Prevalence and determinants of tobacco use among school-going adolescents in 53 African countries:Evidence from global youth tobacco surveys

Introduction: Tobacco use typically begins during adolescence. There is a lack of comprehensive evidence on the use of different tobacco products among adolescents in Africa. Aims and Methods: We used the most recent Global Youth Tobacco Surveys from 53 African countries, covering 2003 – 2020, to estimate the overall and gender specific prevalence of each type of tobacco product by country, Africa region, World Bank income group, and age group among adolescents aged 11-17 years. We further used logit regressions to assess the determinants of using different tobacco products. Results: The overall prevalence of any tobacco use among adolescents was 14.3% [95% CI: 13.5, 15.3]. Specifically, the prevalence for cigarettes was 6.4% [95% CI: 5.9, 7.0], for other smoked tobacco was 6.7% [95% CI: 6.0, 7.4], for smokeless tobacco use was 6.4% [95% CI: 5.9, 6.9], and for shisha smoking was 5.2% [95% CI: 4.4, 6.1]. The prevalence of dual use of smoked and smokeless tobacco was 3.0% [95% CI: 2.8, 3.2], and that of shisha and cigarettes was 1.5% [95% CI: 1.2, 2.0]. Any tobacco use prevalence was higher among boys (17.4%) than girls (10.6%). Seeing health warnings about tobacco dangers, exposure to smoking at home and school, the age restriction to tobacco purchases, and peer pressure were positively associated with the use of all tobacco products. Being a female was negatively associated with tobacco use across all products. Conclusions: Policymakers should prioritize implementing large pictorial health warnings about tobacco dangers covering the entire packaging of different products.