BACKGROUND-AIM:
Youth smoking initiation remains a significant public health concern, as early exposure to nicotine increases the likelihood of long-term dependence and continued smoking into adulthood. In Europe, 11.6% of young people aged 13 -15 use tobacco, which is the world’s highest prevalence of adolescent smoking (WHO, 2025). Effective prevention requires approaches that reflect the social, cultural and economic contexts of youth and benefit from coordinated regional action. Countries in the Central, Eastern and Southeastern European (CESEE) region share similar patterns of tobacco use and regulatory challenges, making comparative analysis valuable for informing evidence-based policies. The aim of this study is to identify key determinants of smoking initiation among young people in ten selected CESEE countries, to support the development of targeted and contextually relevant tobacco control interventions.

METHODS:
This study employs survival analysis to examine the determinants and timing of smoking initiation among adolescents aged 13–15 years. Data were drawn from the Global Youth Tobacco Survey (GYTS) for ten countries Croatia, Hungary, Bulgaria, Romania, Slovenia, Serbia, Bosnia and Herzegovina, Montenegro, Albania, North Macedonia. Survival analysis allow distinguishing between individuals who have initiated smoking and those who have not, while accounting for the age at initiation. Key explanatory variables include cigarette prices, the tobacco control measures implemented, EU membership, parental smoking status and peer smoking influences, and perceived health risks of smoking.

RESULTS:
EU membership has a positive effect on delaying smoking onset among youth. The EU Tobacco Products Directive (EU TPD) reinforces this effect. Results show that higher cigarette prices reduce smoking probability and postpone initiation, confirming that excise tax increases are an effective strategy. Examined variables significantly influence age of initiation. Peer effect is the strongest predictor: if a friend offers a cigarette, early smoking becomes far more likely. Parental smoking status also accelerates initiation, especially when both parents smoke. Gender differences persist, with girls starting later than boys. Perceiving smoking as harmful does not significantly affect behavior - awareness alone is insufficient to prevent adolescent smoking.

CONCLUSIONS:
This analysis expands single-countries’ evidence into a broader regional perspective. Results offer valuable insights for policymakers and public health experts in CESEE countries, emphasizing the importance of both pricing and non-pricing tobacco control measures and their harmonization with EU legislation. The impact of polices is moderated by strong social influences (peers and parents). This underscores the need for targeted prevention programs addressing these social drivers. Evidence-based recommendations can guide the development of new policy documents and strengthen comprehensive strategies to decrease youth smoking prevalences.