INTRODUCTION: Tobacco use among Caribbean adolescents surpasses global averages. Given the adverse effects, regional efforts have prioritized reduction and eventual elimination and have adopted the World Health Organization's Framework Convention on Tobacco Control (WHO-FCTC). Guided by the Health Belief Model, we examine changes in tobacco abstinence and abstinence-related perceptions before and after the WHO-FCTC. METHODS: We conducted a cross-sectional secondary analysis of Global Youth Tobacco Survey data. We specifically examined adolescents aged 13-15 years from three Caribbean countries, including participants surveyed in 2000 (n=3431) and 2017-2018 (n=3767). We first conducted chi-squared tests and t-tests to examine changes in tobacco abstinence and abstinence-related perceptions across survey years. We then used the latest survey data (2017-2018) and logistic regression to assess associations between perceptions and intentions to abstain in the next year, among adolescents who did not report tobacco use (n=3050). All analyses incorporated survey weights and clusters. RESULTS: Compared with 2000, adolescents surveyed in 2017-2018 had improved 30-day tobacco abstinence, including cigarette abstinence (89.67% to 95.39%, p<0.01). However, intentions to abstain in the next year declined over the study years (93.65% to 90.53%, p<0.01). Key tobacco abstinence-related perceptions, including perceived severity (88.51% to 83.87%, p<0.01) and refusal self-efficacy (91.08% to 88.67%, p<0.01), also declined. In regression analysis, perceived benefits of anti-tobacco campaigns (AOR=2.25; 95% CI: 1.40-3.60) and refusal self-efficacy (AOR=11.35; 95% CI: 7.55-17.04) were associated with higher intentions to abstain. Exposure to anti-tobacco messaging (AOR=0.52; 95% CI: 0.30-0.90) was negatively associated with abstinence intentions. CONCLUSIONS: Given that abstinence-related perceptions declined across survey years and were associated with tobacco use intentions, these findings underscore the importance of continued attention to WHO-FCTC anti-tobacco initiatives that address tobacco-related perceptions. Incorporating culturally sensitive messaging may enhance the relevance and effectiveness of such efforts.
Chukwu et al. (Sat,) studied this question.