Prevalence and Correlates of Current Tobacco use and Non-user Susceptibility to using Tobacco Product Among School-going Adolescents in 22 African Countries, 2013-2018

Our study examined the prevalence and associated factors of tobacco product use and non-users’ susceptibility to using tobacco products among school-going adolescents in 22 African countries. We analysed the cross-sectional 2013-2018 GYTS data from 22 African countries. We conducted complex sampling descriptive and logistic regression analyses. We reported our results using frequencies and proportions for descriptive statistics and adjusted odd ratios and 95% condence intervals for logistic model. looks at factors associated with susceptibility to using any tobacco product among never users of tobacco products in our study population. We observed that male and female students exposed to tobacco industry promotion (AOR=1.730;95%CI:1.485-2.015) do not favour banning smoking in enclosed places (AOR= 1.323;95%CI:1.142-1.532) were more likely to be susceptible to using any tobacco product among never users of tobacco products. Students who were not knowledgeable about the harmful effects of secondhand smoke were less likely to be susceptible to using tobacco than those who were aware of the harmful effects of secondhand smoke (AOR=0.759;95%CI:0.642-0.897). Such association was found among males but not females. was reported for the African region in the 1999-2005 global tobacco use survey(16). The of the current use of any and higher than the one reported for males and females in the 1999-2018 GYTS(15). tobacco products use among school-going adolescents in most remains prevalent, it is and lowest in Morocco. disparity attributed to easy access to tobacco products and the presence and implementation of anti-tobacco laws in little in use among adolescents in many countries. The stall in progress may be linked to a lack of human and nancial resources to implement tobacco control activities effectively. Also, increased of industry and limited public support to implement tobacco control initiatives may explain the slow progress in implementing WHO-FCTC articles. less than one in ve tobacco users were to using tobacco (12.1%). Our nding is in line with previous global and African estimates (16, 20) and what has been reported in countries (55, 56) but lowers among Canadian and U.S. high school students(18, 57) in Mexico (19). With increased penetration of the tobacco industry in Africa, our nding suggests the need for more robust interventions to prevent never-users of tobacco in these countries from initiating tobacco use and eventually becoming tobacco product users in their adulthood. Our nding also highlights the need for governments in these countries to formulate policies and interventions targeting young people in their pre-experimentation stages of tobacco use behaviour. Our study found no gender differences regarding susceptibility to using tobacco among never users as it has been reported in previous studies globally (20), in Africa(22), USA(58) and Pakistan(56) but was consistent with studies conducted in South East Asia countries(55) and in Mexico(19). Our nding supports the need for governments to adopt gender-neutral policies and interventions when targeting young people who are susceptible to using tobacco(59). Consistent with studies conducted globally [20] and in South East Asia [55], exposure to tobacco industry promotion was associated with increased susceptibility to using tobacco among non-users. This result further the need for governments to impose a complete ban on tobacco promotion in line with article 13 of the WHO-FCTC framework(54). Knowledge about the harmful effects of SHS was associated with decreased susceptible to using tobacco among non-users in our study, and our result was in line with studies conducted in other regions(55, 56). Also, our study shows that those who were against banning smoking in enclosed places were more likely susceptible to using tobacco among non-users, which indicate lack of knowledge about the harmful effects of secondhand smoke. Our ndings suggest the need for governments and other stakeholders to provide information to adolescents who are prone to using tobacco products regarding the harmful effects of secondhand smoke. Interventions can include the inclusion of harmful effects of secondhand smoke into high school curriculum, using social media social media inuencers to promote the harmful effects of secondhand smoke. Exposure to SHS outside the home was associated with increased susceptibility to smoking among never-smoking males but not females. Our nding is similar to a previous global study although such association was observed in both gender (20). Such a nding underscores the need for governments to create smoke free public spaces and further strengthen the enforcement of a complete ban on smoking in public enclosed spaces.

to initiating cigarette smoking only focused on cigarette smoke (22)(23)(24). Even though cigarette is the major tobacco product that most studies in Africa have to examine, other non-cigarette tobacco products are known to cause adverse health outcomes. Therefore, a comprehensive evaluation of tobacco use behaviour in the African setting is worth exploring. To our knowledge, no study has comprehensively examined the prevalence and associated factors of tobacco product use and non-users susceptibility to using tobacco product among school-going adolescents in the African region using recent GYTS data. To ll this nascent gap, our study used the most recent GYTS (2013-2018) data from 22 African countries to examine the prevalence and associated factors of tobacco product use and non-users susceptibility to using tobacco products among school-going adolescents in Africa.

