Published in PLOS One on 2026-08-31, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Grace Kyule, Samuel Iddi, Noreen Dadirai Mdege, Lyagamula Kisia, Terefe Gelibo Argefa, Olatunbosun Abolarin, Didier M Mirindi, Retselisitsoe Pokothoane, Boscow Okumu, Nelson Mbaya, Franklin Koech, James Kavai, Akinsewa Akiode, Thompson Ademola, Uche Okezie, Fakorede JI, Christelle Tchoupé, Damazo T Kadengye, Shukri F Mohamed, Bijit Biswas
Source: PLOS One • DOI 10.1371/journal.pone.0356891
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
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.
Introduction
Tobacco use during adolescence is a major public health concern, as most adult smokers initiate use before the age of 18 years [1–4], and early initiation increases the likelihood of nicotine dependence, prolonged tobacco use and subsequent tobacco-related diseases later in life [3,5,6]. Globally, an estimated 12% of adolescents aged 13–15 years old use some form of tobacco [7,8]. While tobacco use has declined in many high-income countries, the overall prevalence of tobacco use among adolescents remains high in low- and middle-income countries (LMICs) [7]. LMICs, particularly in sub-Saharan Africa (SSA), are at risk of a rising adolescent tobacco epidemic, driven by a rapidly expanding adolescent population and increasing tobacco industry marketing and investment, exposing adolescents to a variety of products including smoked tobacco (e.g., cigarettes and shisha) and smokeless tobacco (e.g., snuff and chewing tobacco) [9].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Grace Kyule, Samuel Iddi, Noreen Dadirai Mdege, Lyagamula Kisia, Terefe Gelibo Argefa, Olatunbosun Abolarin, Didier M Mirindi, Retselisitsoe Pokothoane, Boscow Okumu, Nelson Mbaya, Franklin Koech, James Kavai, Akinsewa Akiode, Thompson Ademola, Uche Okezie, Fakorede JI, Christelle Tchoupé, Damazo T Kadengye, Shukri F Mohamed, Bijit Biswas. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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