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The Morbidity and Mortality Weekly Report (MMWR) Series is prepared by the Centers for Disease Control and Prevention (CDC) and is available free of charge in electronic format. To receive an electronic copy each week, send an e-mail message to listserv@listserv.cdc.gov. The body content should read SUBscribe Tom

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:57 copy also is available from CDC's Internet server at http://www.cdc.gov/mmwr or from CDC's file transfer protocol server at ftp://ftp.cdc.gonitzel publications/mmwr. Paper copy subscriptions are available through the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 204 telephone 202-512-1800. Data in the weekly MMWR are provisional, based on weekly reports to CDC by state health departments. The reporting week concludes at close of busines Friday; compiled data on a national basis are officially released to the public on the following Friday. Data are compiled in the National Center for Public He Informatics, Division of Integrated Surveillance Systems and Services. Address all inquiries about the MMWR Series, including material to be considered publication, to Editor, MMWR Series, Mailstop E-90, CDC, 1600 Clifton Rd., N.E., Atlanta, GA 30333 or to mmwrq@cdc.gov. All material in the MMWR Series is in the public domain and may be used and reprinted without permission; citation as to source, however, is appreciated Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Servis lle References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of these sites. URL addresses listed MMWR were current as of the date of publication.

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ovPub S E 20 7009 57/20

World No Tobacco Day

May 31, 2008 The theme for World No Tobacco Day 2008 is Tobacco-Free Youth: Break the Tobacco Marketing Net. The tobacco industry spends billions of dollars worldwide on advertising, promotion, and sponsorship. Recent data from the Global Youth Tobacco Survey ndicate an increase in tobacco use among adolescent girls in many countries (1). Much of this increase has peen attributed to aggressive marketing by the tobacco ndustry (2), which encourages potential users, especially adolescents, to try tobacco and become long-term consumers.

Evidence-based tobacco-control strategies that are comprehensive, sustained, and support nonsmoking behavors have been shown to prevent and reduce tobacco use 3). The World Health Organization Framework Conrention on Tobacco Control calls on countries to implenent scientifically proven measures to reduce tobacco ise and its impact (4). Additional information on World No Tobacco Day 2008 activities is available at http:// vww.who.int/tobacco/wntd/2008/en/index.html Leferences Warren CW, Jones NR, Eriksen MP, Asma S. Patterns of global

tobacco use in young people and implications for future chronic disease burden in adults. Lancet 2006;367:749–53. World Health Organization. WHO report on the global tobacco epidemic, 2008. Geneva, Switzerland: World Health Organization; 2008. Available at http://www.who.int/tobacco/mpower/ mpower_report_full_2008.pdf. CDC. Best practices for comprehensive tobacco control programsOctober 2007. Atlanta, GA: US Department of Health and Humans Services, CDC; 2007. Available at http://www.cdc.gov/tobacco/ tobacco_control_programs/stateandcommunity/best_practices/ index.htm World Health Organization. WHO framework convention on tobacco control. Geneva, Switzerland: World Health Organization; 2005. Available at http://www.who.int/tobacco/framework/ WHO_FCTC_english.pdf.

The MMWR series of publications is published by the Coordinating
Center for Health Information and Service, Centers for Disease
Control and Prevention (CDC), U.S. Department of Health and
Human Services, Atlanta, GA 30333.
Suggested Citation: Centers for Disease Control and Prevention.
[Article title]. MMWR 2008;57:[inclusive page numbers).
Centers for Disease Control and Prevention
Julie L. Gerberding, MD, MPH

Director
Tanja Popovic, MD, PhD

Chief Science Officer
James W. Stephens, PhD
Associate Director for Science

Steven L. Solomon, MD
Director, Coordinating Center for Health Information and Service

Jay M. Bernhardt, PhD, MPH
Director, National Center for Health Marketing

Katherine L. Daniel, PhD
Deputy Director, National Center for Health Marketing
Editorial and Production Staff

