Taiwanese Adolescents Research Articles

From childhood victimization to internalizing and externalizing behavior problems through self-esteem in adolescence.

In this study, we aimed to determine whether forms of victimization influence internalizing and externalizing behavior problems differently and whether these relationships are mediated by self-esteem. This study included 2321 Taiwanese adolescents aged 11-21 from a previous case-control study. Six forms of victimization, self-esteem, and seven behaviors were measured. Gender, age, group (justice-involved vs. high-school adolescents), and family dysfunction were covariates in generalized linear models and path analysis. Different forms of childhood victimization were associated with different internalizing and externalizing behavior problems. Additionally, psychological abuse and psychological neglect were negatively associated with self-esteem, which itself was associated with all internalizing and externalizing behavior problems. Significant indirect effects of psychological abuse and psychological neglect on all internalizing and externalizing behavior problems (mediated by self-esteem) were also identified. Due to the limitation of measurement, the interpretation about the influence of victimization patterns could not be made. Findings suggest that different forms of childhood victimization may lead to different mechanisms for internalizing and externalizing behavior problems in adolescents. Further research is needed to identify the mechanisms underlying different forms of childhood victimization and to clarify the effects of victimization patterns to develop effective interventions.

Association between Emotional Eating and Frequency of Unhealthy Food Consumption among Taiwanese Adolescents.

Emotional eating is one factor that increases the consumption of unhealthy food. This study aimed to investigate the association between emotional eating and frequencies of consuming fast food, high-fat snacks, processed meat products, dessert foods, and sugar-sweetened beverages (SSBs) in adolescents. The baseline survey data (2015) from the Taiwan Adolescent to Adult Longitudinal Study (TAALS) were fitted into multivariate logistic regression models adjusted for sex, school type, Body Mass Index (BMI), eating while doing something, nutrition label reading, skipping breakfast, smoking, binge drinking, sedentary lifestyle, physical activity, peer and school support, and parental education level. Among the 18,461 participants (48.5% male and 51.5% female), those exhibiting emotional eating were more likely to consume fast food (Odds ratio (OR) = 2.40, 95% Confidence interval (CI): 2.18–2.64), high-fat snacks (OR = 2.30, 95% CI: 2.12–2.49), processed meat products (OR = 1.92, 95% CI: 1.78–2.08), dessert foods (OR = 2.49, 95% CI: 2.31–2.69), and sugar-sweetened beverages (OR = 1.83, 95% CI: 1.70–1.98). Factors that were positively associated with unhealthy food consumption included eating while doing other activities, binge drinking, smoking, and sedentary lifestyle. Among all the covariates, nutrition label reading was the only factor that was inversely associated with frequent unhealthy food consumption. Sex and school type may moderate the effect of emotional eating on the frequent consumption of specific unhealthy food groups. In conclusion, adolescents with high emotional eating were more likely to report frequent consumption of unhealthy foods in Taiwan. Our findings showed that male participants appeared to consume fast foods, high-fat snacks, processed meat, and SSBs more often and dessert foods less often than females. Future longitudinal studies are recommended for understanding the causal relationship between emotional eating and unhealthy food consumption.

Rate of condom use among sexually active adolescents: a nationwide cross-sectional study in Taiwan from 2012 to 2016

ObjectiveAdolescents’ sexual behaviours are associated with sexually transmitted infections and unwanted pregnancies. This study aimed to estimate the sexual intercourse and condom use rates at first and last sex among...

