Noreen Dadirai Mdege

Tobacco use often begins during adolescence, increasing the risk of lifelong nicotine dependence and future non-communicable diseases. In sub-Saharan Africa, concerns are rising due to aggressive tobacco industry marketing and expanding nicotine product markets, yet nationally representative data covering both in-school and out-of-school adolescents remain limited. Understanding tobacco use patterns during early and mid-adolescence, a critical period for experimentation and initiation, is essential for informing prevention strategies. We conducted nationally representative cross-sectional household surveys between March and June 2024 using harmonized tools and multistage stratified cluster sampling in Democratic Republic of Congo (DRC), Nigeria and Kenya. Adolescents aged 10–17 years completed standardized face-to-face interviews with response rates of 96% in DRC, 94% in Nigeria and 96% in Kenya. The outcomes were current use of any tobacco, smoked tobacco and smokeless tobacco. Current tobacco use was defined as self-reported use in the past 30 days of any tobacco product including cigarettes, cigars, shisha/waterpipe and smokeless-tobacco (snuff/chewing). Analyses incorporated sampling weights to estimate prevalence, assessed subgroup differences using Rao-Scott chi-square tests, and multivariable logistic regression models were fitted separately for each country and outcome. Among 18,612 adolescents (4,675 in DRC, 7,502 in Nigeria, 6,435 in Kenya), 6·5% (95% CI: 4·9–8·6) reported current tobacco use, with variations across countries (11·9% in DRC, 3·6% in Nigeria, and 2·5% in Kenya). Similar patterns were observed for smoked and smokeless tobacco use. Tobacco use was higher among boys, older adolescents, and those engaged in work. In adjusted analyses, being a boy and older was associated with higher odds of use. Being enrolled in school was linked to lower odds of use in DRC and Kenya, while having both parents alive reduced odds of use in DRC and Nigeria. Higher parental education was associated with lower odds of tobacco use in Kenya but higher odds of use in DRC and Nigeria. Overall, adolescents’ tobacco use remains a critical public health challenge and observed cross-country differences highlight the need for tailored, context-specific interventions and strengthened tobacco control efforts.

Background: Tobacco advertising and promotion remain major drivers of tobacco use, particularly at points of sale (PoS). Ethiopia has enacted comprehensive tobacco control laws, including bans on TAPS at PoS. However, little is known about how these laws are implemented, monitored, and enforced in practice. This study explored the facilitators and barriers to implementing, monitoring compliance with, and enforcing TAPS laws at PoS in Ethiopia. Methods: Qualitative interviews with 41 key informants were conducted between December 2022 and January 2023 across 10 purposively selected cities. Participants included policy implementers and stakeholders from government agencies, civil society organizations (CSOs), and international partners. Participants were purposively selected from national and sub-national actors involved in tobacco control, including government agencies (MoH, EFDA, Ministry of Trade, regional health and trade authorities, regulatory bodies, and research institutions) and non-governmental stakeholders (WHO Ethiopia, professional associations, and CSOs). Semi-structured interview guides were developed and administered in local languages. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed thematically using ATLAS.ti software. Results: Key facilitators included strong tobacco control laws (Proclamation No. 1112/2019), federal-level political commitment, and the national tobacco control committee (NTCC). Barriers included the absence of EFDA structures at lower administrative levels, a lack of regionally adapted tobacco control laws, limited dedicated tobacco control departments, unclear enforcement mandates, advertisement of illicit tobacco products, not being a prioritized agenda, low awareness among non-health departments and retailers, tobacco industry interference, and, in some areas, a culture that normalizes tobacco smoking. Conclusions: Strong legislation banning 100% of TAPS and the presence of a national tobacco control committee support implementation; however, enforcement remains limited by structural, operational, and socio-cultural challenges. Enhancing compliance requires strengthening regional regulations, establishing clear institutional frameworks, raising stakeholder awareness about the tactics of the tobacco industry, and ensuring adequate allocation of human and financial resources, particularly in regions with a high prevalence of illicit tobacco products, to achieve the intended public health impact of TAPS laws in Ethiopia.

