Cigarette smoking among junior high school students in Beijing, China, 1988

Prevalence of smoking among adolescents in China: an updated systematic review and meta-analysis

OBJECTIVES

Smoking is a major public health problem worldwide. Estimates for smoking prevalence among adolescents in different regions and in the whole of China are important for the development of public health policies. We conducted a systematic review and meta-analysis to estimate the prevalence of smoking among youth in China.

STUDY DESIGN

This is a meta-analysis study.

METHODS

English (PubMed, EMBASE) and Chinese (China National Knowledge Internet, WANFANG Data, and CBM) databases were independently searched by two investigators from inception to May 2019. Random effects meta-analysis was conducted to estimate the pooled prevalence of smoking. Subgroup analysis and meta-regression were performed to investigate sources of heterogeneity. This study is registered with PROSPERO, number CRD42019130803.

RESULTS

In total, 131 articles were included in the meta-analysis, with a total of 146 studies, involving 684,370 Chinese participants. The total prevalence of smoking among youth in mainland China was 8.17% (95% confidence interval: 6.97-9.45). Subgroup analysis showed that the geographic location and gender could significantly influence the prevalence of smoking. Meta-regression analyses revealed study year, sex ratio (male, %), and response rates did not contribute to the heterogeneity of the results (P-value >0.05). Sensitivity analysis showed that the results were statistically stable.

CONCLUSION

This meta-analysis indicates that smoking is common among adolescents in China, and the rate varies between different regions. More practical and effective policies targeting adolescents are urgently needed.

Cigarette Smoking Habits among High School Boys in the United Arab Emirates

This study reports on findings of a survey of smoking behavior and attitudes of approximately 1500 public secondary school boys in three major cities of the United Arab Emirates (UAE), one of the most rapidly developing societies in the world. Using an adaptation of the World Health Organizations Smoking Questionnaire and a multi-stage cluster sample of public schools and classes, the survey determined that 18.9 percent were current smokers and another 28.2 percent had smoking experience but were not active at the time of the study. The majority of smokers were not UAE nationals and had begun smoking between the ages of ten to fifteen. Almost 60 percent of current smokers reported modest consumption of one to six cigarettes daily and nearly two-thirds reported a desire to stop their smoking. Smokers also were much more likely to come from families in which other family members smoked. Implications of findings for prevention programs point to a broad public and school-based effort for the UAE.

Smoking behaviors and intentions among adolescents in rural China: the application of the Theory of Planned Behavior and the role of social influence

INTRODUCTION

This study investigated the associations between the variables of the theory of planned behavior (TPB), influence of significant others, and smoking intentions and behaviors among adolescents living in rural southern China.

METHODS

A cross-sectional study was conducted among 2609 students in two junior high schools in rural Shantou, Guangdong province, using a self-administered questionnaire. Logistic regression models were fitted to estimate univariate and adjusted odds ratios and corresponding 95% confidence intervals.

RESULTS

Multivariate analyses showed that having favorable attitudes towards smoking on psychological and social aspects, perceived behavioral control, and having most friends who were current smokers were significantly associated with smoking intentions in the next six months and in the next five years. Having most family members who were current smokers was also significantly related to smoking intention in the next five years. Having favorable attitudes towards smoking on psychological aspect and negative attitudes on physical aspect, perceived support from friends on smoking, and having most friends and senior relatives being current smokers were significantly associated with increased likelihood of ever smoking. Perceived behavioral control and having most friends being current smokers were also significantly associated with regular smoking and smoking in the past 30days.

CONCLUSIONS

Our results suggest that the key constructs of the TPB model and friends' smoking behaviors play important roles in accounting for smoking intentions and behaviors among a sample of rural Chinese adolescents.

The Association Between School Bonding and Smoking Amongst Chilean Adolescents

BACKGROUND

The objective of the research was to study the association between school bonding dimensions (school commitment and school attachment) and current adolescent smoking in Chile, controlling for confounding variables using the fifth Chilean School Population National Substance Use Survey, 2003 (CHSS-2003) data set.

