Retselisitsoe Pokothoane

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.

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.

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.

Objectives: To provide first comprehensive estimates of the prevalence of psychoactive substances: alcohol, cigarettes and marijuana and their associated factors among school-going adolescents in 25 African countries, and thereby contribute to the evidence base of substance use in Africa. Methods: We use the publicly available Global School-Based Health Survey (GSHS) data from 25 African countries collected between 2003 and 2017. 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 (ORs) and their 95% confidence intervals (CIs) as the measures of association. Results: The prevalence of alcohol use among African adolescents was 10.6% [95% CI = 9.6, 11.8], that for cigarette smoking was 6.9% [95% CI: 6.1, 7.8], and it was 3.8% [95% CI: 3.2, 4.4] for marijuana. The prevalence of dual use of alcohol and cigarettes was 1.5% [95% CI: 1.2, 1.9], that of alcohol and marijuana was 0.9% [95% CI: 0.7, 1.1], and it was 0.8% [95% CI: 0.6, 1.0] for cigarettes and marijuana. The prevalence of cigarette smoking was significantly higher among boys than girls, but that of alcohol and marijuana was insignificant. The use of alcohol, cigarettes, or marijuana was associated with the West African region, higher-income country group, having parents that smoke any tobacco products, being bullied, missing classes without permission, and experiencing sadness and hopelessness in the previous month were positively associated with being a current user of these products. Conclusions: Africa should invest in data collection on substance use among adolescents who are in and out of school. At both primary and secondary school levels, African countries should develop mentorship and other interventions that fuel positivity and discourage bad practices among students to ultimately reduce substance use. WHAT IS ALREADY KNOWN ON THIS TOPIC: ➢ At the country level, geography, predominant religion, and income level are risk factors for substance use. ➢ At the individual level, home environment, being bullied, feeling sad and hopeless, and having suicidal thoughts are positively associated with students’ substance use in African primary and secondary schools. WHAT THIS STUDY ADDS: ➢ In Africa, cigarette smoking among adolescents differs significantly by gender across different age groups. Nonetheless, for alcohol and marijuana use, there is no statistically significant difference by gender across age groups. ➢ The common dual use of unhealthy products among adolescents is in the form of alcohol and cigarettes. ➢ Staying in the West African region and missing primary or secondary school classes increases the chances of consuming alcohol, cigarettes, and marijuana in both single and dual use. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY: ➢ School-based interventions should be developed or further improved to fuel positivity among students and, finally, minimize negative emotions and activities that lead to substance use.

Background The use of tobacco among adolescents in low- and middle-income countries, is a public health issue of concern. The tobacco industry’s aggressive marketing tactics target young people in African countries, leading to early initiation of tobacco use. While existing evidence focuses on 13-15-year-olds, data from Sub-Saharan Africa indicates that smoking initiation ranges from as young as 7 years old to around 16 years old. The lack of data on adolescent tobacco use in African countries limits policymakers’ ability to implement evidence-based tobacco control policies. This study aims to address the critical lack of quality and timely primary data on adolescent tobacco use thereby enhancing the country’s capacity to target interventions effectively, engage local governments, and attract global attention and funding for adolescent health initiatives. Methods We will conduct a cross-sectional nationwide survey among adolescents aged 10 - 17 years in urban and rural areas of the Democratic Republic of Congo (DRC), Kenya and Nigeria. This household-based survey will utilise a multi-stage stratified sample design to ensure representation across diverse geographic and demographic characteristics. Discussion Through this initiative, we aim to catalyse action at national and international levels to combat the tobacco epidemic among adolescents in SSA. The findings from the DaYTA study will empower stakeholders to advocate for effective tobacco control measures, promote adolescent health, and safeguard future generations from the harmful effects of tobacco use.