Psychosocial stress, self-esteem, and social adjustment: A moderated mediation analysis in Taiwanese adolescents with Tourette syndrome

PurposeRecent studies have shown that tics and related comorbidities can cause poorer social adjustment, lower self-esteem, and higher psychosocial stress among adolescents with Tourette syndrome. This study explored the role of self-esteem in mediating the relationship between psychosocial stress and social adjustment among adolescents with Tourette syndrome, and the role of comorbidities in moderating the relationship between self-esteem and social adjustment. Design and methodsIn this descriptive cross-sectional study, 118 Taiwanese adolescents with Tourette syndrome aged between 12 and 20 years old were recruited via convenience sampling. Their demographic information, Yale Global Tic Severity Scale, stress index for children and adolescents with Tourette syndrome, social adjustment scale for adolescents with Tourette syndrome, and Self-Esteem Scale results were collected. Moderated mediation analysis of the study data was performed with the Hayes's PROCESS macro. ResultsOur results revealed that the self-esteem of adolescents with Tourette syndrome fully mediates the relationship between their psychosocial stress and social adjustment (B = −0.0703, 95% CI, [−0.0176, −0.001]), while comorbidities moderates the relationship between their self-esteem and social adjustment (B = −0.8416, 95% CI, [−1.4529, −0.2302]). The relationship between self-esteem and social adjustment was more pronounced in adolescents without comorbidities than those with comorbidities. ConclusionsPsychosocial stress correlates negatively with social adjustment and self-esteem, and indirectly influences social adjustment through self-esteem, while comorbidities (particularly their absence) moderates the relationship between self-esteem and social adjustment. Practice implicationsDifferent self-esteem strengthening programs to enhance social adjustment for adolescents with Tourette syndrome may be developed in future studies.

Is Brisk Walking an Effective Physical Activity for promoting Taiwanese Adolescents' Mental Health?

PurposeThe aim of the study was to examine if brisk walking is an effective physical activity for promoting adolescents' mental health. Design and methodsThis quasi-experimental study employs a one-group repeated-measure design. Sixty-four volunteer students in 10th to 12th grade were recruited from a high school in central Taiwan, and they participated in a brisk-walking program for 12 weeks. Psychological functioning was measured by self-concept, anxiety, and depression scores (Beck Youth Inventories-Second Edition; BYI-II). Measurements were conducted at baseline, and 4, 10 and 16 weeks after baseline. The effects of the program were analyzed using generalized estimating equations (GEE). ResultsSignificant decreases were seen in anxiety and depression and an increase in positive self-concept. The effect of physical activity on anxiety was clear and could be observed after 6 weeks of the brisk-walking program. Brisk walking for 30-, 60-, and 90-min sessions was examined, with the 60-min session proving more effective than shorter or longer sessions. ConclusionsThe results suggest that a 12-week brisk-walking program may be effective both at decreasing depression and anxiety and at improving self-concept. The study also showed that anxiety could be considered a risk factor for depression. Further, self-concept was found to be a mediator acting on the psychosocial mechanism of physical activity promoting mental health in adolescents. Practice implicationsWhile most physical activity programs in past studies combined different activities, the present study demonstrated that brisk walking alone is a simple, effective exercise regime that promotes adolescents' mental health.

Delayed Romantic Experience: Association of Romantic Relationship and Weight Change Patterns over 7 Years among Taiwanese Adolescents

Stigmatization of overweight and obese individuals is common in interpersonal relationships. This study investigated longitudinal weight change patterns among Taiwanese adolescents and the relationship of weight change patterns with delayed romantic experience from late adolescence to young adulthood by using a representative panel survey. Individuals were divided into six weight change pattern categories according to changes in their body mass index. Two-stage stratified and clustered sampling was used to obtain a representative student sample, and 1,834 junior high school students were followed up over 7 years. Persistent obesity and a change from an underweight to a normal weight status over 7 years were independently associated with delayed romantic experience in both sexes. Moreover, females but not males who changed from an underweight or normal weight status to an overweight or obese status had increased odds of delayed romantic experience. Persistent obesity should be addressed early in life because it plays a crucial role in delayed romantic experience.

An Effective Life-Sex-Emotions Course for Taiwanese Adolescents on Health Perceptions: A Cohort Study.

