Factors associated with tobacco use among Saudi Arabian youth: Application of the Theory of Planned Behavior

Abstract

Introduction: The epidemic of tobacco use poses one of the most severe public health challenges globally, responsible for over 8 million deaths annually according to the World Health Organization (WHO). This study investigates the factors associated with tobacco use among Saudi Arabian youth using the Theory of Planned Behavior (TPB) framework.

Methods: A cross-sectional study used the 2022 Global Youth Tobacco Survey (GYTS) to assess tobacco use among 5610 Saudi students aged 13-15 years. The structured, anonymous questionnaire collected demographic data and TPB constructs (e.g. attitudes, subjective norms, perceived behavioral control, and intentions) were derived from the validated GYTS questionnaire, with items grouped and scored to represent each construct. One-way ANOVA, t-tests, and logistic regression analyses were conducted, with a significance level set at 0.05.

Results: Of the surveyed students, 5610 (80.4%) aged 13-15 years met the inclusion criteria. Tobacco use was prevalent, with 31.3% having ever used tobacco and 8.78% currently using it. Negative attitudes toward tobacco were inversely associated with usage (AOR=0.97; 95% CI: 0.970-0.974). Subjective norms, reflecting perceived social pressure, were positively associated with tobacco use (AOR=1.17; 95% CI: 1.170-1.176). Perceived behavioral control, indicating the ease of quitting or avoiding tobacco, was strongly associated with use (AOR=1.87; 95% CI: 1.848-1.888). Stronger behavioral intentions to use tobacco were also associated with a higher likelihood of use (AOR=1.24; 95% CI: 1.226-1.246).

Conclusions: The high prevalence of tobacco use among Saudi Arabian youth, early initiation, and significant social influences highlight the need for comprehensive public health strategies. Targeted education, reduced tobacco accessibility, and programs to shift social norms and attitudes are essential. Addressing these factors can help prevent initiation and support cessation efforts among young people.

Keywords: Saudi Arabian youth; Theory of Planned Behavior; global youth tobacco survey; tobacco use.