Background: The initiation of tobacco and nicotine product use often occurs in adolescents. This necessitates monitoring of this behaviour in this population, particularly in countries such as the Democratic Republic of the Congo (DRC) where approximately 58% of the population is under 19 years of age. Our study assessed the prevalence of, and factors associated with use in the DRC. Methods: We conducted a nationally representative, cross-sectional, household survey between March and May 2024 among adolescents aged 10 to 17 years. We estimated the prevalence of use of smoked and smokeless tobacco products, heated tobacco products, and nicotine products (i.e., electronic cigarettes and nicotine pouches). We used logistic regression to identify factors associated with current use of any tobacco product, smoked tobacco, and smokeless tobacco using adjusted odd ratios. All analyses included 95% confidence intervals (CI). Results: Of the 4,675 adolescents who completed the survey, the prevalence of current use of any tobacco or nicotine product was 11.87% (95% CI: 6.93-19.58). This was 7.98% (95% CI: 4.23-14.55) for smoked tobacco products, 5.86% (95% CI: 3.42-9.87) for smokeless tobacco products, 0.11% (95% CI: 0.11-0.11) for heated tobacco products and 0.60% (95% CI: 0.10-3.40) for nicotine products. Boys were more likely to use tobacco than girls. Being enrolled in school and having both parents alive were protective from tobacco use. Having a male household head, a household head education level of at least secondary school, and exposure to tobacco smoking in public places increased the odds of being a tobacco user. Conclusions: The DRC should strengthen policies that make tobacco and nicotine products less accessible or appealing to adolescents. This includes raising excise taxes; banning the sale of single cigarette sticks, small packets and flavoured products; and comprehensive smoke-free laws. Policies should account for factors that make adolescents more vulnerable product use. Key messages: What is already known on the topic: The last survey on tobacco use among adolescents in the DRC was a school-based survey among 13-15-year-olds conducted in 2008, and only covered Kinshasa and Lubumbashi. What this study adds: This survey provided national-level estimates that cover adolescents aged 10-17years, includes out-of-school adolescents, and covers both tobacco and nicotine products. It also identifies individual-, household-, and environmental-level factors that are associated with tobacco and nicotine product use among adolescents in the DRC. How this study might affect research, practice or policy: By providing current and more comprehensive data, our study enhances policymakers’ ability to design evidence-based tobacco control interventions that are aimed at preventing the initiation and use of tobacco and nicotine products among adolescents in the DRC and other similar settings.

Objectives The objective of this study was to assess adherence to smoke-free laws at points-of-sale (PoS), that is, retail outlets that sell various goods including tobacco products, and to identify predictors of low adherence. Methods This cross-sectional observational study was conducted in December 2022 across 10 Ethiopian cities covering 1323 PoS such as regular shops, permanent kiosks, khat shops, supermarkets and minimarkets. Sampling was performed using a two-stage cluster design, with random selection of PoS. Data were collected using checklists through covert observations. Logistic regression identified predictors of low adherence. Results More than half of PoS (52.5%) showed good adherence, 23.2% moderate, 20.8% poor or none and only 3.4% met full adherence. Supermarkets/minimarkets had the highest rates of good or full adherence (83.9%), while kiosks and khat shops had the lowest (40.7% and 35.4%, respectively) rates of good or full adherence. Low adherence was higher in kiosks (adjusted OR (aOR)=7.02, 95% CI: 3.76 to 13.13) and khat shops (aOR=6.26, 95% CI: 3.48 to 11.26). Low adherence was also observed in Semera-Logia (aOR=21.27, 95% CI: 13.26 to 34.12) and Gambella (aOR=12.07, 95% CI: 7.64 to 19.08). Predictors of indoor smoking included being a khat shop (aOR=3.13, 95% CI: 1.29 to 7.60), being located in Semera-Logia (aOR=8.47, 95% CI: 3.49 to 26.54), presence of outdoor smoking (aOR=3.38, 95% CI: 2.07 to 5.51) and lighters (aOR=5.26, 95% CI: 3.05 to 9.06). Conclusions The study highlights enforcement gaps at PoS, particularly in khat shops, kiosks, and in Semera-Logia and Gambella cities. Strengthening smoke-free law implementation requires region-specific interventions for high-risk areas and retail outlets.

