Objective: This report examines the prevalence and common correlates of early smoking initiation among male and female school children across seven African countries.

Method: The total sample included 17,725 school children aged 13 to 15 years from nationally representative samples in seven African countries. Univariate and multivariate analyses were conducted to assess the relationship between early smoking initiation, health compromising behaviours, mental distress, protective factors and socio-economic status variables.

Results: Overall 15.5% had experienced smoking initiation before age 14, with the percentages 20.1% among boys and 10.9% among girls. In multivariable analysis, early smoking initiation was among boys associated with ever drunk from alcohol use (OR=4.73, p=0.001), ever used drugs (OR=2.36, p=0.04) and ever had sex (OR=1.63, p=0.04). Among girls, it was associated with higher education (OR=5.77, p=0.001), ever drunk from alcohol use (OR=4.76, p=0.002), parental or guardian tobacco use (OR=2.83, p=0.001) and suicide ideation (OR=2.05, p=0.02).

Conclusion: The study found a high prevalence of early smoking initiation among 13-15 year-olds in seven African countries. Various risk factors have been identified in boys and girls who initiate smoking before age 14, forming a distinct risk group in this setting. Specific interventions are needed for boys and girls in the preteen years, before smoking initiation.