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

Abstract Introduction E-cigarette use among African adolescents is poorly documented, yet early signals suggest rapid penetration. We analyzed recent Global Youth Tobacco Survey (GYTS) data from four contrasting countries to quantify prevalence, determinants and policy leverage points. Methods We used self-reported secondary data from the GYTS using a cross-sectional study design. Overall, 15 914 adolescents aged 13–15 years from grades 7–12 were surveyed across the four countries using stratified two-stage cluster sampling. Survey-weighted multivariable logistic regression models were used to identify independent factors associated with current e-cigarette use and estimate adjusted marginal probabilities. Adjusted odds ratios and their 95% confidence intervals are reported. All statistical tests were conducted using a significance level of 0.05, with results considered significant at p < 0.05. Results The overall current e-cigarette prevalence was 4.9% (95% CI: 4.85–4.95), with marked heterogeneity between countries. Awareness of e-cigarettes was the strongest correlate of current e-cigarette use (aOR = 5.56; 95% CI: 4.60–6.70), followed by ever tried cigarette smoking (aOR = 2.69; 95% CI: 2.15–3.36), and ownership of tobacco-branded merchandise (aOR = 2.69; 95% CI: 2.17–3.34). Support for smoke-free public places (aOR = 0.56; 95% CI: 0.47–0.68) and school-based tobacco education (aOR = 0.53; 95% CI: 0.43–0.64) conferred significant protection. Conclusion E-cigarette use among school going adolescents in Mauritius, Seychelles, Ghana and Togo is no longer negligible with island states and young adolescents disproportionately affected. There is a need to integrate e-cigarettes into existing smoke-free laws, enforcing marketing bans and scaling classroom education. These findings offer valuable evidence to guide tobacco control. Clinical trial number: not applicable