Spatial and Economic Proximity of Cigarette Products to School Children in Mongolia

The Western Pacific Region has the highest rate of cigarette smoking in the world. In this region, Mongolia has ratified the WHO FCTC treaty and, as part of treaty implementation, has monitored school tobacco use in children using the Global Youth Tobacco Survey (GYTS). Our objective was to examine the spatial (student report of cigarette availability near schools) and economic factors (cigarette pricing relative to student pocket money) associated with cigarette use in schoolchildren of Mongolia.

The 2014 and 2019 GYTS are the most recent national surveys of tobacco use in schoolchildren in Mongolia and are cross-sectional, stratified, multi-stage cluster surveys of 13-15-year-old schoolchildren (7298 in 2014, 4146 in 2019). We conducted logistic regression modelling of the two surveys to examine whether spatial, economic, and environmental factors were predictors of cigarette use.

We found that (1) the prevalence of students reporting the availability of cigarettes near schools increased from 65.3% [95% confidence interval(CI) = 61.1-69.4] in the 2014 GYTS to 94.3% [95% CI = 93.5-95.1] in the 2019 GYTS, (2) student report of cigarette availability near schools was associated with increased current smoking of all cigarettes and this effect increased from a non-significant 31% increase in odds in 2014 (OR [95% confidence interval(CI)] = 1.31 [0.99-1.73], P = .06) to a 416% significant increase in odds in 2019 (OR [95% CI] = 5.16[3.31-8.05], P < .0001), (3) student report of cigarette availability near schools was associated with a significant increase in odds of smoking single cigarettes in 2014 (OR [95% CI] = 1.85 [1.19, 2.89], P = .008 and in 2019 (OR[95% CI] = 2.70 [1.42-5.12], P = .005). For both surveys, we also found that cigarette smoking prevalence was higher when students' pocket money exceeded the price of the cigarette pack (approximately 1.8 USD).

Despite the 2012 National Tobacco Laws banning sales of cigarettes and single cigarettes to schoolchildren near schools, our analyses of national samples of schoolchildren indicate that the proportion of students reporting cigarettes being available near their schools remained high (65-94%) during 2014 to 2019.