Prevalence and Determinants of Youth Tobacco Use: An Ecological and Systematic Review

Adolescent use of tobacco products remains a major public health concern worldwide.In this population, tobacco use is influenced by determinants across individual, interpersonal, organizational, community, and policy levels.This systematic review synthesized current evidence to inform adolescent-focused tobacco control strategies.A systematic search of PubMed, Scopus, Web of Science, Korean Studies Information Services System, and Research Information Sharing Service identified 4,712 articles published between 2013 and 2024.After screening, 298 studies (124 international and 174 domestic) were included.Across countries, conventional cigarette smoking has declined, whereas the use of electronic cigarettes and heated tobacco products has increased.At the individual level, frequent tobacco use was consistently associated with male sex, older age, lower socioeconomic status, and psychological factors such as stress, depression, and low self-esteem.Interpersonal influences, including parental, sibling, and peer smoking, were associated with increased risk.School-based prevention policies and educational programs emerged as protective factors, whereas higher tobacco retailer density was associated with increased smoking.At the policy level, higher tobacco taxes, flavor bans, and marketing restrictions were consistently associated with reductions in tobacco use among adolescents.Therefore, adolescent tobacco use results from multiple interacting determinants, and effective prevention requires coordinated strategies to limit product accessibility, reduce marketing exposure, and support school-based interventions.