METHODS

The CHSS-2003 is a stratified cross-sectional survey that gathers information about personal, familial, peer, and school factors and cigarette use using a self-reported questionnaire. Complete data from 21,956 adolescent students for all the variables of interest were used in the analyses. An exploratory factor analysis (EFA) was performed in order to explore the construct validity of the questionnaire and create the main exposure and potential confounding variables. Multivariable logistic regression analyses were undertaken to study the association between school bonding and smoking.

RESULTS

The construct validity of the school attachment and school commitment scales was mainly supported by the EFA. Multivariable analyses showed strong evidence that, after adjusting for factors from different domains, school commitment (student's good grades and school attendance) appears to have a clear inverse association with current smoking (odds ratio [OR]=0.46, 95% confidence interval [CI]: 0.38-0.56). On the other hand, school attachment (their feelings towards their school and their teachers) was not associated with adolescent smoking (OR=1.16, 95% CI: 0.88-1.53).

CONCLUSIONS

School commitment was strongly associated with current smoking. It is important to further study this variable with the aim of ascertaining whether or not interventions that improve school commitment may prevent or reduce smoking amongst adolescent students.

A Protection Motivation Theory-Based Scale for Tobacco Research among Chinese Youth

Rates of tobacco use among adolescents in China and other lower and middle-income countries remain high despite notable prevention and intervention programs. One reason for this may be the lack of theory-based research in tobacco use prevention in these countries. In the current study, a culturally appropriate 21-item measurement scale for cigarette smoking was developed based on the core constructs of Protection Motivation Theory (PMT). The scale was assessed among a sample of 553 Chinese vocational high school students. Results from correlational and measurement modeling analysis indicated adequate measurement reliability for the proposed PMT scale structure. The two PMT Pathways and the seven PMT constructs were significantly correlated with adolescent intention to smoke and actual smoking behavior. This study is the first to evaluate a PMT scale for cigarette smoking among Chinese adolescents. The scale provides a potential tool for assessing social cognitive processes underlying tobacco use. This is essential for understanding smoking behavior among Chinese youth and to support more effective tobacco use prevention efforts. Additional studies are needed to assess its utility for use with Chinese youth in other settings.

The Qingdao Twin Registry: a status update

In 1998, the Qingdao Twin Registry was initiated as the main part of the Chinese National Twin Registry. By 2005, a total of 10,655 twin pairs had been recruited. Since then new twin cohorts have been sampled, with one longitudinal cohort of adolescent twins selected to explore determinants of metabolic disorders and health behaviors during puberty and young adulthood. Adult twins have been sampled for studying heritability of multiple phenotypes associated with metabolic disorders. In addition, an elderly twin cohort has been recruited with a focus on genetic studies of aging-related phenotypes using twin modeling and genome-wide association analysis. Cross-cultural collaborative studies have been carried out between China, Denmark, Finland, and US cohorts. Ongoing data collection and analysis for the Qingdao Twin Registry will be discussed in this article.

Risk factors for adolescent smoking in urban and rural China: findings from the China seven cities study

Cigarette smoking is rising among urban Chinese adolescents and poses a significant public health concern. The majority of Chinese youth live in rural areas, but most research on the risk factors for smoking has been conducted in urban areas of China. This study examined the associations between parental smoking, peer smoking, and low refusal self-efficacy and smoking among urban and rural Chinese youth. This analysis used a cross-sectional sample of 3412 ninth grade students in urban and rural areas under the administrative jurisdiction of seven large cities in China. Multilevel logistic regression models were used to associate the risk factors with lifetime and current smoking, separately in boys and girls. Adolescent smoking was not strongly associated with parental smoking. However it was strongly associated with peer smoking and low refusal self-efficacy across both the urban and rural samples. Students with lower refusal self-efficacy were approximately 5-17 times more likely to be lifetime or current smokers than those with higher refusal self-efficacy. Smoking prevention interventions in China may need to focus on raising adolescents' refusal self-efficacy.

Age-related smoking progression among adolescents in China

PURPOSE

This study examined the differences in smoking progression between middle and upper school students.

