Gender Trends in Youth Tobacco and Nicotine Use in Georgia Across GYTS Rounds, 2014-2023

BackgroundAdolescent tobacco and nicotine product (TNP) use remains a public health concern, with emerging gender convergence and rising e-cigarette use among females. We examined gender-specific trends in Georgian adolescents alongside national tobacco control policies and social context. MethodsWe analyzed nationally representative Global Youth Tobacco Survey data from Georgia (2014, 2017, and 2023) for youth aged 11-17 to estimate prevalence and patterns of current TNP use in the context of tobacco-related advertising and promotion, secondhand smoke, and national policy, via a policy review. Adjusted prevalence estimates were derived using post- estimation predictive margins after fitting multinomial logistic regression models. ResultsFrom 2014 to 2023, current TNP use declined among boys but increased among girls, particularly in exclusive e-cigarette use. The percentages reporting no current TNP use increased among boys from 77.4% to 85.6% (p < 0.01), but declined among girls from 92.1% to 88.1% (p = 0.04). By 2023, exclusive e-cigarette use was more prevalent among girls than boys. Across sexes, exposure to pro-tobacco advertising and promotion and secondhand smoke declined. Exposure to anti-tobacco promotion peaked in 2017 and receded by 2023. The policy review documented strengthened measures, alongside gaps in oversight of digital marketing and newer products, including e-cigarettes. ConclusionsGeorgias tobacco control policies have contributed to reduced TNP use among boys and a less permissive social environment. Rising e-cigarette use among girls is concerning. Policies should close regulatory gaps, enhance enforcement, and address evolving product and marketing developments to prevent TNP uptake and protect adolescents from tobacco-related harms. SUMMARY BOXO_ST_ABSWhat is already known on this topicC_ST_ABSAdolescent tobacco use patterns are shifting globally, with narrowing gender gaps and rising use of new products like e-cigarettes, especially among girls. In Georgia, the impact of recent tobacco control reforms targeting youth tobacco and nicotine product use by gender had not been fully assessed. What this study addsBetween 2014 and 2023, TNP use significantly declined among boys in Georgia but rose in exclusive e-cigarette use among girls. Exposure to tobacco advertising and promotion and secondhand smoke decreased, yet gaps in anti-tobacco promotion and regulation of novel products persist. How this study might affect research, practice or policyFindings from this study reinforce WHOs call for gender-responsive tobacco control policies. Regulatory measures must address how product design and marketing tactics exploit gendered social norms and youth vulnerabilities. Comprehensive, gender-responsive strategies that strengthen anti-tobacco promotion and close regulatory gaps are essential to counter these influences and protect all adolescents from targeted industry tactics.