Study design and data source
The Global Youth Tobacco Survey (GYTS) 2013-2018 dataset from 22 African countries were used to conduct our study. The countries included Algeria, Cameroon, Comoros, Djibouti, Egypt, Gabon, Gambia, Ghana, Kenya, Madagascar, Mauritania, Mauritius, Morocco, Mozambique, Senegal, Seychelles, Sierra Leone, Tanzania, Togo, Tunisia, Uganda and Zimbabwe. The GYTS datasets of these countries are freely available at the WHO Non-Communicable Disease (NCD) microdata repository (25). GYTS is a questionnaire-based cross-sectional survey conducted among school-going adolescents that uses a two-stage cluster sampling design to examine their tobacco use behaviour. A cluster of schools proportional to enrolment size was chosen, followed by the random selection of classes. We used available data from 22 African countries, and the response rate for each country included in our study is shown in additional le 1. In line with previous studies (20,26), we used the most recent dataset for countries in which the GYTS have been conducted more than once.

Measures
Current tobacco use and susceptibility to using any tobacco product among non-users were our main dependent variables. We de ned current tobacco use as the use of cigarettes, smoked tobacco products other than cigarettes and smokeless tobacco products in the last 30 days. Current use of cigarettes was considered as the respondents' response of "≥ one day to the question "During the past 30 days, on how many days did you smoke cigarettes?" Also, current use of smoked tobacco products other than cigarettes was de ned based on participants self-reported response of "yes" to the question "During the past 30 days, did you use any form of smoked tobacco products other than cigarettes (such as cigar, pipe water pipe and shisha)?" In addition, current use of smokeless tobacco product was de ned based on respondents' response of "yes" to the question "During the past 30 days, did you use any form of smokeless tobacco products (e.g. chewing tobacco, snuff, dip)?" Susceptibility to using tobacco among never tobacco users was measured based on the algorithm developed by Pierce et al (27). We identi ed nevertobacco users as those who have never used cigarettes, smoked tobacco products other than cigarettes and smokeless tobacco products, and they include those who responded "No" to each of the following questions "Have you ever tried or experimented with cigarette smoking, even one or two puffs?", "Have you ever tried or experimented with any form of smoked tobacco products other than cigarettes (such as cigar, pipe, shisha or water pipe)?" and "Have you ever tried or experimented with any form of smokeless tobacco products (such as snuff, chewing tobacco)?". Susceptibility to using tobacco was de ned by respondents choosing from the following options "(1) de nitely not; (2) probably not; (3) probably yes; and (4) de nitely yes, based on the following two questions "If one of your best friends offered you a tobacco product, would you use it?" and "At any time during the next 12 months do you think you will use any form of tobacco?" As it has been previously described(26), we considered respondents who chose "de nitely not" to the two questions as nonsusceptible to using tobacco while the rest were considered susceptible. Susceptible and non-susceptible to using tobacco products were recorded as "1" and "0" respectively.
Based on the available literature (20,(28)(29)(30), 11 independent variables were developed that could potentially predict current tobacco use and susceptibility to using tobacco among never tobacco users. These independent variables include age, sex, access to disposable income, exposure to secondhand smoke (SHS) at home and outside the home, knowledge about harmful effects of SHS, exposure to tobacco industry promotion, favour banning smoking in enclosed places, exposure to antismoking media messages and antismoking school education. All variables were dichotomised based on previous studies(16, 20, 26). Additional le 2 gives a detailed description of the dependent and independent variables and how they were recorded.

Data Analysis
The pooled data were analysed using SPSS version 27. Categorical variables were presented using weighted percentages. Given the established gender difference regarding tobacco use, separate analyses were done for male and female. We employed logistic regression analysis to examine the correlates of the current tobacco use and susceptibility to using tobacco among never-smokers. In our analysis, the prevalence and correlates of the current use of cigarettes, current smoked tobacco products other than cigarettes and current smokeless tobacco products and current tobacco use, as well as susceptibility to using tobacco among never-smokers, were reported. We used complex sampling analysis on SPSS to account for sample weights, sampling design effect. All associations were considered statistically signi cant if the p-value was less than 0.05 with a 95% con dential interval in our regression analysis.