METHODS

The China Seven Cities Study (CSCS) is a longitudinal cohort study. The current sample consists of subjects with both baseline and one-year follow-up measures collected between October 2002 and December 2003. There were 4842 students from 62 middle schools and 5806 students from 83 upper schools. Multilevel random-coefficient modeling techniques were applied.

RESULTS

Among male never or lifetime ever smokers, middle school students were susceptible to transitioning more rapidly than upper school students (never--RR: 1.272, 95% confidence interval [CI]: .985-1.642; lifetime ever--RR: 1.497, 95% CI: .979-2.290). Among female lifetime ever smokers, middle school students were more likely to progress than upper school students (RR: 1.353, 95% CI: 1.038-1.763).

CONCLUSION

This longitudinal study is the first to explore differences in smoking progression among adolescents in China. The results revealed that over a one-year interval, there was greater progression across smoking trajectories during early adolescence (corresponding to middle school) than later adolescence (upper school). This is consistent with the neurological development hypothesis, but does not rule out alternative explanations. These findings are important to consider relative to the content and timing of prevention interventions in China where smoking rates approach 70% in adult males and are increasing rapidly in women.

Influences affecting adolescent smoking behavior in China

This study examined multiple influences on the use of tobacco by adolescents in China. Using the theory of triadic influences as a guide, we selected interpersonal, attitudinal/cultural, and intrapersonal constructs from baseline data to predict adolescent smoking 1 year later. We used prospective data from middle and high school students (N = 11,583) and their parents from the China Seven Cities Study, a longitudinal study that is evaluating the effects of changing economic and social factors on health behaviors including tobacco use. A multilevel regression analysis provided some support that each of the influences in the theory of triadic influences affects adolescent smoking in China. After adjusting for important confounders including age, gender, socioeconomic status, and smoking behaviors (lifetime and past 30-day) at baseline, we found significant risk factors within each of the three categories, including interpersonal influences (parental monitoring, good friend smoking, and peer smoking), attitudinal/cultural influences (school academic ranking, initial liking of smoking, and the meaning of smoking), and intrapersonal influences (susceptibility to smoking, and low self-confidence to quit smoking). Results suggest that the etiology of smoking among adolescents in China might be similar to that observed in western countries and that some of the techniques used successfully in prevention programs in those countries might be useful guides when developing prevention programs in China.

Family characteristics and smoking among urban and rural adolescents living in China

BACKGROUND

Adolescent smoking is a public health concern in China. Although the family is an important social influence in China, few associations among family characteristics and adolescent smoking have been examined using Chinese samples.

METHODS

Survey data on psychosocial variables and smoking were collected from a sample of 3629 7th grade adolescents (46% female; 54% male; mean age 12.7 years) in Wuhan, China. For adolescents, past 30-day smoking, family relationships, parents' negative sanctioning of smoking, parents' agreement with smoking, and parents' smoking behaviors are assessed. To account for the clustered data structure, hierarchical logistic regression analyses controlling for demographics (urbanization, age) examined the independent and multivariate effects of family characteristics for each gender.

RESULTS

Girls are less likely than boys to report smoking and are more likely to report positive family relationships, and having parents with negative attitudes toward them smoking. Positive family relationships and age were strongly associated with smoking for both genders. No significant differences exist by gender.

CONCLUSION

These findings suggest that the quality of family relationships are important for adolescent female and male smoking in China.

Project EX--a teen smoking cessation initial study in Wuhan, China

The increasing smoking prevalence in China indicates a need for effective smoking cessation programs, yet, to our knowledge, no studies have evaluated the effects of smoking cessation programs among Chinese adolescents. A group of 46 10th-grade-level cigarette smokers from two schools in Wuhan, China, were provided with Project EX, an eight-session school-based clinic smoking cessation program developed in the United States. Efforts of translation of the Project EX curriculum, verification of translation, curriculum modification, and cultural adaptation were made to adapt the curriculum to the local culture. The 46 smokers represented 71% of all the self-reported 30-day smokers among 622 10th graders at these two schools. Only one student dropped out from the clinic program. Four-month follow-up data indicated a 10.5% 30-day quit rate and a 14.3% 7-day quit rate. The students who did not quit smoking reported a 16% reduction in daily cigarette consumption at posttest and a 33% reduction at 4-month follow-up. Use of a 2 1/2-week prebaseline-to-baseline clinic assessment indicated a clinic cohort nonassisted quit rate of 3%. These data provided evidence that Project EX can be adapted in another country, such as China; can be very well received; and can lead to promising results on cessation.

