Comment on “Modifiable family and school environmental factors associated with smoking status among adolescents in Guangzhou, China”

Abstract

Chen and colleagues describe social factors that are related with Chinese adolescent smoking behaviors [Chen, W., Wen, X., Muscat, J., et al., 2007-this issue. Modifiable family and school environmental factors associated with smoking status among adolescents in Guangzhou, China. Prev. Med. doi:10.1016/j.ypmed.2007.02.009]. These types of studies in China are very much needed given the fact that smoking is a significant health problem in China. Environmental factors may be more important than sometimes thought, since some studies suggest that smoking onset may not be such a ‘reasoned’ process by youngsters (Kremers, S.P., Mudde, A.N., de Vries, N.K., Brug, J., de Vries, H., 2004. Unplanned smoking initiation: new insights and implications for interventions. Patient Educ. Couns. 55 (3), 345–52.). Studies indicate that a multitude of factors are related to smoking onset, and thus deserve attention in a smoking prevention approach (see, e.g., [Tyas, S., Pederson, L., 1998. Psychosocial factors related to adolescent smoking: a critical review of the literature. Tob. Control 7, 409–420; Lantz, P., Jacobson, P., Warner, K., et al., 2000. Investing in youth tobacco control: a review of smoking prevention and control strategies. Tob. Control 9, 47–63]). The study conclusions were derived from a cross-sectional report. Consequently, one needs to be careful in making conclusions about causal pathways [Bauman, K., Fisher, L., 1986. On the measurement of friend behavior in research on friend influence and selection: findings from longitudinal studies of adolescent smoking and drinking. J. Youth Adolesc. 15 (4), 345–353]. Longitudinal studies also suggest the impact of selection mechanisms implying that adolescents were not pressured to start to smoke, but selected smoking friends. Chen, W., Wen, X., Muscat, J., et al.'s [2007-this issue. Modifiable family and school environmental factors associated with smoking status among adolescents in Guangzhou, China. Prev. Med. doi:10.1016/j.ypmed.2007.02.009.] work is important because it describes one of the many steps that are needed in China for realizing effective smoking prevention programs, a study that could be described as one of the first steps in the planning cycle of health promotion [Green, L., Kreuter, M., 1999. Health Promotion Planning: An Educational and Ecological Approach. Mayfield Publishing Company, Mountain View, CA]. Ultimately Chen and colleagues may want to develop smoking prevention interventions. These interventions should indeed incorporate the modifiable social factors, and – as the Chinese data suggest – should be gender sensitive. Consequently, the great challenge for Chen and several other Chinese colleagues will be to develop an integral long-term approach for their country to prevent smoking onset as effectively as possible using comprehensive approaches.