Objectives:
The use of tobacco by youth constitutes a major public health problem globally as well as in South Africa. Early onset of smoking increases the risk of contracting a wide range of potentially fatal diseases. Therefore, the aim was to assess the prevalence and risk factors of tobacco smoking in youth.

Methods:
Cross-sectional study across five medical male circumcision (MMC) sites in three provinces in South Africa among young healthy men aged 10-18 years. Data were collected on demographics, tobacco (positive urine cotinine test) and dagga smoking, risky behaviour, and alcohol consumption. A CO breathalyser test was done to categorise smokers as either mild, moderate or severe. Multivariable logistic regression was used to determine risk factors of tobacco smoking.

Results:
Of the 1109 participants, 68.9% were aged 10-14 years, 93.3% were in school/studying, 17.7% and 41.0% had mothers and fathers who smoke, 10% (105/1088) of participants were tobacco smokers with 51.7% being severe smokers. Participants aged 15-18 years were more likely to have anyone smoking indoors in the past 30 days (32.0% vs. 19.8%, p<0.0001), to smoke tobacco (86.7% vs. 13.3%, p<0.0001) and to have smoked marijuana (25.6% vs. 0.4%, p<0.0001). In the multivariate analysis, the odds for tobacco smoking were higher for age (OR: 1.360; CI: 1.186-1.558), those not in school (OR: 2.408; CI: 1.117-5.192), often have anyone smoking inside their home (OR: 2.047; CI: 1.103-3.798), have smoked marijuana (OR: 8.789; CI: 4.551-16.97) and drink alcohol (OR: 4.368; CI: 2.261-8.439).

Conclusions:
The prevalence of tobacco smoking increased with age. Participants who were not in school, have smoked marijuana and drink alcohol had higher odds of smoking tobacco. Therefore, it is vital to develop interventions that will help prevent initiation of smoking among youth. This will be helpful in decreasing future tobacco associated mortality rates.

Funding:
Perinatal and HIV Research Unit for internally funding the study as well as Soweto Matlosana SAMRC Collaborating Centre for HIV/AIDS and TB (SoMCHAT).