Prevalence of Tobacco Smoking and Associated Factors Among High School Students in Harar Town, Eastern Ethiopia: A School-Based Cross-Sectional Study

Background Tobacco use during adolescence is an important public-health concern because early initiation increases the likelihood of continued tobacco use and dependence. This study assessed the prevalence of tobacco smoking and factors associated with ever smoking among high school students in Harar town, eastern Ethiopia. Methods A school-based cross-sectional study was conducted among 467 students in grades 9-12 from selected public and private high schools in Harar town. Data were collected using a self-administered questionnaire adapted from the Global Youth Tobacco Survey. Descriptive statistics and binary logistic regression were used. Variables were entered into a multivariable logistic regression model based on the prespecified analytical approach, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated. Statistical significance was declared at p<0.05. Results Among 467 students, 64 (13.7%; 95% CI 10.9-17.1%) reported ever smoking tobacco, while 25 (5.4%; 95% CI 3.7-7.8%) were current smokers. In the SPSS multivariable logistic regression model, grade 11 (AOR 10.61, 95% CI 3.52-31.97) and grade 12 (AOR 12.18, 95% CI 3.95-37.53), alcohol drinking (AOR 2.60, 95% CI 1.25-5.40), khat chewing (AOR 9.57, 95% CI 4.04-22.65), and access to tobacco (AOR 3.18, 95% CI 1.58-6.43) were independently associated with ever smoking. Male sex, age [&ge;]18 years, and grade 10 were not statistically significant in the adjusted model. Conclusion Ever smoking was reported by approximately one in seven students and current smoking by about one in twenty. Alcohol drinking, khat chewing, access to tobacco, and higher grade were independently associated with ever smoking. School- and community-based tobacco prevention should address substance use and the availability of tobacco products around schools.