Association between exposure to tobacco control measures and current nicotine use among adolescents in Saudi Arabia: Evidence from the 2022 global youth tobacco survey.

Objectives: The World Health Organization's six tobacco control strategies (Monitor, Protect, Offer help, Warn, Enforce, and Raise; MPOWER) aim to reduce tobacco use, yet little is known about their impact on individual-level adolescent nicotine use in Middle Eastern countries. This study examined whether exposure to MPOWER policies is associated with current nicotine use among adolescents in Saudi Arabia. Methods: This cross-sectional analysis used nationally representative data from the 2022 Global Youth Tobacco Survey conducted in schools across Saudi Arabia. The analytic sample included 5092 adolescents aged 13-15 years with complete data on nicotine use and policy exposure. A five-domain MPOWER index (Protect, Offer help, Warn, Enforce, Raise) was constructed from self-reported survey items. The primary outcome was any nicotine product use in the past 30 days. Survey-weighted logistic regression was used to estimate adjusted odds ratios (ORs), controlling for age, sex, school grade, and spending money. Results: The prevalence of current nicotine use was 11.1 %. MPOWER exposure was significantly lower among users than non-users (2.5 vs. 2.8, p < 0.001). Higher policy exposure was associated with reduced odds of nicotine use (adjusted OR per unit increase = 0.65, 95 % CI: 0.57, 0.73). The association was stronger with the standardised index (adjusted OR = 0.11, 95 % CI: 0.06, 0.21). Conclusions: Greater individual-level exposure to World Health Organization MPOWER tobacco control measures was inversely associated with adolescent nicotine use in Saudi Arabia. Causal inference cannot be made, and longitudinal studies are warranted.