Factors related to smoking habits of male adolescents

A cross-sectional study was conducted to identify the factors related to smoking habits of adolescents among secondary school boys in Kelantan state, Malaysia. A total of 451 upper secondary male students from day, boarding and vocational schools were investigated using a structured questionnaire. Cluster sampling was applied to achieve the required sample size. The significant findings included: 1) the highest prevalence of smoking was found among schoolboys from the vocational school; 2) mean duration of smoking was 2.5 years; 3) there were significant associations between smoking status and parents' smoking history, academic performance, perception of the health hazards of smoking, and type of school attended. Peer influence was the major reason students gave for taking up the habit. Religion was most often indicated by non-smokers as their reason for not smoking. Approximately 3/5 of the smokers had considered quitting and 45% of them had tried at least once to stop smoking. Mass media was indicated as the best information source for the students to acquire knowledge about negative aspects of the smoking habit. The authors believe an epidemic of tobacco use is imminent if drastic action is not taken, and recommend that anti-smoking campaigns with an emphasis on the religious aspect should start as early as in primary school. Intervention programs to encourage behavior modification of adolescents are also recommended.

Family harmony as a protective factor against adolescent tobacco and alcohol use in Wuhan, China

PURPOSE

To investigate the association between family harmony (FH) and tobacco and alcohol use (TAU) in Chinese adolescents.

METHODS

Participants completed a survey in 1998 as part of a larger study of adolescent health in Wuhan, China. Analyses were performed on subjects for whom complete data were available (n = 183; 50.8% male; mean age = 13.17 yrs, std dev = 0.59). Structural equation modeling was utilized to quantify the relationships between the FH, TAU, depression, and academic aptitude factors.

RESULTS

The conceptualized structural equation model was found to have a good fit to the data (CFI = 0.995; chi2 = 39.57 df = 38; p = 40). FH was a significant predictor of TAU (beta = -0.42, p < 0.05) and was protective. FH' was also negatively related to depression (r = -0.24, p < 0.05) and positively related to academic achievement/aptitude (r = 0.35, p < 0.05).

CONCLUSIONS

These central findings highlight the value and importance placed on FH within the Chinese culture. Future prevention programs may benefit by taking into account FH as a potential mediator of TAU in adolescents in China.

Peer influences and access to cigarettes as correlates of adolescent smoking: a cross-cultural comparison of Wuhan, China, and California

BACKGROUND

Few studies have assessed the effects of access to cigarettes and peer influences on adolescent smoking in non-Western countries. Using samples characterized by two distinct cultural, social, and economic systems, this study evaluated the associations of friends' smoking and perceived access to cigarettes with adolescent smoking behavior in California and Wuhan, China.

METHODS

Survey data were obtained from 5870 eighth-grade students in the Independent Evaluation of the California Tobacco Control Program and 6992 seventh- to ninth-grade students in the Wuhan Smoking Prevention Trial. Odds ratios for lifetime and 30-day smoking, according to friends' smoking and perceived access to cigarettes, were calculated for boys and girls in both samples and compared.

RESULTS

California students were more likely than Wuhan students to have friends who smoked and to perceive easy access to cigarettes. The smoking prevalence was lower in Wuhan than in California, mainly due to the low smoking prevalence among Wuhan girls. Friends' smoking was strongly associated with smoking in both samples, and the strength of this association did not differ between the two cultures. Access to cigarettes was associated with a higher risk of lifetime smoking in both cultures and a higher risk of past 30-day smoking in California only.

