Abstract
Objective: To estimate the prevalence and social, psychological and environmental-structural determinants of tobacco experimentation among adolescents in Shanghai, China. Methods: We conducted a cross-sectional study based on a two-stage cluster sample design by using the Chinese version of the Global Youth Tobacco Survey (GYTS) to investigate smoking behavior among 19,117 students from 41 junior and senior high schools in Shanghai, China. The association between potential factors and tobacco experimentation were assessed using complex samples procedure logistic regression. Results: Of the 19,117 respondents, 10.5% (15.3% boys and 6.2% girls) reported the tobacco experimentation. The main social, psychological, and environmental-structural factors associated with tobacco experimentation were having close friends who smoke (AOR = 8.21; 95% CI: 6.49–10.39); one or both parents smoking (AOR 1.57; CI: 1.39–1.77); a poor school tobacco control environment (AOR 1.53; CI: 1.37–1.83); a high acceptance level of tobacco use (AOR 1.44; CI: 1.28–1.82); and a high level of media tobacco exposure (AOR 1.23; CI: 1.10–1.37). Peer smoking might contribute to smoking experimentation among girls (AOR 8.93; CI: 5.84–13.66) more so than among boys (AOR 7.79; CI: 5.97–9.94) and media tobacco exposure had no association with tobacco experimentation among female students. Conclusions: Social, psychological, and environmental factors are closely associated with tobacco experimentation among adolescents. Prevention programs aimed at reducing teen tobacco experimentation should be conducted at home and school with support by parents, peers and teachers. Our findings should prove useful for future development of intervention strategies among adolescents in Shanghai, China.
Highlights
Tobacco is a leading cause of preventable morbidity and mortality globally and it exerts a substantial negative impact on people’s health [1,2]
We found that the peer smoking contributed to tobacco experimentation among girls (AOR 8.93; confidence intervals (CI): 5. 84–13.66) more so than among boys (AOR 7.59; CI: 5.79–9.94)
The World Health Organization (WHO) requested that countries repeat the Global Youth Tobacco Survey (GYTS) every three years for 13–15 year old students from junior high school [3] and we suggested that such requests should be extended to include students from 16–18 year old from senior high schools as well
Summary
Tobacco is a leading cause of preventable morbidity and mortality globally and it exerts a substantial negative impact on people’s health [1,2]. The World Health Organization (WHO) estimates that approximately over 1 billion people smoke tobacco currently, among whom 12% of adolescent boys and 7% of adolescent girls smoke cigarettes [3,4]. According to nationally representative data from the Global Adult Tobacco Survey (GATS) conducted during 2008–2010, the estimated prevalence of current tobacco use among adults aged 15 years and above is 28.1%, which corresponds to nearly 0.38 billion smokers in China in year 2010 [7]. Current estimates are that one million people in China will die annually of diseases related to smoking, and this will increase to two million by 2025 [8]. Studies in developed countries show that most people begin using tobacco in their teens, and assessing tobacco use by youth through the Global Youth Tobacco
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