Purpose: To assess tobacco use among school-going adolescents and delineate determinants of their tobacco-use status. Methods: The study utilizes Global Youth Tobacco Survey data collected in 2006 (9,990 unweighted; 773,982 weighted). Univariate and bivariate analyses were performed to determine the relationship between the dependent (tobacco-use status) and independent variables. Logistic regression analyses were conducted to identify the key determinants of tobacco use among adolescents in Ghana. Results: The gap in tobacco use between males and females was narrow (6.7% vs. 4.4% for ever cigarette smoker; 2.4% vs. 1.4% for current cigarette smoker; 6.8% vs. 5.2% for user of noncigarette tobacco products). Youth tobacco use was significantly associated with exposure to tobacco industry promotions and tobacco-use behavior of familial relations. Conversely, knowledge about the harmful effects of secondhand smoke was associated with decreased likelihood of tobacco use; however, it was significant only for users of noncigarette tobacco products. Conclusions: The narrow gap in tobacco use among school-going adolescents in a country where tobacco-use prevalence among adult males is more than 10 times that of females is a major policy concern. Additionally, the finding that about 15% of students have either acquired tobacco-branded merchandise or been offered a free cigarette suggest that tobacco marketing is reaching adolescents in the country, which demands urgent policy response. Dealing with such problems requires a comprehensive ban on tobacco industry advertising and promotion and marketing strategies, and policies that restrict youth access to and demand for tobacco products.