Prevalence and associated factors of adolescent tobacco use in three Sub-Saharan African countries: A comparative analysis of national cross-sectional surveys.

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.