Declining tobacco control awareness and support among Polish adolescents: Trends from the Global Youth Tobacco Survey 2003-2022.

Introduction: The Global Youth Tobacco Survey (GYTS) is a cross-sectional, schoolbased survey that provides insight into tobacco use and related behaviors among adolescents aged 13-15 years. This study examines trends in tobacco-related attitudes, education, and media exposure among Polish youth, using data from the 2022 GYTS alongside previous surveys conducted in 2003 and 2016.

Methods: The study sample was stratified by geographical regions: rural areas, small towns, and large cities. Data were collected from 98 schools across Poland, involving 95 schools (96.9%), 224 classes (97.8%), and 3985 students (78.9%). The primary analysis focused on 3573 students aged 13-15 years. Data from 2003 and 2016 GYTS editions were also used for comparison. Sampling, data weighting, and the methodological framework followed WHO guidelines.

Results: Between 2003 and 2022, there was a notable decline in the proportion of Polish adolescents receiving tobacco education in school, from 61.4% to 43.1%. Perceptions of the harms of secondhand smoke also fell substantially, from 65.8% to 34.4%. Support for smoke-free policies weakened, with a decline in support for both indoor and outdoor smoking bans. Exposure to anti-tobacco messages in media dropped dramatically, from 89.4% in 2003 to 34.9% in 2022. On the other hand, perceptions that smoking enhances social interactions rose from 40.8% to 45.5%, while tobacco industry advertising and depictions of tobacco use in media remained prevalent, though declining over time.

Conclusions: The findings suggest concerning trends in tobacco-related attitudes and behaviors among Polish adolescents, indicating weakened prevention efforts and a shift towards pro-tobacco norms. The decline in tobacco education, public support for smoke-free policies, and media exposure to anti-tobacco messages highlight the need for renewed public health interventions. Strengthening school-based education, reinforcing smoke-free policies, and regulating tobacco portrayals in media are critical to reversing these trends. Additionally, policy measures such as plain packaging and a ban on tobacco displays at points of sale are necessary to protect future generations from tobacco initiation. Without decisive action, there is a risk of undermining the progress made in tobacco control.