Tobacco use among middle school pupils in Sousse, Tunisia across three years of monitoring

Background Tobacco use represents a major risk factor for incident disability-adjusted life years among adolescents especially in developing countries. In Tunisia, a national strategy to reduce tobacco use was set up since 2008. However, no surveillance system was implemented to evaluate it. Objective To examine trends in tobacco use among middle school children in Sousse, Tunisia between 2014 and 2016 and to determine predictors of its experimentation. Methods and findings Three cross-sectional studies were conducted in 2013/2014, 2014/2015 and 2015/2016 school years among middle school-children randomly selected from the governorate of Sousse-Tunisia. The required sample size for each study was 760 participants. Each year, the same procedure was used to recruit pupils from the same middle schools. The same pre-tested questionnaire was self-administered anonymously to participants in their classrooms. Results Lifetime tobacco use rose from 11% in 2013/2014 to 17.3% in 2015/2016 (p = 0.001). Across the three years of survey, predictors of lifetime tobacco use were: The male gender (OR, 95% CI: 4.4 [3.2-6.1]), age above 13 (OR, 95% CI:2.3 [1.7-3.1]), lifetime illicit substances use (OR, 95% CI: 3.9 [1.1- 13.8), lifetime inhalant products use (OR, 95% CI:2.2 [1.2-4.3]), tobacco use among the father (OR, 95% CI:2.2 [1.2-4.3]), tobacco use among siblings (OR, 95% CI:1.7 [1.2-2.4]) and current anxiety problem (OR, 95% CI: 1.8 [1.4-2.4]). Conclusions Tobacco experimentation is in expansion among the young adolescents of Sousse. Its prevention should integrate a comprehensive substances use prevention program with emphasis on second hand smoking and the associated mental health problems. Key messages More attention should be paid to young adolescents in order to prevent tobacco and other substances use among them. Second hand smoking and mental health problems should be considered when planning for prevention programs of tobacco use.