Tobacco and nicotine product use among adolescents in Sub-Saharan Africa: protocol for a cross-sectional multi-country household survey

Lyagamula Kisia^1*Shukri Farah Mohamed¹Grace Kyule¹Christelle Tchoupe^2,3Olatunbosun Abolarin⁴Retselisitsoe Pokothoane^5,6Terefe Gelibo Agerfa^5,7Samuel Iddi¹Boscow Okumu¹Nelson Mbaya¹Damazo T Kadengye¹Didier Munguakonkwa Mirindi³Akinsewa Akorede Akiode⁸Thompson Ademola⁸Uche Okezie⁴Noreen Mdege^10,5,9

• ¹African Population and Health Research Center (APHRC), Nairobi, Kenya
• ²Laboratory for Survey & Research for Development, Douala-Bonanjo,, Cameroon
• ³Research Initiatives for Social Development (RISD), Bukavu, Democratic Republic of Congo
• ⁴APIN PUBLIC HEALTH INITIATives, Abuja, Nigeria
• ⁵Development Gateway: An IREX Venture, Washington, United States
• ⁶School of Economics, Faculty of Commerce, University of Cape Town, Cape Town, Western Cape, South Africa
• ⁷ICAP, Columbia University Mailman School of Public Health, Addis Ababa, Ethiopia
• ⁸Research and Communications Services Ltd (RCS), Lagos, Nigeria
• ⁹University of York, York, United Kingdom
• ¹⁰Centre for Research in Health and Development, York, United Kingdom, York, United Kingdom

Introduction: The use of tobacco among adolescents in low-and middle-income countries, is a public health issue of concern. The tobacco industry's aggressive marketing tactics target young people in African countries, leading to early initiation of tobacco use. While existing evidence focuses on 13-15-year-olds, data from Sub-Saharan Africa indicates that smoking initiation ranges from as young as 7 years old to around 16 years old. The lack of data on adolescent tobacco use in African countries limits policymakers' ability to implement evidence-based tobacco control policies. This study aims to address the critical lack of quality and timely primary data on adolescent tobacco use thereby enhancing the country's capacity to target interventions effectively, engage local governments, and attract global attention and funding for adolescent health initiatives. Methods: We will conduct a cross-sectional nationwide survey among adolescents aged 10 -17 years in urban and rural areas of the Democratic Republic of Congo (DRC), Kenya and Nigeria. This household-based survey will utilize a multi-stage stratified sample design to ensure representation across diverse geographic and demographic characteristics. The sample size calculations resulted in nationally representative samples of 6,701 adolescents in Kenya, 4,803 adolescents in the DRC, and 7,948 adolescents in Nigeria.Discussion: Through this initiative, we aim to catalyze action at national and international levels to combat the tobacco epidemic among adolescents in SSA. The findings from the DaYTA study will empower stakeholders to advocate foradvocate effective tobacco control measures, promote adolescent health, and safeguard future generations from the harmful effects of tobacco use.