Youth smoking initiation in CESEE: A comparative analysis of 10 selected countries

Youth smoking initiation remains a critical public health challenge in Central, Eastern and South-Eastern Europe (CESEE), where early onset of tobacco use contributes to long-term nicotine dependence and chronic disease risk. Understanding the determinants of smoking initiation is essential for designing effective strategy for tobacco control. The aim of this study is to examine the timing and determinants of smoking initiation among adolescents aged 13-15 in 10 CESEE countries, comparing EU and non-EU member countries to identify policy and behavioural factors influencing early uptake. The study uses data from the Global Youth Tobacco Survey (GYTS). Survival analysis techniques were applied to estimate the age of initiation and assess the impact of cigarette prices, non-price tobacco control measures, parental smoking behaviour, peer behaviour and risk perception. The findings indicate that higher cigarette prices significantly delay smoking initiation, particularly in non-EU countries, where price sensitivity is greater. Non-price policies, especially the combined implementation of advertising bans and indoor smoking restrictions, also contribute to postponing onset. EU membership, measured through mandatory adoption of the Tobacco Products Directive, has a positive effect on delaying initiation. However, social factors remain dominant: peer behaviour is the strongest predictor of early smoking, followed by parental smoking behaviour. Gender differences were observed, with girls initiating later than boys. These results underscore the need for comprehensive strategies combining fiscal and regulatory measures with interventions targeting the social drivers of youth smoking.

Keywords: Youth smoking initiation, cigarette prices, tobacco control, peer behaviour, survival analysis

JEL classification: I12, I18, C41

Countries covered: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Hungary, Montenegro, North Macedonia, Romania, Serbia, Slovenia