response rates less than 80%. Third, findings are based on self‐reports from students who may under‐ or over‐report their behaviour and the behaviour of others. Though the extent of potential reporting bias cannot be determined in all countries that participate in GYTS, responses to questions about cigarette smoking and other tobacco use have shown good test‐retest reliability in a study of American students.20
Conclusion
Tobacco use and SHS exposure are major contributors to global chronic disease mortality. Findings from the GYTS suggest that projections that tobacco‐associated deaths will double over the next decade may be conservative if tobacco use prevalence and widespread SHS exposure among youth remain at current rates.21 In addition to preventing youth from starting to smoke and helping current smokers to quit, this report shows that the global tobacco control community must improve efforts to reduce SHS exposure. Creating smoke‐free areas and educating the public about the dangers of SHS will have complementary effects on tobacco control efforts by reducing the social acceptance of tobacco use around non‐smokers.22 Ongoing surveillance is necessary to measure progress toward eliminating SHS exposure, track implementation of laws and policies to reduce exposure and enforcement of these measures, and gauge public support for a smoke‐free society. GYTS data have shown widespread and strong support among students for bans on smoking in public areas all over the world. Countries should engage this positive public health attitude among youth to promote and enforce smoke‐free public places and workplaces.
Abbreviations
CDC - US Centers for Disease Control and Prevention
CHD - coronary heart disease
GYTS - Global Youth Tobacco Survey
SHS - secondhand smoke
WHO - World Health Organization
Footnotes
* Notable countries, by WHO Region, that have not completed the GYTS include Canada (Region of the Americas), most countries in Western Europe (European Region), and Australia, Japan, and New Zealand (Western Pacific Region).
† The core GYTS questionnaire in Arabic, English, French, and Spanish can be found at: www.cdc.gov/tobacco/global.
Competing interests: none declared
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