Prevalence and Predictors of Cigarette Smoking Among School-Going Adolescents in Africa Based on the Global Youth Tobacco Survey: 2001-2021

ABSTRACT Introduction Tobacco smoking among school-going adolescents poses a major global public health challenge, contributing significantly to future disease burden. Understanding the prevalence and determinants of cigarette smoking in this group is critical for effective interventions. Methods This study analyzed data from the Global Youth Tobacco Surveys collected between 2001 and 2021, covering 439, 322 school-going adolescents aged 11 to 19 across 45 African countries. Descriptive statistics estimated smoking prevalence by age, sex, school grade, country, and survey year. Predictive modelling identified independent correlates 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. Prevalence increased with age, rising from 9.5% at 12 years to 22.4% at 18 years. Boys smoked more than girls (14.0% vs. 7.3%). Smoking varied widely across countries, with the highest rates in Burkina Faso 48.9%, and South Africa (18.9%), and the lowest in Angola (1.5%, 95% CI: 0.86-2.13), Eritrea (2.1%). Use of other tobacco products strongly increased the prevalence of cigarette smoking for smokeless chew (35%, 95% CI: 29.6–40.3). Being taught in school about the effects of smoking showed protective effects, while ownership of tobacco-branded items increased smoking likelihood (17.8%, 95% CI: 17.52-18.13). Smoking prevalence declined over time, with lowest rates in recent years (3.5% in 2020). Conclusion 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. Urgent, youth-focused tobacco control strategies especially targeting males and older teens are needed. Strengthening school-based education and implementing tobacco control policies among students can help reduce smoking rates. These findings offer vital evidence to inform global tobacco control efforts within the African context