Aim: Adolescence is a time of transition from childhood to adulthood, when young people go through a number of vital physical and psychological developments. It is surprising yet unfortunate that the number of teenage suicide deaths and teenage infections of gonorrhea have increased over the years, becoming serious public health concerns in Taiwan. The aim of this study was to investigate the effect of an education course on teenagers' understanding of adolescence and their attitudes toward life, sex, gender equality, and mental health.Material and Methods: Participants were comprised of Taiwanese students in Grades 5 to 9 who completed a Life–Sex–Emotions course, titled “Sailing through Adolescence.” The effect of the course was measured using pre- and post-test scores on the Perception Index of Life–Sex–Emotions Education (PILSEE) instrument. Qualitative data included subjective responses to questions before and after the course. Data were collected between September 2017 and June 2020.Results: A total of 10,506 completed questionnaires were collected. The mean PILSEE pretest scores for each subscale ranged from 8.71 to 13.37 (SD = 1.499–1.99); posttest subscale scores ranged from 9.30 to 13.95 (SD range = 1.490–2.288). The mean overall pretest score was 86.86 (SD = 10.83); the mean posttest score was 92.62 (SD = 10.30). The paired t-test demonstrated that post-test scores were significantly higher than pretest scores (t = 55.46; p < 0.01). Qualitative feedback indicated that the course improved students' self-esteem, their understanding adolescence, and awareness of influences of the media.Conclusion: Our findings indicate that an educational course about life, sex, and emotions during adolescence can be an effective intervention to help teenagers understand the impact of adolescence on attitudes toward life, sex, mental health, and gender equality.

Trajectory of Food Insecurity and Its Association with Longitudinal Mental Health and Sleep Outcomes in Adolescents from Economically Disadvantaged Families.

Background: Adolescence is a critical transition period in the course of human development. Although food insecurity (FI) has been shown to be associated with adverse mental health and sleep outcomes in US adolescents, there is a paucity of research examining the relationships between FI, mental health, and sleep outcomes in Taiwanese adolescents. Furthermore, it is unknown how the change of FI over time (i.e., the trajectory of FI) is related to health outcomes. Methods: The data come from the Taiwan Database of Children and Youth in Poverty, which is a national longitudinal project measuring FI in five survey waves (2009–2017). We employed group-based trajectory modeling to classify various FI trends over the five waves using STATA. Furthermore, a generalized estimating equation analysis was conducted with FI trajectories as the independent variable to see how FI trajectory is related to mental health and sleep outcomes. Results: In total, 1921 participants aged 12–18 years in the first wave were deemed valid for the analysis. We classified the participants into four FI trajectory groups: persistently low FI (24.8%), persistently moderate FI (64.7%), declining from high to low FI (4.1%), and food-secure groups (6.4%). As compared to food-secure adolescents, the persistently moderate FI group was more likely to have mental problems (β = 0.30, [95% confidence interval 0.21–0.38]), while the other FI groups were only marginally associated with mental health problems. Moreover, adolescents in the persistently low FI group (β = 0.13, [0.02–0.23]) and persistently moderate FI group (β = 0.39, [0.29–0.48]) were found to have more sleep problems than those in the food-secure group. Conclusions: Our study describes the FI profile of adolescents from economically disadvantaged families and the difficulties they might encounter. With this information, healthcare providers can aid adolescents in the early stages of mental health problems and provide guidance when appropriate.

Self-Sacrifice Is Not the Only Way to Practice Filial Piety for Chinese Adolescents in Conflict With Their Parents

We applied the theoretical perspective of the dual filial piety model to consider the diversity of parent–child conflict resolution strategies in order to determine whether Chinese adolescents use strategies other than self-sacrifice to practice filial piety when in conflict with their parents. Study 1 utilized a cross-sectional design with 247 valid responses. The structural equation modeling analysis indicated that Taiwanese adolescents’ authoritarian filial piety (AFP) beliefs are positively related to use of a self-sacrifice strategy, and reciprocal filial piety (RFP) beliefs are positively related to use of compatibility and compromise strategies. Adolescents’ AFP and RFP beliefs are negatively related to use of utility and escape strategies. Study 2 applied a temporal separation procedure with a 1-year lag to remedy common method variance bias. Analysis of 1,063 valid responses replicated the findings of Study 1 and indicated that adolescents’ function-oriented appraisal of conflict can play a mediating role between RFP and the use of the compatibility and compromise strategies. These findings broaden the understanding of filial piety in modern Chinese societies and have implications for adolescents’ well-being and family life.

