Prevalence and Factors Associated with Electronic Cigarette Use Among Adolescents Attending School in Four African Countries Using Global Youth Tobacco Survey Data from 2015 to 2019

In the modern world, the landscape of tobacco use is shifting. For decades, public health efforts focused on the dangers of burning tobacco leaves in cigarettes, a habit that has long been known to cause severe illness and death. Recently, however, a new type of product has entered the scene: electronic cigarettes. These devices heat a liquid to create an aerosol that users inhale, often marketed as a cleaner or more modern alternative to traditional smoking. While they are sometimes promoted as tools to help adults quit smoking, they contain nicotine, a substance that can be highly addictive and is particularly harmful to the developing brains of young people. As these products become more common, health officials worry that they might be drawing a new generation into nicotine dependence, potentially undoing years of progress made in reducing smoking rates. Understanding who is using these devices, where, and why is essential for creating rules that protect children and keep communities healthy.

A team of researchers set out to map this emerging trend across four African nations: Ghana, Mauritius, Seychelles, and Togo. They turned to a massive, standardized database known as the Global Youth Tobacco Survey, which collects information from students in schools around the world. By pooling data from over 15,000 students ranging in age from 11 to 17, collected between 2015 and 2019, the researchers could see a clear picture of how many young people were currently using electronic cigarettes and what factors might be driving that behavior. While the survey is designed to focus on the 13–15 age group, the actual sample included younger adolescents (11–12 years) and older teens (16–17 years). Their analysis revealed that while the overall use of these devices among school-going teens in these countries was relatively low at just under five percent, the situation was far from uniform. The use of electronic cigarettes was not evenly spread; it was significantly higher in the island nations of Mauritius and Seychelles compared to the mainland countries of Ghana and Togo. In Mauritius, for instance, the rate was more than double that of Ghana, suggesting that geography and local conditions play a major role in how quickly these products take hold.

The study dug deeper to understand what was happening inside the minds and social circles of these adolescents. The most powerful predictor of whether a student was using an electronic cigarette was simply whether they knew what one was. Students who had heard of these devices were far more likely to be using them than those who had not. This suggests that awareness itself acts as a gateway; once the concept is introduced, the likelihood of experimentation rises sharply. Beyond awareness, the researchers found that a student's history with other tobacco products was a strong indicator. Those who had ever tried a traditional cigarette or used smokeless tobacco were much more likely to be using electronic cigarettes as well. This points to a pattern where young people who are already experimenting with nicotine in one form are likely to try it in another. Social pressure also played a critical role; students who had friends that smoked were twice as likely to use electronic cigarettes, highlighting how peer behavior can normalize these products.

The researchers also looked at what might protect young people from starting to use these devices. They found that education and strong community rules were effective shields. Students who had been taught about the dangers of tobacco use in their schools were significantly less likely to use electronic cigarettes. Similarly, students who supported bans on smoking in public places were less likely to be users themselves. This suggests that when schools actively teach the risks and when communities enforce rules that keep public spaces smoke-free, young people are less likely to pick up these devices. Interestingly, the study noted that exposure to tobacco advertisements on television was actually associated with a lower likelihood of use, perhaps because such ads are less common now or because they are viewed with more skepticism, whereas exposure to radio ads was linked to higher use. The data also showed that students from lower socioeconomic backgrounds were more likely to use electronic cigarettes than their wealthier peers, indicating that economic factors cannot be ignored in the fight against this trend.

Despite the clear patterns, the researchers were careful to note the limits of their work. Because the data came from a single point in time, they could not prove that one thing caused another; they could only show that they happened together. The study was also limited to students who were still attending school, meaning it might have missed the most vulnerable youth who had dropped out. Furthermore, the data was collected before the rapid changes in the market and regulations that occurred after the global pandemic, so the current situation might look different today. Nevertheless, the findings provide a crucial baseline. They show that electronic cigarette use is no longer a negligible issue in these African nations, particularly in island states where it has taken deeper root. The study concludes that to protect young people, countries need to update their laws to specifically include electronic cigarettes, enforce bans on marketing, and ensure that schools continue to teach the dangers of nicotine. By addressing these factors, public health officials can hope to prevent a new generation from becoming addicted to a product that threatens their long-term health.