Gender Trends in Youth Tobacco and Nicotine Use in Georgia Across GYTS Rounds, 2014-2023

Background: Adolescent tobacco and nicotine product (TNP) use remains a public health concern, with emerging gender convergence and rising e-cigarette use among females. We examined gender-specific trends in Georgian adolescents alongside national tobacco control policies and social context. Methods: We analyzed nationally representative Global Youth Tobacco Survey data from Georgia (2014, 2017, and 2023) for youth aged 11-17 to estimate prevalence and patterns of current TNP use in the context of tobacco-related advertising and promotion, secondhand smoke, and national policy, via a policy review. Adjusted prevalence estimates were derived using post-estimation predictive margins after fitting multinomial logistic regression models. Results: From 2014 to 2023, current TNP use declined among boys but increased among girls, particularly in exclusive e-cigarette use. The percentages reporting no current TNP use increased among boys from 77.4% to 85.6% (p < 0.01), but declined among girls from 92.1% to 88.1% (p = 0.04). By 2023, exclusive e-cigarette use was more prevalent among girls than boys. Across sexes, exposure to pro-tobacco advertising and promotion and secondhand smoke declined. Exposure to anti-tobacco promotion peaked in 2017 and receded by 2023. The policy review documented strengthened measures, alongside gaps in oversight of digital marketing and newer products, including e-cigarettes. Conclusions: Georgia tobacco control policies have contributed to reduced TNP use among boys and a less permissive social environment. Rising e-cigarette use among girls is concerning. Policies should close regulatory gaps, enhance enforcement, and address evolving product and marketing developments to prevent TNP uptake and protect adolescents from tobacco-related harms.