Tobacco marketing exposure and engagement profiles among Moroccan adolescents and their association with tobacco product use: A secondary dataset analysis of the Morocco Global Youth Tobacco Survey 2016

Abstract

INTRODUCTIONTobacco use often begins during adolescence, and tobacco marketing contact occurs through multiple channels that may cluster into distinct patterns of exposure and engagement.This study aimed to characterize patterns of tobacco marketing exposure and engagement among Moroccan adolescents using latent class analysis (LCA) and to examine their associations with tobacco product use.METHODS This was a secondary dataset analysis of the 2016 Morocco Global Youth Tobacco Survey (GYTS), a nationally representative, school-based survey conducted in Morocco among school-going adolescents.The analytic sample included 3614 adolescents with complete data on the latent class indicators.LCA was used to identify distinct exposure and engagement classes; models with 2-7 classes were compared using information criteria, entropy, goodness-offit statistics, and interpretability.Differences across classes were assessed using chi-squared tests.Associations between class membership and tobacco use (cigarette use, smoked tobacco other than cigarettes, and smokeless tobacco use) were examined using binary logistic regression, reporting Model A (sociodemographic and socioeconomic covariates) and Model B (Model A plus peer influence).RESULTS Among 3614 adolescents, a three-class solution was retained: media depiction exposure (66.60%), media and point of sale exposure (24.71%), and multimodal exposure and engagement (8.69%).Compared with the reference class, the multimodal class was consistently associated with higher odds of tobacco use across products in Model B (cigarette: AOR=3.70;95% CI: 1.86-7.38,p<0.001; other smoked: AOR=2.14;95% CI: 1.11-4.13,p<0.05; smokeless: AOR=1.95;95% CI: 1.04-3.67,p<0.05), whereas the media and point-ofsale exposure class did not differ significantly.CONCLUSIONS These findings highlight heterogeneous tobacco marketing exposure and engagement patterns and suggest the need for continued monitoring, particularly at points of sale and through indirect promotional channels.Longitudinal studies are needed to clarify temporal relationships with tobacco product use.