Current tobacco use and associated factors among school-going adolescents in the Republic of Congo: Secondary analysis of the 2019 Global Youth Tobacco Survey and development of a simple identification score

Data on adolescent tobacco use in the Republic of Congo are scarce, despite a 2012 tobacco control law and 2018 decrees banning smoking in public places and tobacco advertising, promotion and sponsorship. This study aimed to estimate current tobacco product use among Congolese middle school students, identify associated factors, and develop a simple score to identify current use. Secondary analysis of the cross-sectional 2019 Global Youth Tobacco Survey (GYTS). Current use was defined as self-reported use, in the past 30 days, of cigarettes (CR7), other smoked tobacco products (CR10) or smokeless tobacco (CR14). The estimates and regression models accounted for the sampling weights, 34 strata and 70 primary sampling units. A point-based score was developed from eight questionnaire-based factors and evaluated via cross-validation, which was grouped by primary sampling unit. Among the 6,297 students with a usable tobacco use status, 842 reported current use; the weighted prevalence was 13.5% (95% CI: 11.1–16.3%). The full model included 5,251 students, 597 of whom were current users. Being offered free tobacco by a tobacco company representative (aOR = 3.05), exposure to smoke at home (aOR = 2.71), seeing teachers smoke at school (aOR = 2.60) and exposure to smoke in enclosed public places (aOR = 2.02) were associated with current use. The score, ranging from 0 to 18 points, had a weighted AUROC of 0.771 in the development data and 0.765 in the grouped cross-validation data. Current tobacco use affects a substantial proportion of middle-school students. The associations with social and commercial exposures support the strengthening of prevention and the enforcement of existing legislation. The score is exploratory and requires external validation before any operational use.