Frederic E. Shaw, MD, JD
Editor, MMWR Series

Teresa F. Rutledge
(Acting) Managing Editor, MMWR Series

Douglas W. Weatherwax
Lead Technical Writer-Editor
Donald G. Meadows, MA

Jude C. Rutledge

Writers-Editors

Peter M. Jenkins
(Acting) Lead Visual Information Specialist

Lynda G. Cupell

Malbea A. LaPete
Visual Information Specialists
Quang M. Doan, MBA

Erica R. Shaver
Information Technology Specialists

GYTS is a school-based survey that collects data on sth dents aged 13–15 years using a standardized methodolog for constructing the sample frame, selecting schools an: classes, and processing data. The Sri Lanka GYTS uses a two-stage cluster sample design that produces representative samples of students in grades 8-10, which are assocated with ages 13–15 years (3). At the first sampling stage school selection was proportional to the number of students enrolled in grades 8–10. At the second stage, classes within the selected schools were randomly selected. All students attending school in the selected classes on the dar the survey was administered were eligible to participate. A weighting factor was applied to each student record :0 adjust for nonresponse (by school, class, and student) and probability of selection at the school and class levels (3). A final adjustment sums the weights by grade and sex to the population of school children in the selected grades in each sample site (3). In 1999, a total of 2,896 students completed GYTS; 1,845 did so in 2003, and 1,764 did so :) 2007. The school response rate was 85.7% in 1999, 100%in 2003, and 100% in 2007. The class response rate was 100% in all survey years. The student response rate was 89.0% in 1999, 79.1% in 2003, and 85.0% in 2007 The overall response rate was 76.3% in 1999, 79.190 in 2003, and 85.0% in 2007.*

This report describes changes during 1999–2007 in seeral important tobacco-use indicators, including 1) lifetime cigarette smoking"; 2) current cigarette smoking": 3 current use of other tobacco products"; 4) likely initiation of smoking in the next year among never smokers (i.e., subceptibility) (4)**; 5) exposure to SHS in public places 6) exposure to pro-tobacco advertising and promotion either direct (e.g., exposure to billboards, newspapers, and magazines) or indirect (having been offered a free cigarette by a cigarette company representative or having an object

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Editorial Board William L. Roper, MD, MPH, Chapel Hill, NC, Chairman

Virginia A. Caine, MD, Indianapolis, IN

David W. Fleming, MD, Seattle, WA
William E. Halperin, MD, DrPH, MPH, Newark, NJ
Margaret A. Hamburg, MD, Washington, DC
King K. Holmes, MD, PhD, Seattle, WA
Deborah Holtzman, PhD, Atlanta, GA

John K. Iglehart, Bethesda, MD
Dennis G. Maki, MD, Madison, WI
Sue Mallonee, MPH, Oklahoma City, OK

Stanley A. Plotkin, MD, Doylestown, PA
Patricia Quinlisk, MD, MPH, Des Moines, IA
Patrick L. Remington, MD, MPH, Madison, WI

Barbara K. Rimer, DrPH, Chapel Hill, NC
John V. Rullan, MD, MPH, San Juan, PR

Anne Schuchat, MD, Atlanta, GA
Dixie E. Snider, MD, MPH, Atlanta, GA

John W. Ward, MD, Atlanta, GA

* The overall response rate is calculated as the school response rate x the ut

response rate x the student response rate. Based on a positive response to the question, “Have you ever tried : experimented with cigarette smoking, even one or two puffs?" Based on a response of “1 or more days” to the question, “During the past days (1 month), on how many days did you smoke cigarettes? Based on positive responses to either of the following questions: "During : past 30 days (1 month), did you use any form of smoked tobacco proto other than cigarettes (e.g., cigars, water pipe, cigarillos, little cigars, or pipe and “During the past 30 days (1 month), did you use any form of such tobacco products (e.g., chewing tobacco, snuff, or dip)?" Based on a responses of anything but “definitely no" to the questions. It cx best friend offered you a cigarette, would you smoke it?" and "Do you 3

you will try smoking a cigarette in the next year?" # Based on a response of “1 or more days” to the question, “During the per

days, on how many days have people smoked in your presence, in pl.cw .cy than your home?”