Ethics Consideration received ethics approval from their respective Ministries of Health. Besides, a written informed consent was obtained from the parents and guardians of the students who lled the survey questionnaires. Table 1 provides details of the study population. The study population consisted of 90853 school-going adolescents from 22 African countries. Half of them were males (50.3%), and more than two-thirds were between the ages 13-15years (68.7%). Close to one in three school-going adolescents had been exposed to secondhand smoke at home (28.3%), and more than half were exposed to secondhand smoke outside their homes (57.9%). Less than one in ve were exposed to tobacco industry promotion (13.8%), whereas more than two-thirds favoured banning smoking in enclosed places (69%). Table 2 gives detail of the prevalence of current cigarette smoking and non-cigarette tobacco product use (current use smoke tobacco product other than cigarette and Current use of smokeless tobacco) and susceptibility to using any tobacco product among never users among male and female adolescents from the 22 African countries. The overall prevalence of current cigarette smoke was 10.9%, 95%CI:(9.8%-12.1%). with huge gender disparity [males: 15.2%;95%CI (13.4%-17.1%) compared to females 6.5%;95%CI (5.7%-7.5%)]. The highest (37.9%) and lowest (5.6%) prevalence of current cigarette smoke was reported in Zimbabwe and Morocco, respectively. Only 4.3% of school-going adolescents from the 22 African countries were current smokers of tobacco products other than cigarettes, and the highest (9.8%) and lowest (2.6%) were found in Seychelles and Kenya, respectively. Also, the fewer schoolgoing adolescents (4.1%) were currently using smokeless tobacco and the highest (7.6%), and lowest (1.8%) prevalence were observed in Djibouti and Gambia, respectively. The overall prevalence of current use of any tobacco product among male and female adolescents from the 22 African countries considered in this analysis was 19.1%, with more males (23.7%) than females (13.7%) being current users of any tobacco product. The highest (47.1%) and lowest (12.6%) prevalence of current any tobacco product users were found in Zimbabwe and Morocco, respectively. The prevalence of the susceptibility to using tobacco products among never users of tobacco products was 12.2%, with no signi cant differences between males (11.8%) and females (12.7%).

Results
The highest and least prevalence of the susceptibility to using tobacco products among never users of tobacco products was observed in Mozambique (24.6%) and Algeria (4.5%), respectively.
Tables 3 summarises the predictors of current cigarette smoking among male and female school-going adolescents in the 22 African countries. Males compared to females were more likely to be current cigarette smokers (AOR=2.650; 95%CI: 2.219-3.165). Exposure to secondhand smoke inside (AOR=2.593; 95%CI:2.126-3.163) and outside (AOR= 2.315; 95%CI:1.925-2.783) the home was associated with current cigarette smoking, and such association pattern was observed in males and females. Also, exposure to tobacco industry promotion AOR=3.076;95%CI:2.580-3.666), not in favour of banning smoking in enclosed places (1.526(1.203-1.935) and not exposed anti-smoking media messages (AOR=1.296;95%CI:1.140-1.475) were associated with current cigarette smoking among school-going adolescents in the 22 African countries considered in this study. Similar associations were found among males and females. Table 4 provides factors associated with the current use of smoke tobacco other than cigarettes. Exposure to secondhand smoke at home (AOR=2.166;95%CI:1.638-2.864), exposure to tobacco industry promotion (AOR= 4.127;95 %CI:3.297-5.166) and lack of knowledge about the harmful effects of secondhand smoke (AOR=1.337;95%CI:1.027-1.740) were associated with the current use of smoke tobacco other than cigarettes. Exposure to secondhand smoke outside the home was associated with the current use of smoke tobacco other than cigarettes only among females (AOR=1.354;95%CI:1.006-1.823). Table 5 shows the factors associated with smokeless tobacco use among our study population. No signi cant gender difference was observed regarding the use of smokeless tobacco. Exposure to secondhand smoke at home was a predictor of smokeless tobacco use (AOR=1.848; 95CL:1.500-2.278), but such association was observed only among males (AOR= 2.242;95%CI:1.836-2.738). Exposure to tobacco industry promotion was found to be associated with the use of smokeless tobacco (AOR=4.194;95%CI:3.322-5.294), and such association was found in males and females. No signi cant gender difference was observed regarding the use of smokeless tobacco. Table 6 summarises the correlates of the current use of any tobacco products use, and we found signi cant gender difference existed with males being more likely to be current users of tobacco products than their female counterparts (AOR=1.930; 95%CI:1.614-2.307). Exposure to secondhand smoke within (AOR=2.069;95%CI:1.763-2.429) and outside (AOR=1.364;95 %CI:1.138-1.635) the home, not knowledgeable about the harmful effect of secondhand smoke (AOR=1.413;95%CI:1.178-1.693), exposure to tobacco industry promotion (AOR=3.027;95%CI:2.653-3.453) and not in favour of banning smoking in enclosed places (AOR=1.222;95%CI:1.014-1.472) were found to be predictors of tobacco product use among school-going adolescents in the 22 African countries considered in this study. Such associations were observed in males and females. Table 7 looks at factors associated with susceptibility to using any tobacco product among never users of tobacco products in our study population. We observed that male and female students exposed to tobacco industry promotion (AOR=1.730;95%CI:1.485-2.015) do not favour banning smoking in enclosed places (AOR= 1.323;95%CI:1.142-1.532) were more likely to be susceptible to using any tobacco product among never users of tobacco products. Students who were not knowledgeable about the harmful effects of secondhand smoke were less likely to be susceptible to using tobacco than those who were aware of the harmful effects of secondhand smoke (AOR=0.759;95%CI:0.642-0.897). Such association was found among males but not females.