CONCLUSIONS

Despite divergent tobacco control policy enforcement, social structures, and cultural contexts, similarities exist between Wuhan and California. The findings suggest support for adapting a social-influences-based smoking prevention program developed in the United States to the culturally specific needs of youth in Wuhan, China.

Adolescent smoking in Wuhan, China: baseline data from the Wuhan Smoking Prevention Trial

BACKGROUND

This study reports the prevalence of adolescent smoking in the urban and rural areas of Wuhan, China, the capital of Hubei Province, on the Yangtze River in central China.

METHODS

Smoking behavior was examined by age, gender, and urbanicity as part of the Wuhan Smoking Prevention Trial. Subjects included 6994 seventh- to ninth-grade students attending 22 randomly selected schools in urban and rural districts. Outcome measures included lifetime smoking, past-30-day smoking, established smoking (>100 cigarettes in lifetime), and susceptibility to smoking (absence of a firm commitment not to smoke).

RESULTS

Lifetime smoking prevalence was 47% among boys and 18% among girls. Past-30-day smoking prevalence was 16% among boys and 4% among girls. Established smoking prevalence was 2% among boys and 0% among girls. The prevalence of susceptibility to smoking was 31% among boys and 10% among girls. Smoking increased significantly with age (p<.0005). Susceptibility was more prevalent in rural areas than in urban areas (p<.05), but there were no urban-rural differences in lifetime, past 30-day smoking, or established smoking. Trend analyses revealed that smoking increased with age more rapidly among boys than among girls (p<.05). Smoking was more prevalent among rural boys than among urban boys, but it was more prevalent among urban girls than among rural girls (p<.05).

CONCLUSIONS

Adolescent smoking is a significant public health problem in China. Boys are at particularly high risk, as are girls living in urban areas. Effective smoking prevention programs for adolescents, as well as restrictions on tobacco industry marketing and youth access to tobacco, are needed to prevent tobacco-related morbidity and mortality in China.

Hazard of smoking initiation by age among adolescents in Wuhan, China

BACKGROUND

Knowledge about age of smoking initiation among adolescents in China is helpful for exploring cultural differences in adolescent smoking behavior and informative for global tobacco control. However, little has been documented on this issue.

METHOD

Adolescents (6,473) attending grades 7, 8, and 9 completed the baseline survey of a longitudinal, randomized smoking prevention trial. Data were collected in classrooms with a paper-and-pencil questionnaire. A survival model was used in the statistical analysis.

RESULTS

The hazard of smoking initiation for boys showed a pattern previously observed in the United States: very low (<2%) before 7 years of age, increasing rapidly after age 10, and peaking at 14-15 years of age. The hazard for girls was below or around 1% until 12 years of age before it increased. The hazard levels were similar for adolescents both in urban and in rural areas, but higher for those in grade 7 than in grades 8 and 9.

CONCLUSIONS

Chinese boys in Wuhan, China, experienced a hazard pattern of smoking initiation by age similar to those observed in the United States, while Chinese girls there experienced a rather low risk of smoking initiation. The hazard pattern suggests that the best time for smoking prevention is between 10 and 15 years of age. Adolescents in lower grades are at higher risk of early smoking initiation, suggesting a potential cohort effect in adolescent smoking initiation in Wuhan, China.

