Tobacco Smoking Behaviour and Awareness of Associated Health Risks among Secondary School Students in Calabar, Cross River State, South South Nigeria

Background: Tobacco use initiation commonly occurs during adolescence and is closely linked to lifetime addiction, lung disease, and cardiovascular complications. Cross River State in South South Nigeria has seen rising reports of tobacco use among young people, yet detailed local studies remain sparse. This study assessed the prevalence of tobacco smoking and related health risk awareness among secondary school students in Calabar. Methods: A cross-sectional descriptive survey was conducted among 350 students selected through multistage sampling from five secondary schools. A self-administered questionnaire captured demographic data, smoking behaviour, peer influence, access to tobacco products, and awareness of health consequences. Results: The prevalence of current smoking was 12.6 percent, higher in males (18.4%) than females (6.8%). Awareness of cancer risk was high (78%), but awareness of cardiovascular and reproductive health risks was below 40 percent. Peer influence was the most commonly cited initiation factor (54%). Availability of cigarettes near school premises was reported by 71 percent. Conclusion: Tobacco use among Calabar secondary school students is notable and warrants evidence-based school health programmes. Enforcement of regulations restricting tobacco sales near schools must be prioritised. Keywords: tobacco smoking, adolescents, Calabar, health risk awareness, secondary school