Abstract
OBJECTIVES: To examine the association between cigarette price increase and youth smoking initiation in Bosnia and Herzegovina (B&H), and to assess additional factors-including parental smoking, peer influence, pocket money, anti-tobacco media exposure and smoking in school environments-that potentially affect smoking initiation among adolescents. DESIGN: A pseudopanel study using WHO Global Youth Tobacco Survey (GYTS) data from two compatible surveys conducted in 2018 (Republic of Srpska) and 2019 (Federation of B&H). A split-population duration model was employed to estimate the hazard of youth smoking initiation. SETTING: Primary and secondary schools across two entities in B&H, covering both urban and rural areas. PARTICIPANTS: A total of 9702 students aged 13-15 years completed the surveys. Inclusion criteria involved being enrolled in grades 7-9 of primary school or the first year of secondary school. No additional exclusion criteria were applied beyond incomplete or invalid survey responses. INTERVENTIONS: None. PRIMARY OUTCOME MEASURE: Self-reported smoking initiation, defined as having tried or experimented with cigarette smoking, even one or two puffs. RESULTS: A 10% increase in cigarette prices was associated with a 4.9% reduction in the probability of youth smoking initiation (price elasticity of -0.491, p<0.001). Exposure to antitobacco media messages was linked to a lower likelihood of smoking initiation. Conversely, parental smoking, peer influence, observing smoking within school premises and having greater disposable pocket money all showed significant positive associations with youth smoking initiation. CONCLUSIONS: Raising cigarette prices constitutes an effective measure to discourage smoking initiation among youth in B&H, operating both directly and indirectly through reductions in parental and peer smoking. Nonetheless, non-price factors play a substantial role, highlighting the complexity of adolescent smoking behaviour and the necessity for a comprehensive, multifaceted tobacco control strategy. TRIAL REGISTRATION: Not applicable (observational study).