Use of Cigarettes and Other Tobacco Products among Primary and Secondary School Students in Khartoum State, Sudan

Introduction: In Sudan, tobacco use is common; it is used in some form by 20% of the population. As most users start during adolescence, we aimed to determine the prevalence of ever use of tobacco products (i.e. cigarettes, herbal cigarettes, shisha and tombak) among Sudanese adolescent males and females, and to assess associations between tobacco ever use and personal characteristics. Methods: This cross-sectional study was conducted in Khartoum State, Sudan. The study data were collected in June 2014. The target population consisted of adolescents in 8th grade of primary education or 1st and 2nd grade of secondary education. They were asked to fill in a written questionnaire during the school break. Schools were randomly selected using a stratified two-stage cluster sampling design method. Results: A total of 1229 respondents (56.4% male), with a mean age of 14.5 years, were included in the analysis. Prevalence of cigarettes, herbal cigarettes, shisha and tombak ever use were 13%, 7.8% 5.9% and 3.5%, respectively. Older respondents were significantly more likely to have ever smoked cigarettes. Males were found to be significantly more likely to have ever used any tobacco products. Urban adolescents were significantly more likely to have ever used shisha. Respondents were in the bottom third percentiles with regard to academic achievements, had an almost three-fold increased risk of having ever smoked a cigarette and were at least five-fold more likely to have ever smoked herbal cigarettes. Moreover, respondents in the middle third percentiles were more than twice as likely to have ever smoked herbal cigarettes. Conclusion: As uptake of tobacco products increased significantly with age among males with a middle and lower school performance living in urban areas, timely prevention targeting adolescents, such as school-based tobacco control programmes, are recommended. Our findings show that prevention should start in primary school.