th a cigarette logo on it)$$; 7) cessation efforts (among rrent smokers)^!; and 8) tobacco education.*** Statisti1 differences were determined by comparing 95% confi- ince intervals; nonoverlapping confidence intervals were

nsidered statistically significant. Data are based on at ist 35 respondents for each denominator. The

percentage of students aged 13–15 years in Sri Lanka no reported lifetime cigarette smoking declined from 1999 2.1%) to 2003 (6.3%); the percentage in 2007 (5.1%) is not significantly different from 2003 (Table 1). Boys ere more likely than girls to have ever smoked cigarettes · 1999 and 2003, but no significant difference was vserved in 2007. For boys, current cigarette smoking creased from 1999 (6.2%) to 2007 (1.6%); for girls the rcentage did not change significantly. Boys were more ely than girls to smoke cigarettes in 1999, but no sigficant difference was observed in 2003 and 2007. Curat use of other tobacco products remained unchanged om 1999 and 2007, both overall and for both sexes. Boys 're more likely than girls to use other tobacco products 1999, but no significant difference was observed in 2003 d 2007. Current use of other tobacco products was higher an cigarette smoking overall in 1999, 2003, and 2007; : boys in 2003 and 2007; and for girls in 1999 and 2003. ne percentage of never smokers who were susceptible to tiation of smoking did not change significantly from 1999 2007, both overall and for both sexes. Susceptibility was zher for boys than girls in 1999, but no significant difence was observed in 2003 and 2007. The percentage of students who reported that their parts smoke decreased from 50.8% in 1999 to 41.2% in 03 to 29.9% in 2007; however, exposure to SHS in pub

places remained unchanged over time (67.9% in 1999 d 65.9% in 2007) (Table 2). Support for a ban on smokz in public places did not change from 1999 (91.4%) to 07 (87.9%).

Exposure to cigarette advertising and promotion decreased from 1999 to 2007. The percentage of students who saw pro-cigarette advertisements on billboards did not change from 1999 to 2003 but decreased from 2003 (79.3%) to 2007 (67,4%). The percentage of students who saw procigarette advertisements in newspapers or magazines decreased from 1999 to 2007 (83.4% in 1999, 78.4% in 2003, and 68.4% in 2007). The percentage of students who owned an item with a cigarette brand logo on it did not change from 1999 to 2003 but decreased from 2003 (11.0%) to 2007 (5.7%). The percentage of students who reported receiving free cigarettes from a cigarette company representative decreased from 1999 (6.4%) to 2007 (3.0%).

In 2007, 76.5% of current smokers indicated that they would like to stop smoking; this percentage was not significantly different from 1999 to 2007. The percentage of students who reported having been taught in school during the past school year about the dangers of tobacco use increased from 1999 (62.7%) to 2003 (79.8%) but remained unchanged from 2003 to 2007 (72.8%). Reported by: PW Gunasekara, Ministry of Education, Sri Lanka. K Rahman, PhD, DN Sinha, MD, South-East Asia Regional Office, World Health Organization, New Delhi, India. CW Warren, PhD, J Lee, MPH, V Lea, MPH, S Asma, DDS, CDC. Editorial Note: The findings in this report indicate that, among students aged 13–15 years in Sri Lanka, cigarette smoking and the likely initiation of smoking by never smokers decreased from 1999 to 2007, whereas other tobacco use remained unchanged over time. During 1999–2007, other tobacco use was consistently higher than cigarette smoking.

Some of the changes in tobacco use reflected in this analysis can be attributed to various tobacco-control policies implemented by the government of Sri Lanka (2). In 2003, Sri Lanka ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) (5). In 2006, the Parliament of Sri Lanka enacted the National Authority on Tobacco and Alcohol Act (NATAA) (6). NATAA includes 1) a ban on smoking in health-care, education, and government facilities and in universities, indoor offices, and other indoor workplaces; 2) prohibition of pro-tobacco advertisements on national television and radio, in local magazines and newspapers, on billboards, at point of sale, and on the Internet; and 3) a ban on tobacco-product promotions, such as free distribution, promotional discounts, and sponsored events. In concordance with NATAA, Sri Lanka has enacted strong enforcement policies (2).

Based on 1) a response of “a lot” or “a few” to the question, “During the past 30 days (1 month), how many advertisements for cigarettes have you seen on billboards?" 2) a response of “a lot” or “a few” to the question, “During the past 30 days (1 month), how many advertisements or promotions for cigarettes have you seen in newspapers or magazines?” 3) a positive response to the question, “Do you have something (t-shirt, pen, backpack, etc.) with a cigarette brand logo on it?" and 4) a positive response to the question, “Has a cigarette company representative ever offered you a free cigarette? Based on a response of “1 or more days” to the question, “During the past 30 days (1 month), on how many days did you smoke cigarettes?" and a positive response to the question, “Do you want to stop smoking now?" Based on a positive response to the question, “During this school year, were you taught in any of your classes about the dangers of smoking?"

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