Cigarette smoking habits among high school boys in a developing country

The aim of this cross-sectional study was to determine the habits, practices, attitudes and knowledge about cigarette smoking among high school boys aged 15-19 years in the United Arab Emirates, and to provide a basis for comparisons with international data. The World Health Organisation questionnaire was used, together with a multi-stage stratified cluster sampling technique; 1,700 subjects aged 15 years and above were randomly selected. A total of 1,486 individuals (87.4%) from among the populations of Al-Ain City, Abu-Dhabi and Dubai Emirates participated in the study. The prevalence of smoking among the studied group was 19%; 28.2% admitted that they had smoked before but had now given up, and the remaining 52.9% denied having ever smoked. Among 18-year-olds (or older) 30.3% smoked. In 70.8% of cases a friend was reported as having been the first source of their cigarette. Fifty-four percent of smokers started between the age of 10 and 15 years. The families of 15.7% of those studied approved of their smoking, while 78.3% did not: 6% did not have an opinion. Nearly two-thirds of the smokers (66.5%) wanted to stop smoking, while the remaining third (33.5%) did not. Differences in parental education (specifically that of the father) were found to have a significant effect on attitudes towards smoking. Contrary to expectations, the highest prevalence of smoking was found among sons of university graduates, and the lowest among sons of illiterate fathers (12.6% and 24.3%, respectively). There was a statistically significant difference in respect to family income and smoking. Among the ex-smokers, religion (40%) and health (26%) were important reasons for giving up smoking. Of the smokers, 33% claimed that stress is the most important factor which makes people smoke. The source of the student's information regarding smoking hazards was lowest from doctors (17-19%), and highest from the media (35%). All student groups were equally aware that smoking is a risk factor for lung cancer, respiratory diseases, and ischaemic heart diseases, but among the smokers only 28.9% were very concerned about the harmful effects of cigarettes. At the time of their graduation (18 years or older), one-third of the students were already regular smokers, a figure liable to increase as they start university or work.

Smoking behavior among adolescents in the city, suburbs, and rural areas of Shanghai

PURPOSE

The study was designed to investigate differences in predisposing factors, enabling factors, reinforcing factors, and smoking behavior among middle school students living in the city, suburbs, and rural areas of Shanghai.

DESIGN

A one-time cross-sectional survey design was applied in this study.

SETTING

The study was conducted in 11 schools in three areas.

SUBJECTS

A total number of 1116 students from these three areas participated in this study. The response rates were 92, 88, and 84% for city, suburbs, and rural areas, respectively.

MEASURE

A PRECEDE instrument including predisposing, enabling, and reinforcing factors was employed to collect data. A Multivariate Analysis of Variance (MANOVA) and Multiple Regression Analysis were used to analyze the data.

RESULTS

Smoking was reported by 39.8% of boys and 5.14% of girls. Students in the city of Shanghai had the best (against smoking) predisposing factors, but students in rural areas had the best (against smoking) enabling and reinforcing factors and consumed the fewest cigarettes.

CONCLUSION

Results indicated that smoking behavior in students was affected strongly by enabling factors and reinforcing factors that were related to socioeconomic, cultural, and environmental influences in China.

The relationship between cigarette smoking and education revisited: implications for categorizing persons' educational status

OBJECTIVE

This study sought to reassess the relationship between cigarette smoking and education.

METHODS

Data from the 1983 to 1991 National Health Interview Survey for participants aged 25 years and older were used to plot the prevalence of current smoking, ever smoking, heavy smoking, and smoking cessation, as well as the adjusted log odds ratios, by years of education.

RESULTS

The "less than high school graduate" category consisted of two groups with distinct smoking patterns: persons with 0 to 8 years and persons with 9 to 11 years of education. The latter were the most likely to be current, ever, and heavy smokers and the least likely to have quit smoking, whereas the former were similar to persons having 12 years of education. After 11 years of education, the likelihood of smoking decreased and that of smoking cessation increased with each successive year of education. These results persisted after the statistical adjustment for age, sex, ethnicity, poverty status, employment status, marital status, geographic region, and year of survey.

CONCLUSIONS

The relationship between smoking and education is not monotonic. Thus, when evaluating smoking in relation to education, researchers should categorize years of education as follows: 0 to 8, 9 to 11, 12, 13 to 15, and 16 or more years.