Discussion
Our study examines tobacco products use and susceptibility to using any tobacco product among never users in 22 African countries. Our study provides a comprehensive analysis of school-going adolescents' tobacco product use behaviour in Africa using the most recent GYTS data (2013-2018) from 22 African countries. Although there is a signi cant disparity in the prevalence of tobacco product use among countries, there is a relatively high prevalence of tobacco use and susceptibility to using any tobacco product among never users. There was a signi cant gender difference among current cigarette smokers, non-cigarette tobacco products (except smokeless tobacco users), any tobacco product users but not among those susceptible to using any tobacco product. Students exposed to secondhand smoke within and outside their homes, exposure to tobacco industry promotion were more likely to be current tobacco users (cigarette and non-cigarette tobacco products). Being exposed to tobacco industry promotion and not in favour of banning smoking in enclosed places were associated with susceptibility to using any tobacco product among never users of tobacco.
In line with the global prevalence of current cigarette smoking among adolescents 13-15 years in 143 countries (15) and among 12-15 years in 68 lowincome and middle-income countries (17), we found that one in ten school-going adolescents in the 22 African countries considered were current cigarette smokers. Our nding was lower than the prevalence reported in the Western Paci c and higher than the rates reported in Europe, Southeast Asia and the Eastern Mediterranean (17). Our nding was also higher than what was reported for the African region in the 1999-2005 global tobacco use survey among 13-15years old school-going adolescents using the GYTS dataset(16). In addition, the rate of cigarette smoking in both males and females in our study was higher than the prevalence reported for males and females in the 1999-2018 GYTS (15). The difference in prevalence observed may be attributed to differences in the sources of data and the duration of the study considered. We used the recent GYTS data (2013-2018) from 22 African countries, whereas the study by Xi et al. (17) used GSHS data from 2006-2013. The prevalence of the current use smoke tobacco product other than a cigarette in our study was lower than the global estimate of 11.2%, whereas the prevalence of the current use of any tobacco product was higher than the global estimate using both GYTS and GSHS datasets (15,17). In the study by Xi et al. in which they used GSHS data, the prevalence of any tobacco products use in the African region was lower than what we found in our study and this was the case for the Americas, Europe, Southeast Asia, Eastern Mediterranean except for Western Paci c region in which the prevalence was found to be 17.6%. The prevalence of the current use of any tobacco product in our study was also consistent with what was reported for the African region in the 1999-2005 global tobacco use survey(16). The prevalence of the current use of any tobacco product for males and females in our study was higher than the one reported for males and females in the 1999-2018 GYTS (15). Our results have demonstrated that tobacco products use among school-going adolescents in most African countries remains prevalent, and it is highest in Zimbabwe and lowest in Morocco. Such disparity may be attributed to easy access to tobacco products and the presence and implementation of anti-tobacco laws in these countries. For instance, although Zimbabwe has recently rati ed the WHO-FCTC, it remains the largest tobacco producer in Africa and it is known to contribute largely to the country's economy accounting for 10% of its GDP (12,31,32). It is believed that Zimbabwe's signing of the WHO-FCTC treaty is undermining efforts to enforce the stipulated measures as few of the laws implemented so far are aimed at reducing tobacco supply or protecting the environment (12). On the other hand, like other African countries, Morocco has signed and rati ed the WHO-FCTC and have laws prohibiting smoking in public places(8). Even though most countries in the African region have rati ed the WHO-FCTC(8), the high prevalence of cigarette smoking and any tobacco product use in our study suggest that little progress has been made over the years in preventing tobacco use among tobacco adolescents in many African countries. The stall in progress may be linked to a lack of human and nancial resources to implement tobacco control activities effectively. Also, the increased in uence of the tobacco industry and limited public support to implement tobacco control initiatives may explain the slow progress in implementing WHO-FCTC articles.