The impact of caregiver stigma on real-life social experience of Taiwanese adolescents with autism spectrum disorder.

Caregivers of people with autism spectrum disorder commonly experience stigma. As a result, they may avoid contact with others, in turn, influencing their child's social participation. This study aimed to explore the impact of stigma perceived by the caregivers on the everyday social experience of Taiwanese adolescents with autism spectrum disorder. We asked 76 adolescents with autism spectrum disorder who did not have intellectual disability (69 males, aged 10-16 years) to carry a mobile device for 7 days. The device prompted them 7 times each day to record who they were interacting with, what they perceived, and how they felt about their social interactions. In addition, we asked their caregivers to complete the Affiliate Stigma Scale to measure their experience of stigma. We found that participants whose caregivers perceived high levels of stigma were more likely to spend time with family members and less likely to be interested in interacting with people at school. Those participants also were more likely to experience anxiety while interacting with family. Our study suggests that it is important for clinicians to implement support services for adolescents with autism spectrum disorder and help caregivers in managing stigma to promote their child's social participation.

Cyber deviance among adolescents in Taiwan: Prevalence and correlates

Using a nationally representative dataset from Taiwan, this paper reports the prevalence of cyber deviance among adolescents and examines its association with gender, age, parental monitoring, substance use, offline delinquent behavior, school bullying and victimization, and life satisfaction. 1,928 students from junior high (grades 7–9) and senior high (grades 10–12) schools participated in this study. Students were given an anonymous questionnaire including items regarding basic demographics and deviant behaviors in cyber space. The results showed that cyber deviance is prevalent among Taiwanese adolescents. Of all forms, digital/media piracy was the most common, followed by illegal website visits and online flaming, and lastly, by internet pornography. Logistic regression analyses showed that substance use and school bullying perpetration are associated with the presence of all forms of cyber deviance. In addition, females were more likely to engage in online flaming. Male adolescents and seniors and those with offline delinquency history and a low level of life satisfaction were more likely to engage in internet pornography and visiting illegal websites. School bullying victimization was associated with the presence of internet pornography. However, the association between parental monitoring and each form of cyber deviance was non-significant. These findings implied that policy and intervention programs need to tackle cyber deviance at a national level. The potential policy and programs should target senior students and aim to promote adolescent life satisfaction and reduce student’s risk of being bullied in school. To maximize their effectiveness, such programs should focus on tackling adolescents’ problematic offline behaviors, including substance use, school bullying, and delinquency.

The longitudinal interaction of adolescents’ interest in physical education, school burnout, and disturbed sleep related to social media and phone use

This study attempted to explain the relationship of disturbed sleep related to social media and phone use, interest in physical education, and school burnout. A longitudinal survey of two waves was conducted among 2304 eighth- and ninth-grade Taiwanese adolescents of an average age of 13.89 years (SD = .76) at Time 1. Cross-lagged modelling revealed that school burnout at Time 1 was positively associated with disturbed sleep related to social media at Time 2; however, the reverse association was not substantial. Moreover, students’ interest in physical education at Time 1 did not significantly predict either school burnout or disturbed sleep at Time 2. In contrast, adolescents who had elevated school burnout tended to report lower interest in physical education later, with a very small effect size for practical significance. Physical activities may not easily break the bond of the negative factors of burnout and disturbed sleep unless special programmes are designed.

