Prevalence and Predictors of Shisha Smoking in Ghana and Sierra Leone: Findings from the 2017 Global Youth Tobacco Surveys

Introduction Rising shisha use among young people in Africa is a growing public health challenge. Yet in countries like Ghana and Sierra Leone, there remains a critical gap in understanding the behavioral patterns and underlying factors driving this trend. Methods We retrieved secondary data from a public sphere collected using a cross-sectional study design. Overall, 12,281 students in grades associated with 11-18 year olds were selected using stratified two-stage cluster sampling. Descriptive statistics estimated smoking prevalence by age, sex, school grade, country, and survey year. Multivariate logistic regression models were used to determine associations between socio-demographic, behavioural, tobacco policy factors and current Shisha smoking. Adjusted odds ratios and their 95% confidence intervals are reported. Results The overall prevalence of current shisha smoking was 7.2% (7.8% males and 6.6% of females). The prevalence was slightly higher in Sierra Leone (7.69%, 95% CI: 7.05-8.33) than Ghana (6.58%, 95% CI: 5.94-7.23). Adolescents who did not support banning tobacco sales to minors had higher shisha use (7.96%, 95% CI: 7.34-8.57) than their counterparts (6.01%, 95% CI: 5.34-6.67). Participants who smoked cigarettes, were more likely to smoke shisha compared to those who did not smoke (AOR = 9.86; 95% CI: 7.84–12.38; p < 0.001). Conclusion Shisha smoking among school-going adolescents in Ghana and Sierra Leone reviewed emerging patterns suggesting early initiation and strong association with cigarette use. There is a need for stronger enforcement of tobacco control policies, targeting poly-tobacco use control and factors influencing early initiation. These findings provide valuable insight to inform tobacco control. Clinical trial number: not applicable