Regression analysis indicates that exposure to secondhand smoke within and outside the home is a predictor of tobacco use (cigarette, non-cigarette tobacco products) among school-going adolescents in the 22 African countries. Our nding is in line with previous global surveys in which exposure to secondhand smoke was found to be associated with tobacco use among school-going adolescents globally and in the African region (17,33) and studies conducted in Asian countries (34,35), USA(36, 37) and Europe(38). Our nding suggests that tobacco product use by a family member and smoking in public places, especially enclosed places, is a strong in uence on school-going adolescents tobacco use behaviour. Studies have reported that parental use of tobacco products predicts tobacco use among youths (39). Family and community in uence on adolescent tobacco product use may be explained because adolescents are likely to practice high-risk behaviours practised by their parents, siblings, and community members (40). Even more worrisome is the impact of secondhand smoke on those who are never smokers. A previous study in Africa found that a considerable number of never-smoking adolescents in Africa were exposed to secondhand smoke (41). In the same study, parental and peer smoking and less exposure antismoking media messages were associated with exposure to secondhand smoke (41). Children's exposure to secondhand smoke is considered a public health concern as it makes them become adult smokers in the future [42] and affects their health, given the hazardous chemicals, they inhale (42,43). A recent study among school-going Korean adolescents found that high concentrations of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and cotinine were present in the blood of children of smoking parent compared to those with non-smoking parents (44). Given the high prevalence of secondhand smoke and its association with tobacco use in our study and the fact that all of the countries considered in our study have recti ed WHO-FCTC suggest that more needs to be done in fully implementing article 8 of the WHO-FCTC. This can include implementing educational campaign for family and household members and enforcing a complete smoking ban at home and in public, especially enclosed household spaces.
Similarly, exposure to tobacco industry promotion was associated with tobacco product use (cigarette, non-cigarette tobacco products) among schoolgoing adolescents in the 22 African countries considered in our study. Our ndings are consistent with studies conducted elsewhere (45)(46)(47). Our nding may be attributed to the increased market in uence of the tobacco industry in many African countries(48). Such penetration has been attributed to weak legislation on tobacco promotion, less enforcement of existing law, low taxes on tobacco products, and innovative ways by the tobacco industry to reach young people (49)(50)(51). Some of the innovative ways young people have been reached include the use of School programmes and youth camps, provision of scholarships and the use of social media in uencers as brand ambassadors (50,52). Also, the tobacco industry is known to use subtle ways to in uence tobacco control policy development and implementation, and these include acquiring membership of critical policy-making committees and agencies, putting pressure on governments to in uence the work of tobacco enforcement institutions as well as the use of their corporate social responsibility programmes to shape public opinion (53). Also, there have been instances where the tobacco industry actively misled African governments in formulating and implementing tobacco control policies (11).In addition, a recent report by Jackson and colleagues highlights the unethical dealing of British American Tobacco in Africa to block or weaken tobacco control legislation, and these range from bribery, blackmailing governments to blocking potential competitors(9, 10). Going forward, governments in Africa need to fully enforce article 13 of the WHO-FCTC framework (54) to ensure that young people are prevented from tobacco industry promotions. The complete ban of all forms of tobacco advertisement, sponsorship and promotion will help to prevent young people from being exposed to a tobacco product.
