Exposure to Anti-Tobacco Messages and Its Association with Tobacco Use Among Zambian Adolescents: Analysis of the 2021 Global Youth Tobacco Survey

ABSTRACT Introduction Adolescence is a vulnerable period for tobacco initiation, yet evidence on exposure to anti-tobacco messaging in Zambia is limited. Understanding who is reached by media and school-based campaigns is fundamental to designing effective strategies for preventing tobacco initiation and reducing use, in line with tobacco control goals. Methods We analyzed data from 6,499 in-school adolescents (11–17 years) in the 2021 Zambia Global Youth Tobacco Survey. Exposure was defined as having seen or heard anti-tobacco messages via television, radio, newspapers, or magazines. Weighted prevalence estimates were calculated, and multivariable logistic regression examined associations with sociodemographic, behavioral, and household factors. Results Overall, 61.6% of adolescents reported exposure to anti-tobacco messages, predominantly through television and radio rather than print media. Exposure was greater among adolescents who had ever tried smoking (OR = 1.37, 95% CI: 1.15–1.63), had friends who smoke (OR = 1.50, 95% CI: 1.27–1.76), lived with a parent/guardian who smokes (OR = 1.58, 95% CI: 1.31–1.93), or received school-based tobacco education (OR = 1.81, 95% CI: 1.60–2.04). Male adolescents had lower odds of exposure (OR = 0.83, 95% CI: 0.73–0.94). Age, grade, current smoking, and observing teachers smoking were not significant predictors. Conclusion Anti-tobacco messages reached almost two-thirds of Zambian adolescents through schools and mass media, but exposure is strongly influenced by social and household environments. Gender- and context-sensitive strategies targeting male adolescents and peer/family networks could strengthen preventive impact, supporting Zambia’s tobacco control goals and compliance with the WHO Framework Convention on Tobacco Control.