BACKGROUND-AIM:
Tobacco use remains a major public health concern worldwide, particularly among adolescents, for whom early experimentation increases the risk of long-term dependence and adverse health outcomes. In recent years, the diversification of tobacco and nicotine products, including e-cigarettes, has raised new challenges for prevention efforts. Understanding patterns of tobacco experimentation and use, as well as associated behaviors, is essential to inform effective school-based and community interventions. This study aimed to assess trends in tobacco experimentation and current use among high school students in Sousse, Tunisia, and to identify factors independently associated with tobacco product experimentation.

METHODS:
Two successive cross-sectional studies were conducted among adolescents randomly selected from four high schools in Sousse. The questionnaire was self-administered anonymously to participants in their classrooms in the presence of pre-trained physicians.

RESULTS:
A total of 1399 and 1342 high school students participated in 2018 and 2019, respectively with a female predominance (60.5% and 63.2%). The prevalence of tobacco experimentation was 29.4% in 2018 and 26.7% in 2019, while current cigarette use was 9.8% and 7.4% (p=0.026), respectively. Current e-cigarette use (adjusted OR 6.4 [4.5-9.0]), cannabis experimentation (adjusted OR 5.3 [2.7-10.7]), and alcohol use (adjusted OR 3.9 [2.5-6.3]) were the main factors independently associated with tobacco products experimentation among students.

CONCLUSIONS:
Tobacco experimentation is strongly correlated with other substances use among high school students in Sousse. National programs addressing substances use among Tunisian youth should integrate a comprehensive and multisectoral approach of health promotion.