Factors associated with current tobacco use among Zambian adolescents using the 2021 Global Youth Tobacco Survey

Current tobacco use, defined as use of any tobacco product within the previous 30 days, remains a major public health concern globally, as early initiation increases the risk of long-term addiction, morbidity, and premature mortality. In Zambia, evidence on adolescent tobacco use and its multi-level drivers remains limited. This study examined the prevalence of current tobacco use and the individual, interpersonal, and environmental factors associated with tobacco use among Zambian adolescents. We analyzed secondary data from the 2021 Zambia Global Youth Tobacco Survey (GYTS), a nationally representative school-based cross-sectional survey of adolescents aged 11–17 years. The primary outcome was current tobacco use (CTOB), defined as the use of any tobacco product, including cigarettes, hand-rolled cigarettes, other smoked tobacco, smokeless tobacco, or electronic cigarettes, within the past 30 days. Guided by a socio-ecological framework, explanatory variables were grouped into individual, interpersonal, and environmental levels. Survey-weighted modified Poisson regression with robust variance estimation was used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals. Among 6,274 adolescents, the overall prevalence of current tobacco use was 38.0%. Prevalence was highest among adolescents in tobacco-growing regions (51%) and lowest in Lusaka (25%). Higher tobacco use was associated with susceptibility to future tobacco use (aPR = 1.66), peer smoking (aPR = 1.24), second-hand smoke exposure at home (aPR = 1.50), seeing teachers smoke at school (aPR = 1.24), tobacco availability near schools (aPR = 1.15), and ownership of tobacco-branded items (aPR = 1.29). Knowledge that tobacco causes cancer (aPR = 0.83), perceived harm of second-hand smoke (aPR = 0.75), and school-based education on the dangers of tobacco use (aPR = 0.74) were protective. Current tobacco use among Zambian adolescents is shaped by a combination of behavioural, social, and environmental influences. Strengthening school-based prevention, smoke-free environments, regulation of tobacco marketing, and enforcement of age-of-sale laws is essential to reduce early tobacco initiation and progression to regular tobacco use and prevent long-term tobacco-related health consequences.