Parental smoking and sociodemographic factors related to smoking among German medical students

Smoking among medical students has been found to vary strongly between European countries. Few studies have addressed factors associated with smoking among medical students within countries. In this study, we assessed the association of parental smoking and sociodemographic factors with smoking habits of medical students at the University of Ulm, Germany, Students who entered the 1st, 3rd and 5th year of medical school in fall 1992 were asked to complete a self-administered questionnaire. Questionnaires were returned by 696 (85.2%) of 817 eligible students. Overall, 23.7% of students were current smokers, and 11.9% were former smokers. Smoking habits were related to maternal smoking: Odds ratios for the association of maternal smoking with ever or current smoking of students were 2.11 (95% CI: 1.48-3.03) and 2.01 (95% CI: 1.35-3.01), respectively, after adjustment for potential confounders in multiple logistic regression. In contrast, no association was found between paternal smoking and students' smoking status. Male students were more likely to smoke than female students, and living in a large city during secondary school was also associated with ever smoking. No association was found between students' smoking habits and educational achievement of their mothers and fathers. These results suggest a key role of maternal smoking for smoking among medical students in this society.

Cigarette smoking and its risk factors among elementary school students in Beijing

OBJECTIVES

This study investigated patterns of and risk factors for smoking among elementary school children in Beijing, China.

METHODS

In 1988, anonymous questionnaires were administered to a multistage stratified cluster sample of 16996 students, aged mostly 10 to 12, in 479 fourth- to sixth-grade classes from 122 Beijing elementary schools.

RESULTS

Approximately 28% of boys and 3% of girls had smoked cigarettes. The most frequently cited reasons for smoking initiation were "to imitate others' behavior" and "to see what it was like." Girls were more likely to get cigarettes from home than to purchase their own. Having close friends who smoked and being encouraged by close friends to smoke were strong risk factors for smoking. Smoking was also associated with lower parental socioeconomic status; having parents, siblings, or teachers who smoked; buying cigarettes for parents; performing poorly in school; and not believing that smoking is harmful to health.

CONCLUSIONS

Gender differences in smoking prevalence among adolescents in China are larger than those among US teenagers, whereas the proximal risk factors for smoking are similar. Major efforts are needed to monitor and prevent smoking initiation among Chinese adolescents, particularly girls.

Prevalence of tobacco use among school and college going adolescents of Haryana

The prevalence of tobacco use among the school and college going adolescents of Haryana, a state in northern India was studied. 1130 male and 256 female students were given a self administered questionnaire regarding tobacco use. 160 (14.2%) male and 6 (2.3%) female students reported to have smoked at any time in the past. The prevalence of current smoking (defined as smoked in last one week) was only 7.1%. Of the 166 ever smokers, 44% had started this habit between 10 to 15 years of age. There was no rural-urban difference. Univariate analysis showed, male sex, age > 15 years, smoking by father, mother, sister, and friends to be significantly associated with smoking by the adolescent children. By logistic regression, only smoking by friend (O.R. 6.14), brother (O.R. 1.74) and male sex (O.R. 4.67) were found to be significantly associated with smoking by adolescent children. About 8% of the smokers were spending more than Rs. 10 per week on this habit. Both the smokers and non smokers were well aware of the adverse health effects of smoking indicating that mere provision of information on hazards of smoking may not be enough to reduce the prevalence of smoking. A more concerted effort for inducing behavioural change including legislation, communication is called for the fight against smoking.

Smoking among high school students in 10 Italian towns: patterns and covariates

The associations between tobacco smoking and demographic, socioeconomic, environmental, and behavioral factors among adolescents were investigated by administering an anonymous questionnaire to 5,221 ninth (aged 14-15 years) and 4,154 thirteenth grade (aged 18-19 years) students in 10 Italian towns. Using logistic regression analysis, both current smoking and experimental smoking were statistically associated with sibling, best friend, and partner smoking, alcohol drinking, and frequency of drunkenness in both grades and sexes. Attitude of parents toward children's smoking was also found to be associated with the probability of being a current smoker, especially among ninth graders. Parental smoking was associated with current smoking among females only. Socioeconomic factors and level of knowledge of the health consequences of smoking were not associated with either experimental or regular smoking. In conclusion, this survey suggests that social environment plays a fundamental role in both first experimentation with smoking and the process of becoming a regular smoker among adolescents. Students with one or more siblings who smoke, and especially those with best friends and a partner who smoke, were much more likely to have tried smoking and to be current smokers than students without smokers in their environment.