Our study found that less than one in ve tobacco users were susceptible to using tobacco (12.1%). Our nding is in line with previous global and African estimates (16, 20) and what has been reported in Asian countries (55, 56) but lowers among Canadian and U.S. high school students(18, 57) in Mexico (19). With increased penetration of the tobacco industry in Africa, our nding suggests the need for more robust interventions to prevent neverusers of tobacco in these countries from initiating tobacco use and eventually becoming tobacco product users in their adulthood. Our nding also highlights the need for governments in these countries to formulate policies and interventions targeting young people in their pre-experimentation stages of tobacco use behaviour. Our study found no gender differences regarding susceptibility to using tobacco among never users as it has been reported in previous studies globally (20), in Africa (22), USA(58) and Pakistan(56) but was consistent with studies conducted in South East Asia countries (55) and in Mexico (19). Our nding supports the need for governments to adopt gender-neutral policies and interventions when targeting young people who are susceptible to using tobacco(59). Consistent with studies conducted globally [20] and in South East Asia [55], exposure to tobacco industry promotion was associated with increased susceptibility to using tobacco among non-users. This result further showcases the need for governments to impose a complete ban on tobacco promotion in line with article 13 of the WHO-FCTC framework (54). Knowledge about the harmful effects of SHS was associated with decreased susceptible to using tobacco among non-users in our study, and our result was in line with studies conducted in other regions (55,56). Also, our study shows that those who were against banning smoking in enclosed places were more likely susceptible to using tobacco among non-users, which indicate lack of knowledge about the harmful effects of secondhand smoke. Our ndings suggest the need for governments and other stakeholders to provide information to adolescents who are prone to using tobacco products regarding the harmful effects of secondhand smoke. Interventions can include the inclusion of harmful effects of secondhand smoke into high school curriculum, using social media social media in uencers to promote the harmful effects of secondhand smoke. Exposure to SHS outside the home was associated with increased susceptibility to smoking among never-smoking males but not females. Our nding is similar to a previous global study although such association was observed in both gender (20). Such a nding underscores the need for governments to create smoke free public spaces and further strengthen the enforcement of a complete ban on smoking in public enclosed spaces.

Strengths and Limitations
To the best of our knowledge, our study is the rst to examine the prevalence and correlates of tobacco use and susceptibility to using any tobacco product among school-going adolescents using the most recent GYTS datasets in 22 African countries. Notwithstanding, GYTS is a school-based survey, which means our ndings are only representative of school-going adolescents. Also, students provided self-reported responses and were therefore prone to recall bias. In addition, our study did not assess the in uence of contextual factors such as the presence or absence of national tobacco control plans across countries as data on such a variable was absent in the datasets. Further, given the cross-sectional nature of the GYTS, we cannot make causal inferences. There is a possibility for disparity in the current rates for some countries, given that we used the most recent data available from the GYTS, which dates back to 2013. However, our analysis is robust enough to be relied on for the studied population.

Conclusion
Our study has identi ed that approximately one in ve school-going adolescents are current users of any tobacco product in 22 African countries, with the highest and lowest prevalence observed in Zimbabwe and Morocco, respectively. Being male, exposure to SHS in and outside the home, not knowledgeable about the harmful effects of SHS, exposure to tobacco industry promotion and being against banning smoking in enclosed places were associated with the current use of any tobacco product. Less than one in ve of never users of tobacco were susceptible to using tobacco in our study. Not being knowledgeable about the harmful effects of SHS, exposure to tobacco industry promotion, and being against banning smoking in enclosed places were signi cantly associated with susceptibility to using tobacco among never users of tobacco. Our study provides a comprehensive insight into the tobacco use behaviour and an understanding of the early stages of tobacco use behaviour with the aim to implement policies and interventions that stop and prevent tobacco use among adolescents. As part of public health efforts, governments and other stakeholders need to fully implement anti-tobacco use campaigns, enforce a complete ban on tobacco promotion and advertising, institute anti-tobacco use educational programs for families, communities and schools in line with WHO-FCTC guidelines.
Abbreviations CI: Con dential Intervals Ethics approval and consent to participate: Ethics approval was not required for this study given that the GYTS data are deidenti ed and publicly available. The GYTS for the 22 countries received ethics approval from their respective Ministries of Health. A written informed consent was obtained from the parents and guardians of the students who participated in the survey. We con rm that methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication: Not Applicable
Availability of data and materials: The datasets analysed during the current study are publicly available via the WHO NCD Microdata Repository https://extranet.who.int/ncdsmicrodata/index.php/catalog/GYTS Competing interests: The authors declared no con ict of interest  Tables   Table 1 Sample distribution by country population characteristics of Global Youth tobacco survey male and female school-going adolescents in 22 African   Table 4 Predictors of current use of smoke tobacco other than cigarette among male and female school going adolescents in in 22 African Countries  Table 7 Predictors of susceptibility to using any tobacco product among never users of tobacco product among male and female school-going adolescents in in 22 African Countries susceptibility to using any tobacco product among never users of tobacco product AOR (95%CI)