title: Age of smoking initiation among adolescents in Africa.
abstract: OBJECTIVE
  To estimate prevalence and identify correlates of age of smoking initiation among adolescents in Africa.
  
  
  METHODS
  Data (n = 16,519) were obtained from nationally representative Global Youth Tobacco Surveys in nine West African countries. Study outcome was adolescents' age of smoking initiation categorized into six groups: ≤7, 8 or 9, 10 or 11, 12 or 13, 14 or 15 and never-smoker. Explanatory variables included sex, parental or peer smoking behavior, exposure to tobacco industry promotions, and knowledge about smoking harm. Weighted multinomial logit models were conducted to determine correlates associated with adolescents' age of smoking initiation.
  
  
  RESULTS
  Age of smoking initiation was as early as ≤7 years; prevalence estimates ranged from 0.7 % in Ghana at 10 or 11 years age to 9.6 % in Cote d'Ivoire at 12 or 13 years age. Males, exposures to parental or peer smoking, and industry promotions were identified as significant correlates.
  
  
  CONCLUSIONS
  West African policymakers should adopt a preventive approach consistent with the World Health Organization Framework Convention on Tobacco Control to prevent an adolescent from initiating smoking and developing into future regular smokers.
authors: Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Ewing Hall Suite 1.128, Galveston, TX, USA. spveeran@utmb.edu.
authors: Sreenivas P
authors: SP
authors: Veeranki
authors: Indian Institute of Technology, Jodhpur, Rajasthan, India.
authors: Rijo M
authors: RM
authors: John
authors: School of Public Health, University of Ghana, Legon, Accra, Ghana.
authors: Abdallah
authors: A
authors: Ibrahim
authors: Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Ewing Hall Suite 1.128, Galveston, TX, USA.
authors: Divya
authors: D
authors: Pillendla
authors: Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors: James F
authors: JF
authors: Thrasher
authors: Department of Biostatistics and Epidemiology, Health Policy and Management, College of Public Health, East Tennessee State University, Johnson City, TN, USA.
authors: Daniel
authors: D
authors: Owusu
authors: Tobacco Control, WHO Regional Office for Africa, Brazzaville, Congo.
authors: Ahmed E O
authors: AE
authors: Ouma
authors: Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors: Hadii M
authors: HM
authors: Mamudu
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000354:Africa, Western / Q000453:epidemiology; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D040541:Marketing; D010379:Peer Group; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D062789:Tobacco Products
keywords: Adolescent; Africa; Age of smoking initiation; Global Youth Tobacco Survey