Objectives To provide comprehensive estimates of the prevalence of psychoactive substance use, specifically alcohol, cigarettes and marijuana, and factors associated with their use among school-going adolescents in 25 African countries. Design and methods We used a pooled cross-sectional dataset from the publicly available Global School-based Health Survey (GSHS) from 25 African countries. We used descriptive statistics to estimate the prevalence of alcohol, cigarette and marijuana use as well as their dual use among adolescents aged 11–16 years. Additionally, we used logistic regressions to model factors associated with the use of each substance, with adjusted Odds Ratios (aORs) and their 95% Confidence Intervals (CIs) as the measures of association. Setting and participants The study focused on school-going adolescents aged 11–16 years in 25 African countries that have conducted the GSHS between 2003 and 2017. Outcome measures The key outcome measure is the proportion of adolescents who have used a specific substance in the past 30 days. These substances include: (1) alcohol, (2) cigarettes, (3) marijuana, (4) alcohol and cigarettes, (5) cigarettes and marijuana and (6) alcohol and marijuana. Results The prevalence of alcohol use among adolescents was 9.5% (95% CI 8.4% to 10.7%), that of cigarette smoking was 6.2% (95% CI 5.0% to 7.6%), and it was 3.4% (95% CI 2.7% to 4.2%) for marijuana. The prevalence of dual use of alcohol and cigarettes was 3.1% (95% CI 2.4% to 3.9%), that of alcohol and marijuana was 2.0% (95% CI 1.5% to 2.5%), and it was 1.4% (95% CI 1.1% to 1.8%) for cigarettes and marijuana. The prevalence of cigarette smoking was significantly higher among boys than girls. However, there was no statistically significant difference in the prevalence of alcohol or marijuana by sex. Having parents who smoke any tobacco products, being bullied, missing school without permission and experiencing sadness and hopelessness were positively associated with being a current user, irrespective of substance type. Conclusions There is a need for comprehensive, current data on substance use among adolescents. Interventions that tackle bullying, reduce school absenteeism, build resilience against difficult situations and increase self-efficacy to resist the use of these substances have the potential to curb substance use among adolescents in Africa.

This study aimed to estimate the proportion of cigarettes consumed in the Democratic Republic of the Congo (DRC) that are illicit and the extent of cigarette tax evasion; and to identify the origins of and factors associated with illicit cigarettes. Data were collected from May 15 to June 9, 2023. Stratified, multistage sampling was used to select 32 health areas from which empty cigarette packs were collected. Each collected pack was examined and classified as licit if it complied, or illicit if it did not comply, with the DRC’s tax stamp or written health warning requirements, or the requirements to have a notice indicating the prohibition of sale by/to minors or information on tar and nicotine content. We reported frequencies as numbers and percentages, and continuous variables as means or medians. We performed regression analysis and used adjusted odds ratios (aOR) and their 95% confidence intervals (CI) to measure associations. 8.6% (95% CI: 8.1, 9.2) of the 10622 empty cigarette packs collected were illicit, and had also evaded cigarette tax. 8.0% of the collected packs did not comply with written health warning requirements, 5.6% did not indicate the prohibition of sale by/to minors, and 4.5% did not have information on tar and nicotine content. Packs from low-income areas were more likely to be illicit than those collected from high-income areas (aOR 1.90; [95% CI: 1.48-2.43]). The likelihood of being an illicit cigarette increased with increasing susceptibility to armed conflict/insecurity. Packs from border provinces were less likely to be illicit than those from non-border provinces (aOR 0.48; [95% CI: 0.25-0.90]). All illicit cigarettes were imports from other countries. There is, therefore, a need to secure the cigarette supply chain, strengthening border controls and enforcement and compliance monitoring, and strengthening political commitment by ratifying the Protocol to Eliminate Illicit Trade in Tobacco Products.