Proposing and Validating the Diagnosis Scale for Internet Gaming Disorder in Taiwanese ADHD Adolescents: Likert Scale Method Based on the DSM-5.

The paper aims to adjust the Taiwanese version of Internet gaming disorder-short form Likert scale with Likert (IGD-SF-T-L) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria to a Likert scale model and test its psychometric property among children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Confirmatory factor analysis (CFA) was conducted for validity and the Cronbach’s α for reliability of IGD-SF-T-L. The ROC (receiver operating curves) was used to propose the cut-off point for assessing the instrument’s psychometric properties and its corresponding indices for the diagnostic accuracy. In total, 102 children and adolescents with ADHD were recruited. The construct validity of IGD-SF-T by CFA was model well fitted with excellent reliability (Cronbach’s α = 0.918). The ROC using the Chen’s CIAS > 56 as the state variable for IGD diagnosis showed the AUC (areas under the curves) was 0.918. The cut-off point proposed for IGD-SF-T-L to indicate a diagnosis of IGD was ≥ 10. The corresponding indices of accuracy: sensitivity, specificity, LR (likelihood ratio) +, LR-, and AUC were 0.893, 0.826, 5.134, 0.130, and 0.859, respectively. The proposed IGD-SF-T-L is an adequate, standardized psychometrical measurement for diagnosing IGD among Taiwanese adolescents with ADHD. More attention should be paid toward recent ADHD youth with Internet gaming disorder and their family.

Education tracking and adolescent smoking: a counterfactual and prospective cohort study.

Adolescent smoking is a health issue and a potential health inequality issue. Education tracking, which is the placement of students into different school types and curricula based on their learning needs or abilities, is an indicator of inequality and risk factor of adolescent smoking. We examined the effect of educational tracking, dividing students into vocational and academic high school tracks, on adolescent smoking in Taiwan. Longitudinal panel data, collected annually from 2000 over a period of 6years as part of the Taiwan Youth project, were used. Adolescents (aged 13-18years) from the first six waves of the Taiwan Youth Project were included in the project, of whom 2147 had clear information on track attendance in 10th grade, control variables in 7th/8th grades and smoking behavior in 8th grade (before track placement). Post-track smoking behavior was measured at 10th, 11th and 12th grades. The outcome variable was the self-reported smoking status in the 8th grade and between 10th and 12th grades. The treatment variable of interest was education tracking (vocational versus academic), which was conducted when the student was in 10th grade. Several important confounders were used for the difference-in-differences propensity score matching (e.g. parents' education and same classroom peer smoking). Placement of a student in the vocational track increased the proportion of smokers by 3.3 percentage points in 10th grade (P=0.039). The effect was even more pronounced in 11th grade (6.2 percentage points; P=0.000) and 12th grade (5.9 percentage points; P=0.003). Education tracking (placement of students into different school curricula based on learning needs or abilities) appears to be a risk factor for adolescent smoking among Taiwanese adolescents.

Gender differences in the association between social support and caregiver alcohol use in posttraumatic stress disorder of east Taiwan adolescents.

Objectives:This study investigates traumatic experiences in a sample of high-risk Taiwanese adolescents in rural areas of Taiwan; correlation with psychosocial factors is assessed with focus on social support and caregiver alcohol use.Materials and Methods:This was a cross-sectional study using stratified cluster sampling. Structured questionnaires were used to collect demographic characteristics, social support (Taiwan Relationship Inventory for Children and Adolescents), and posttraumatic stress disorder (PTSD) symptoms (Chinese version of UCLA-PTSD Reaction Index) from a sample of 751 adolescents (54.6% females) with 61.2% response rate in high schools in Hualien County, Taiwan.Results:Girls with trauma experiences manifested significantly higher PTSD scores, concurrent with higher number of traumatic events (TE), while the likelihood of reporting trauma and subsequent PTSD symptoms was similar in both genders. Increased risk of reported trauma and PTSD in adolescent Taiwanese is strongly associated with caregiver alcohol use and lack of social support, particularly in girls.Conclusion:We found that girls reported higher numbers of TE which was concurrent with significantly higher PTSD scores. Early detection of alcohol use disorders among caregivers as well as assessment of quality of family interaction would benefit at risk adolescents through specifically tailored interventions to address these factors.

