Prevalence and determinants of tobacco use among school-going adolescents in 53 African countries: evidence from Global Youth Tobacco Surveys

Abstract

ABSTRACT 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 data 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. We further used independent logit regression models to assess the determinants of the use of different types of tobacco products. The datasets covered 204,537 primary/secondary school- going adolescents aged 11 - 17 years. Pooled prevalence estimates were computed using the individual-level data. Results The overall prevalence of any tobacco use among African adolescents was 14.3% [95% CI: 13.5, 15.3]. Specifically, the prevalence for cigarette smoking 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]. The prevalence of any tobacco use was higher among boys (17.4%) than girls (10.6%). Exposure to anti-tobacco smoking messages, exposure to smoking at home and school, the age restriction to tobacco purchases, and peer pressure were positively associated with the tobacco use, irrespective of product type. Being a female was a protective factor of tobacco use for almost all products. Country-level factors such as predominant religion, African region, and World Bank income group were significant factors only for cigarettes and shisha smoking. Conclusions The prevalence of tobacco use among African adolescents aged 11 - 17 years is high, but similar across different tobacco products. Peer pressure and school environment significantly influence adolescents’ decisions to participate in tobacco use. Policymakers could prioritize implementing large pictorial health warnings about tobacco dangers covering the entire packaging of different products. IMPLICATIONS African countries and regions need to strengthen tobacco control policies that are most effective in reducing tobacco consumption among young people, such as increasing tobacco taxes, textual and graphic health warnings and banning tobacco industry influence: advertising and any sponsorships. It is also important to have comprehensive surveillance systems that monitor the use of the whole range of tobacco and nicotine products overtime.