Gender differences in use of cigarette and non-cigarette tobacco products among adolescents aged 13-15 years in 20 African countries.

INTRODUCTION: Examining gender differences in youth tobacco use is important as it aligns tobacco control within the context of broader human development goals seeking to eliminate gender inequalities. In this study, we examined gender differences in adolescent use of cigarettes, smokeless tobacco, shisha, and e-cigarettes in Africa. METHODS: This was a cross-sectional study using data from the Global Youth Tobacco Survey. Our analytical sample comprised 56442 adolescents aged 13-15 years from 20 African countries. Weighted, country-specific prevalence estimates were computed overall and by gender. Adjusted prevalence ratios (APRs) were calculated in a multivariable Poisson regression model to examine whether correlates of tobacco use differed between boys and girls. RESULTS: Ever cigarette smoking prevalence was significantly higher among boys than girls in 16 of the 20 countries, but a significantly higher percentage of girls reported earlier age of cigarette smoking initiation than boys within pooled analysis. Some of the largest gender differences in current cigarette smoking were seen in Algeria (12.2% vs 0.8%, boys and girls, respectively), Mauritius (21.2% vs 6.6%), and Madagascar (15.0% vs 4.1%). Current use of e-cigarettes, shisha, and smokeless tobacco was generally comparable between boys and girls where data existed. Among girls, higher levels of reported exposure to tobacco advertisement were positively associated with shisha smoking whereas perceived tobacco harm was inversely associated with current cigarette and shisha smoking. Among boys, perceived social acceptability of smoking at parties was associated with an increased likelihood of cigarette smoking (APR=2.27; 95% Cl: 1.20-4.30). CONCLUSIONS: The prevalence of cigarette smoking among boys was higher than that of girls in many countries. However, girls who smoke tend to start at an earlier age than boys. Differential gender patterns of cigarette and non-cigarette tobacco product use among youth may have implications for future disease burden. As the tobacco control landscape evolves, tobacco prevention efforts should focus on all tobacco products, not just cigarettes.

A Rapid Evaluation of the US Federal Tobacco 21 (T21) Law and Lessons From Statewide T21 Policies: Findings From Population-Level Surveys.

BACKGROUND: On December 20, 2019, the minimum age for purchasing tobacco in the US was raised nationally to 21 years. We evaluated this law (Tobacco 21 [T21]) 1 year after implementation. We also compared states with versus without T21 policies during 2019 to explore potential equity impacts of T21 policies. METHODS: We examined shifts in tobacco access among 6th through 12th graders using the National Youth Tobacco Survey. To explore equity of state T21 policies among youths and young adults, the associations with tobacco use were explored separately for race and ethnicity by using data from the 2019 Behavioral Risk Factor Surveillance System (for persons aged 18 to 20 years) and the 2019 Youth Risk Behavior Survey (for high school students). RESULTS: The overall percentage of 6th to 12th graders perceiving that it was easy to buy tobacco products from a store decreased from 2019 (67.2%) to 2020 (58.9%). However, only 17.0% of students who attempted buying cigarettes in 2020 were unsuccessful because of their age. In the 2019 BRFSS, those aged 18 to 20 years living in a state with T21 policies had a lower likelihood of being a current cigarette smoker (adjusted prevalence ratio [APR], 0.58) or smoking cigarettes daily (APR, 0.41). Similar significant associations were seen when analyses were restricted to only non-Hispanic White participants but not for participants who were non-Hispanic Black, non-Hispanic Asian, Hispanic, or of other races or ethnicities. Consistent findings were seen among high school students. CONCLUSION: Greater compliance with the federal T21 law is needed as most youth who attempted buying cigarettes in 2020 were successful. Comparative analysis of states with versus states without statewide T21 policies in 2019 suggest the policies were differentially more protective of non-Hispanic White participants than other participants. Equitable and intensified enforcement of T21 policies can benefit public health.

A cross-sectional analysis of U=U as a potential educative Intervention to mitigate HIV stigma among youth living with HIV in South Africa.

Introduction: the HIV educative campaign Undetectable Equals Untransmissible (U=U) is a potential gamechanger to address HIV stigma. We investigated what percentage of South African adolescents were aware of U=U, and the associations with perceived HIV stigma and past-year HIV testing. Methods: we used a cross-sectional design. Data were from the 2017/2018 South African National HIV prevalence, incidence, behaviour and communication survey. HIV status was measured using both laboratory confirmation and self-reports. Among adolescents aged 15-18 years, we calculated the percentage who believed that "the risk of HIV transmission through sex can be reduced by an HIV-positive partner consistently taking drugs that treat HIV." Data were weighted to yield nationally representative estimates. Results: overall, 49.8% of all adolescents aged 15-18 years (and 49.2% of this HIV seropositive) believed that the risk of HIV transmission through sex can be reduced by an HIV-positive partner consistently taking drugs that treat HIV. After adjusting for HIV status, geographic location, race, sex, and orphanhood status, those with belief in U=U were less likely to endorse stigmatizing statements that teachers with HIV should not teach (IRR=0.63, 95%CI, 0.47-0.84), pupils with HIV should not attend class (IRR=0.62, 95%CI, 0.45-0.84), or that children with HIV in general should be in segregated schools (IRR=0.55, 95%CI, 0.41-0.74). Among those reporting not living with HIV, U=U belief was associated with increased likelihood of past-year HIV testing (IRR=1.19, 95%CI, 1.01-1.41). Conclusion: U=U belief was associated with reduced stigma perceptions and increased HIV testing. Adoption of U=U into clinical practice guidelines in South Africa may benefit public health.

Gender norms, HIV risk, and attitudes towards pre-exposure prophylaxis and other HIV preventive interventions among South African adolescents.

Introduction: we examined HIV-related social norms and perceptions among South African adolescents aged 15-18 years and evaluated their openness to using pre-exposure prophylaxis (PrEP) to reduce HIV risk. Methods: we analyzed cross-sectional data of 4,567 adolescents aged 15-18 years from the "fifth South African National HIV prevalence, HIV incidence, behaviour and communication survey (2017/2018)". Outcomes of interest in our study were HIV-related social norms and awareness of HIV prevention methods, including pre-exposure prophylaxis (PrEP). Results: our results showed that compared to their female counterparts, a significantly higher percentage of male adolescents endorsed the statement "Men can have two or more sexual partners at the same time" (14.2% vs 10.1%, p=0.021). Condoms were the most popular method of HIV prevention, with 83.5% of all participants reporting awareness. Yet, 35.4% of those sexually active in the past year reported not using condoms all the time. Perceived parental sex education and exposure to community campaigns for HIV prevention were both associated with increased awareness of HIV prevention measures and openness to PrEP. Unaided recall of PrEP was very low (3.7%), but most of those who were HIV seronegative (69.3%) were open to using it after learning about it. Openness towards PrEP was significantly higher among those reporting vs not reporting past-year sexual activity (adjusted prevalence ratio (APR=1.16, 95%CI, 1.06-1.28), and binge-drinking (APR=1.24, 95%CI, 1.08-1.41). Conclusion: this study showed that while many South African adolescents were interested in trying PrEP, initial awareness was low. Ensuring barrier-free access to evidence-based preventive strategies may benefit public health.