Prevalence and predictors of cigarette smoking among school-going adolescents in Africa: A cross-sectional analysis of the Global Youth Tobacco Survey 2001–2021

Introduction Tobacco smoking among school-going adolescents poses a major global public health challenge, contributing significantly to future disease burden. The aim of this study was to examine the prevalence and determinants of cigarette smoking among school-going adolescents in Africa using data from the Global Youth Tobacco Survey (GYTS). Methods A secondary data analysis was conducted using data obtained from the Global Youth Tobacco Surveys, which employed a cross-sectional study design. The data were collected from 439322 school-going adolescents aged 11–19 years across 45 African countries between 2001 and 2021 using a self-administered, anonymous questionnaire that included both core and optional questions. Descriptive statistics estimated smoking prevalence by age, sex, school grade, country, and survey year. Predictive modeling identified independent associates of current cigarette smoking under complex two-stage cluster sampling. Results Overall, 23.8% (95% CI: 20.20–27.57) of adolescents reported cigarette smoking. The odds of smoking cigarettes increased with age peaking at 18 years (AOR=2.05; 95% CI: 1.78–2.36; p<0.001). Boys had significantly higher odds of smoking than girls (AOR=3.21; 95% CI: 3.09–3.34; p<0.001). Smoking varied widely across countries, with the highest adjusted odds seen in Seychelles (AOR=2.03; 95% CI: 1.79–2.31; p<0.001), and the lowest in Eritrea (AOR=0.46; 95% CI: 0.40–0.52; p<0.001). Use of other tobacco products such as smokeless chew, increased the odds of cigarette smoking to nearly five times (AOR=4.83; 95% CI: 4.62–5.05; p<0.001). Ownership of a tobacco branded item equally increased the odds of cigarette smoking (AOR=2.61; 95% CI: 2.51–2.71; p<0.001). On the other hand, banning of cigarette sales to minors reduced the likelihood of cigarette smoking (AOR=0.79; 95% CI: 0.74–0.84; p<0.001). The odds of cigarette smoking declined over time, with the lowest adjusted odds observed in 2021 (AOR=0.49; 95% CI: 0.45– 0.54; p<0.001). Conclusions Cigarette smoking among school-going adolescents in Africa is a growing public health concern influenced by factors such as age, gender, country, behavior, and media exposure. These findings contribute to the existing body of literature and highlight the need for further studies to better understand the driving forces behind these associations, particularly exploring the role of the environments. Additionally, longitudinal and context specific research across different countries is essential to generate comprehensive evidence on smoking patterns among students.