Cognitive Exposure to Tobacco Marketing and Preventive Health Messages Among Adolescents: A School-Based Cross-Sectional Study

Abstract

Background: Adolescents are frequently exposed to tobacco-related environmental cues, yet limited evidence exists on how such exposure is cognitively processed, particularly in low- and middle-income settings. Understanding adolescents’ psychological engagement with tobacco marketing and preventive messages is essential for effective prevention strategies.

Methods: A school-based cross-sectional study was conducted among 1,017 adolescents. A structured, self-administered questionnaire assessed exposure to tobacco advertisements at points of sale, cognitive responses to health warnings on cigarette packages, and recall of school-based tobacco education. Gender-based differences were examined using chi-square tests.

Results: Overall, 42.9% of adolescents reported exposure to tobacco advertisements at points of sale in the past 30 days, with significantly higher exposure among males (p < 0.001). Only 24.8% reported that health warnings prompted reflective thinking about quitting or not initiating tobacco use, while 40.6% did not notice warnings. Cognitive responses to health warnings differed significantly by gender (p = 0.010). Recall of school-based tobacco education was reported by 42.3% of participants, with no significant gender differences.

Conclusion: Despite widespread exposure to tobacco control measures, meaningful cognitive engagement among adolescents remains limited. Strengthening tobacco prevention efforts requires adolescent-centered approaches that enhance psychological salience, reduce exposure to marketing cues, and improve the effectiveness of school-based education.