Background: The 2019 Ethiopia’s comprehensive tobacco control proclamation mandates 100% smoke-free public places and workplaces. Despite the proclamation, compliance remains uncertain, particularly at hospitality venues (HVs). The aim of this study was to evaluate the extent of compliance with smoke-free laws in HVs and to also understand the factors associated with non-compliance. Methods: This cross-sectional observational study was conducted in 10 cities in Ethiopia—Addis Ababa, Adama, Assosa, Bahir Dar, Dire Dawa, Gambella, Harar, Hawassa, Jigjiga, and Semera-Logia -between December 5^th and 28^th, 2022. Data were collected electronically using smartphones, utilizing a pre-tested, standardized checklist and covert observation. The subjects were selected through multi-stage cluster sampling. A total of 1,370 HVs (hotels, restaurants, bars, bars and restaurants, café and restaurants, butcher houses and restaurants, groceries, and nightclubs/ lounges) were observed. Specific and composite compliance indicators were computed for indoor and outdoor spaces. Poisson regression analyses identified factors associated with indoor active smoking and non-compliance. Statistical significance was set at P<0.05. Data were analyzed using SPSS version 26. Results: Among the 1,370 HVs included in this study, 1,368 had indoor spaces, 327 had both indoor and outdoor spaces, and two had only outdoor spaces. Active smoking was observed in 32.2% (95% CI:30–35) of indoor HVs, with the highest rates in nightclubs/lounges (68.6%) and bars (65.7%). Semera-Logia reported the highest prevalence of active smoking (70.4%). Adherence with ‘no smoking’ signage was low (35.2%), while ashtrays, lighters, and designated smoking areas (DSAs) were rarely present. Outdoor active smoking was observed in 46.5% (95% CI:41–52) of HVs. Only 12.8% of indoor spaces were fully adherent to the smoke-free law requirements. Venues in Semera-Logia were over twice as likely to have active smoking (adjusted prevalence ratio [aPR]: 2.71; 95% CI: 2.00–3.66) compared to Addis Ababa. Bars and nightclubs/lounges had significantly higher prevalence of active smoking than cafés/restaurants. ‘No smoking’ signs were associated with reduced prevalence of indoor active smoking (aPR: 0.77; 95% CI: 0.67–0.89), while smoking within a 10-meter range (aPR: 2.67; 95% CI: 2.13–3.32), the presence of lighters (aPR: 1.69; 95% CI: 1.41–2.02), and the sale of tobacco products (aPR: 1.58; 95% CI: 1.34–1.86) were all associated with higher prevalence of indoor active smoking. Conclusion: Compliance with ‘no active smoking’ and adherence to smoke-free laws in HVs remain low, particularly in bars, nightclubs/lounges, and Semera-Logia, with high rates of active smoking both indoors and outdoors. Enhanced enforcement and targeted are needed to educate the public and HV owners about the risks of SHS and the importance of tobacco control laws.

Introduction: In Nigeria, there is very limited evidence on factors that influence shisha smoking, and this hinders effective tobacco control policymaking. We, therefore, aimed to identify factors associated with shisha smoking among the general population adults in Nigeria. Methods: We...

This study aimed to estimate the proportion of cigarettes consumed in the Democratic Republic of the Congo (DRC) that are illicit and the extent of cigarette tax evasion; and to identify the origins of and factors associated with illicit cigarettes. Data were collected from May 15 to June 9, 2023. Stratified, multistage sampling was used to select 32 health areas from which empty cigarette packs were collected. Each collected pack was examined and classified as licit if it complied, or illicit if it did not comply, with the DRC’s tax stamp or written health warning requirements, or the requirements to have a notice indicating the prohibition of sale by/to minors or information on tar and nicotine content. We reported frequencies as numbers and percentages, and means for continuous variables. We performed regression analysis and used adjusted odds ratios (aOR) and their 95% confidence intervals (CI) to measure associations. 8.6% of the 10622 empty cigarette packs collected were illicit. All of the illicit packs were also identified as having evaded cigarette tax. Approximately 8.0% of the collected packs did not comply with written health warning requirements, 5.6% did not indicate the prohibition of sale by/to minors, and 4.5% did not have information on tar and nicotine content. Packs from low-income areas were more likely to be illicit than those collected from high-income areas (aOR 1.90; [95% CI: 1.48-2.43]). The likelihood of being an illicit cigarette increased with increasing susceptibility to armed conflict/insecurity. Packs from border provinces were less likely to be illicit than those from non-border provinces (aOR 0.48; [95% CI: 0.25-0.90]). Our results show that the illicit cigarette trade market in the DRC is currently small, and most illicit cigarettes are imported from other countries. There is a need to secure the cigarette supply chain, including strengthening border controls.