Factors related to Taiwanese adolescents’ academic engagement and achievement goal orientations

The present study examined the relationships of Taiwanese eighth graders’ perceived autonomy support from teachers, parental psychological control, implicit theories of intelligence, and achievement goal orientations to their agentic, behavioral, emotional, and cognitive engagement in schoolwork. Also, the current research explored the determining factors of Taiwanese adolescents’ achievement goal orientations. Four hundred and two eighth-grade Taiwanese students completed a self-reported survey assessing the variables described above. Results of hierarchical regression analyses indicated that autonomy support from teachers along with incremental theory of intelligence positively predicted all the four components of academic engagement. Each aspect of academic engagement was associated with different achievement goal orientations. Additionally, results of this study suggested that teachers’ autonomy support versus parental psychological control as well as students’ incremental versus entity theories of intelligence all positively predicted mastery-avoidance, performance-approach, and performance-avoidance goal orientations. Implications for educational practices and future research are discussed.

The moderating role of parental support in the relationship between latent profiles of bullying victimization and sense of school belonging: A cross-national comparison

Bullying victimization has a negative relationship with adolescents’ sense of school belonging, which is an important contributor to their adaptive development. Based on the ecological systems perspective—which suggests that multiple systems in adolescence including the family and school are interconnected—experiences at home are linked with experiences at school. Thus the current study examined the relationship among bullying victimization, sense of school belonging, and parental support. Self-reported data of students from five Northeast Asian regions (Beijing-Shanghai-Jiangsu-Guangdong China, Hong Kong, Japan, South Korea, Taiwan) and the United States from the 2015 Programme for International Student Assessment, an international cross-sectional survey, was used. First, latent profile analysis was conducted to identify subgroups of adolescents who differ in their experiences of bullying victimization. Second, multivariate regression analysis was used to examine the association between victimization profiles and sense of school belonging, and to investigate the moderating role of parental support in this relationship. There were more similarities in subgroups of victimization than differences across the six regions. The association between latent risk profiles and sense of school belonging varied across the different regions. The buffering effect of parental support on the relationship between victimization profiles and sense of school belonging was supported only by the data from Taiwanese adolescents. Despite regional similarities and differences, a common finding emerged: membership to any subgroup of victimization lowered adolescents’ sense of school belonging, when compared to membership to the very low group. Implications for intervention design for victimized adolescents are discussed.

Psychological correlates of eating behavior in overweight/obese adolescents in Taiwan: Psychometric and correlation analysis of the Three-Factor Eating Questionnaire (TFEQ)-R21

The Three-Factor Eating Questionnaire (TFEQ) is a self-assessment scale used widely in the studies of eating behavior, but its short form TFEQ-R21 has not been validated in the Taiwanese population. This study aimed to assess the factor structure and reliability of TFEQ-R21 and to identify the correlates of eating behavior in obese and non-obese Taiwanese adolescents. A total of 445 individuals aged 13-15 years were analyzed. They self-reported their eating disorder behavior, body shape preoccupation, weight-related self-stigma, anxiety, and depression. We applied a confirmatory factor analysis to test the model fit of TFEQ-R21 for the three pre-conceptualized domains in the data. Further univariate and multivariate linear regression analyses were applied to identify the correlates of different TFEQ-R21 subdomains. The Comparative Fit Index for the TFEQ-R21 was 0.908, which confirmed the three-factor structure (i.e., cognitive restraint [CR], uncontrolled eating [UE], and emotional eating [EE]) in the Taiwan version of TFEQ-R21. Only CR correlated with disordered eating (r=0.351, p<0.001). Body shape discrepancy, rather than weight status, was associated with CR in both males (β=0.15, 95% odds ratio [CI] 0.05-0.25) and females (β=0.21, 95% CI 0.10-0.32). Gender differences were noted in the correlates of UE and EE, where ideal body shape in males and self-perceived stigma in females were the main associative factors. The Taiwan version of the TFEQ-R21 is a robust, reliable tool by which to measure adolescent eating behavior. Gender differences in the eating behavior correlates require clinical and public health attention when implementing weight management programs.

