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Introduction Tobacco use is one of the largest causes of preventable deaths, killing 8.7 million people each year and causing tens of millions more to develop preventable disease ( The health consequences of early smoking initiation aside, adolescence is a key target for smoking prevention with estimates that more than half of adults that smoke initiated this behavior when aged 1216 years ( In this study, we assessed the age of cigarette smoking initiation and its associated factors among adolescents aged 1315 years in 144 countries/territories (hereafter countries), using the most recent data collected in the GYTS from 201020