Smoking attitudes between smokers and non-smoker secondary school students in three geographic areas of China: a cross-sectional survey based on social cognitive theory

Abstract

BackgroundAccording to a 2014 China youth tobacco report, nearly 7% of junior secondary school students are using tobacco products and 30% of junior secondary school boys have tried tobacco products. The attitudes of secondary school students to smoking give insight into the related factors affecting the smoking behaviours. The aim of this study was to assess smoking-related attitudes of secondary school students. MethodIn this cross-sectional study, we adopted the proportional sampling method to survey secondary school students in three areas, namely, Chongqing, Liaocheng, and Tianjin, China. We used a self-administered five-point Likert school student's smoking attitudes scale in Chinese based on social cognitive theory scale in English with established validity and reliability in the USA. This study was approved by the Ethics Committee of the Chongqing Medical University. All participants submitted written informed consent. FindingsWe included 1805 students (878 [49%] boys, 927 [51%] girls, mean age 16·16 years (SD 1·29 years) of whom 162 (9%) were smokers. 1462 (81%) students had never been taught about smoking or tobacco prevention at school. We observed significant differences between smokers and non-smokers in age (t=3·42, p=0·0006), sex distribution (16% boys vs 3% girls; χ2=84·2929, p<0·0001), nationality (16% Tujia population smokers vs 8% Han population smokers; χ2=21·3334, p<0·0001), academic performance in class (χ2=22·7234, p<0·0001). Non-smokers had significantly higher mean score of attitudes towards outcome expectations for not smoking (t=8·70, p<0·0001), outcome expectancies for not smoking (t=4·97, p<0·0001), not smoking (t=8·61, p<0·0001), and an environment not supportive to smoking (t=8·61, p<0·0001) than smokers. Smokers were significantly higher in the mean score of attitudes towards self-efficacy for not smoking (t=12·42, p<0·0001), self-efficacy in overcoming barriers while not smoking (t=11·81, p<0·0001), self-control for not smoking (t=10·43, p<0·0001), and emotional coping for not smoking (t=11·65, p<0·0001)” than non-smokers. InterpretationSmoking-related attitudes are significantly associated with smoking-related behaviour. This study provides more detailed consideration of how to prevent teenagers from smoking. Our findings indicate that smoking prevention programmes could focus on modifying attitudes based on social cognitive theory towards smoking. School classes about smoking or tobacco prevention need to be further strengthened. FundingScience & Technology Commission, Shapingba District, Chongqing, China (NO.PJ20140047).