Theoretical asthma self-management program for Taiwanese adolescents with self-efficacy, outcome-expectancy, health behaviour, and asthma symptoms: A randomized controlled trial

BackgroundThe asthma prevalence of Taiwanese adolescents continued to rise. With physical and psychological changes in adolescents, managing asthma can be quite challenges and affect social, emotional and physical wellbeing. Adolescents with high self-efficacy levels are more likely to be involved in prevention and management activities. The aim of this study was to develop an effective asthma self-management program taking account for adolescents' developmental stages and based on Bandura's self-efficacy model. MethodsA two-arm, parallel group, randomized controlled trial was used. The outcomes were self-efficacy, outcome-expectancy, asthma prevention and self-management behaviour, and controlling asthma symptoms. Translation and back-translation process were used for original tools in English. Good consistent reliabilities of Chinese versions tools were identified. A t-test or Mann-Whiney U test was employed to determine any mean differences of outcome variables between groups overtime. ResultsA sample of 83 patients completed the study. The mean age was 14.2 years (SD = 1.8). Approximately 56.6% of the participants were males. 73% of participants (n = 61) had a mild to intermittent level of asthma severity. Significant improvements were found on self-efficacy, t = −2.8; outcome-expectancy, U = 646, prevention behaviours, t = −3.5, and management behaviours, t = −3.2, but non-significant results for the outcome of asthma control, U = 716. ConclusionsThe results provided evidence to support the efficacy of the asthma self-management program. The findings indicated the program improved adolescents’ self-confidence in managing their asthma symptoms. Future clinical practice should consider delivering an educational program using multifaceted and interactive learning strategies.

Comparing the Characteristics of Cigarette Smoking and e-Cigarette and IQOS Use among Adolescents in Taiwan.

Objectives Our objective in this study was to identify the risk factors for cigarette, e-cigarette, and IQOS use among adolescents in Taiwan, with a particular focus on socioeconomic status, smoking status of parents and peers, cigarette promotions, and anti-tobacco campaigns. Methods Data were obtained from the 2018 version of the annual cross-sectional Taiwan Global Youth Tobacco Survey, which is used to monitor tobacco use among Taiwanese adolescents in junior and senior high schools. The dependent variables in the study were “current cigarette smoking,” “current use of e-cigarettes,” and “current use of IQOS devices” (i.e., during the 30 days prior to survey completion). Independent variables included gender, school grade, monthly income/allowance, educational level of parents, smoking status of parents, smoking status of close friends, access to free cigarettes, exposure to cigarette advertisements, and attendance at anti-tobacco courses. Logistic regression was used in the identification of factors correlated with the current use of cigarettes, e-cigarettes, or IQOS. Results We determined that 5.65% of the adolescents in the study were currently using cigarettes, 2.74% were currently using e-cigarettes, and 2.33% were currently using IQOS. Our analysis revealed a number of factors that have a bearing on smoking behavior, including gender, monthly allowance, educational level of parents, smoking status of parents and close friends, access to free cigarettes, and exposure to cigarette advertisements. Conclusions The tobacco product that was most widely used by adolescents was cigarettes, followed by e-cigarettes and IQOS. The socioeconomic status, smoking status of parents/close friends, and access to cigarettes were all identified as important factors related to the current use of cigarettes, e-cigarettes, and IQOS by adolescents.