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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

Background Despite public health intervention, exposure to secondhand smoke, specifically in the home, remains high. Secondhand smoke has been linked to several health outcomes however there is limited information on how secondhand smoke impacts on severity of smoking. Methods We report interim results of a cross-sectional study among young men (10-34 years) attending five Voluntary Medical Male Circumcision (VMMC) clinics in South Africa. Data were collected on participant and parental smoking status; exposure to secondhand smoking and alcohol consumption. A qualitative urine test for cotinine and a breathalyser test for Carbon monoxide measured in parts per million (COppm) were administered. COppm scores were classified into two categories: moderate/mild and severe. Secondhand smoking was defined as exposure to indoor and family members smoking. Logistic regression was used to determine risk factors associated with severe smoking. Results Of the 2465 participants, median age 20 (IQR: 13-27) years, 32.5% (785/2418) tested positive for urine cotinine of which 98.6% (774/785) had a COppm result. COppm result showed 53.2% (412/774) were severe smokers, 46.8% (362/774) were moderate/mild smokers. A total of 46.3% (189/408) of severe smokers reported often having someone smoking in their home of whom 27.8% (72/259) reported that their mother and 59.9% (100/167) report that their father smokes. Overall, 80.3% (330/411) of severe smokers self-reported drinking alcohol. Multivariate analysis adjusting for age and alcohol use showed that severe smoking was associated with often exposure to indoor smoking at home (OR: 1.612 95%CI: 1.195-2.173) and to family members that smoke (OR: 3.495 95%CI: 1.413-8.646). Conclusions Family members who smoke and alcohol use put young men at risk of severe smoking. Rules and social norms must encourage smokers to smoke outside of their houses. Policy interventions should focus on highlighting the risks and reducing the prevalence of secondhand smoking.