Code for "From Quit Intentions to Cessation Support: Correlates, Equity Gaps, and Policy Priorities for Adolescents in Zambia"

Background: Adolescent tobacco control is incomplete if it prevents initiation but does not help young users stop. Zambia now has substantial evidence on tobacco initiation, current use, second-hand smoke, and access, but less is known about where adolescents sit along the cessation continuum and whether support reaches those who need it. We assessed four cessation indicators and translated them into implementation priorities for WHO FCTC Article 14 and MPOWER. Methods: We analysed the nationally representative 2021 Zambia Global Youth Tobacco Survey using an Adolescent Cessation Continuum and Enabling Environment (ACCEE) framework. Four WHO-derived outcomes among eligible tobacco-smoking adolescents were examined separately: desire to stop now, a quit attempt in the previous 12 months, confidence in ability to stop, and receipt of programme or professional help. Survey weights, strata, and primary sampling units were incorporated. Survey-weighted modified Poisson models estimated adjusted prevalence ratios for prespecified demographic, household/school environment, and information/support correlates. Dependence was reserved for sensitivity analysis to avoid overadjustment. Findings: Among adolescents aged 13–15 years, 67.1% wanted to stop, 58.4% had attempted to quit in the previous year, 70.9% believed they could stop, and 48.7% reported programme or professional help. In the full observed age range, desire to stop increased at ages 15–16 years (aPR 1.49, 95% CI 1.11–1.98) and 17 years (1.66, 1.24–2.23) relative to ages 13–14 years. Second-hand smoke exposure at home was associated with greater reported desire to stop (1.21, 1.00–1.45). Receipt of programme/professional help was higher in the Rest of Country than Lusaka (1.54, 1.08–2.19), among 17-year-olds (1.42, 1.02–1.97), and among adolescents reporting school tobacco education (1.26, 1.04–1.53). Descriptively, programme/professional help was reported by 34.2% in Lusaka, 55.9% in the Rest of Country, and 45.9% in Tobacco Regions. Interpretation: The 2021 Zambia GYTS reveals a substantial reservoir of quit motivation and self-efficacy, but a thinner and geographically uneven layer of structured support. The policy opportunity is to convert motivation into sustained cessation through adolescent-responsive screening, brief advice, referral, follow-up, and smoke-free enabling environments. Because the survey is cross-sectional and each cessation indicator has a different eligible denominator, the estimates should be interpreted as an implementation dashboard rather than a longitudinal treatment cascade.