Prevalence and predictors of shisha smoking among school-going adolescents in Ghana and Sierra Leone using data from the 2017 Global Youth Tobacco Surveys

Abstract

Rising shisha use among young people in Africa is a growing public health challenge. Yet in countries like Ghana and Sierra Leone, there remains a critical gap in understanding the behavioral patterns and underlying factors driving this trend. The aim of this study was to examine the prevalence and determinants of shisha smoking among school-going adolescents in Ghana and Sierra Leone using data from the Global Youth Tobacco Survey (GYTS). We retrieved self-reported secondary data from the Global Youth Tobacco Survey (GYTS) using a cross-sectional study design. Overall, 12,281 students aged 11–18 years from grades 7–12 were surveyed across the two countries using stratified two-stage cluster sampling. Descriptive statistics, including frequencies and percentages were used to estimate smoking prevalence by age, sex, school grade, country, and survey year. Multivariable logistic regression models were used to determine associations between socio-demographic, behavioral, and current Shisha smoking. Adjusted odds ratios and their 95% confidence intervals are reported. All statistical tests were conducted using a significance level of 0.05, with results considered significant at p < 0.05. The overall prevalence of current shisha smoking was 7.2% (7.8% males and 6.6% of females). The prevalence was slightly higher in Sierra Leone (7.69%, 95% CI: 7.05–8.33) than Ghana (6.58%, 95% CI: 5.94–7.23). Adolescents who did not support banning tobacco sales to minors had higher shisha use (7.96%, 95% CI: 7.34–8.57) than their counterparts (6.01%, 95% CI: 5.34–6.67). Participants who smoked cigarettes, were more likely to smoke shisha compared to those who did not smoke (AOR = 9.86; 95% CI: 7.84–12.38; p < 0.001). Shisha smoking among school-going adolescents in Ghana and Sierra Leone revealed emerging patterns suggesting early initiation and strong association with cigarette use. There is a need for stronger enforcement of tobacco control policies, targeting poly-tobacco use control and factors influencing early initiation. These findings provide valuable insight to inform tobacco control.