Smoking among youths in China

OBJECTIVES: To inform a prevention strategy, this study determined the prevalence of and attitudes toward smoking among Chinese secondary school students. METHODS: Self-completion questionnaires were administered to 13- to 18-year-olds attending school in Zhejiang Province, eastern China. RESULTS: Of the 6674 respondents, 15.9% (25.7% of the boys, 5.4% of the girls) were ever smokers. Only 0.3% were regular smokers. Of the ever smokers, 41.9% had smoked before 10 years of age and 7.9% before 5 years of age. Parental smoking was the strongest predictor of smoking. CONCLUSIONS: The very low prevalence of regular smoking found in this age group suggests that prevention programs in school may be beneficial. Parents should be encouraged to adopt more responsible attitudes toward smoking in the home.     

Somatotype, physical growth, and sexual maturation in young male smokers.

One thousand school boys aged 8 to 16 were examined for their somatotype, physical growth, sexual maturation, and smoking habits. Fifty-two boys were found to be smokers, of whom 30 were regularly smoking between two and 20 bidis or cigarettes a day for a mean duration of 2.5 years. The mean height and weight of the smokers was significantly lower than that of the non-smokers at all ages, more so in regular than occasional smokers. Sixty-nine per cent of the smokers had mesomorphic type of body build; about 65% of the non-smokers had ectomorphic somatotype (P less than 0.001). Onset of puberty occurred significantly earlier among smokers compared with non-smokers, as was evident from the early appearance of genital stage 2, and an early and rapid increase in testicular size. Genital stage 2 appeared at a mean age of 11 years in smokers and 11.6 years in non-smokers. However, the appearance of pubic, axillary, and facial hair was delayed. The possible significance of this is discussed.     

Prevalence of cigarette smoking among Australian secondary school students in 1993

Abstract: The prevalence of cigarette smoking in Australian secondary school students in 1993 was estimated from a survey of 22 696 12- to 17-year-old students from 332 secondary schools (and feeder schools) in all states and the Northern Territory. Self-administered questionnaires were answered anonymously by groups of up to 20 students selected randomly from school rolls, a method that replicated previous surveys in 1984, 1987 and 1990. Current smoking (smoking at least one cigarette in the week preceding the survey) at 12 years of age was 8 per cent in boys and 7 per cent in girls, but in those 17 years of age the prevalence was much higher (28 per cent of boys, 31 per cent of girls). Age was also associated with the mean number of cigarettes smoked per week by current smokers (8.6 in boys and 7.0 in girls at age 12 and 43.8 in boys and 32.0 in girls at age 17). After controlling for sex, age, school type and state of residence, the percentage of 12- to 15-year-olds who were current smokers rose from 15.7 per cent to 17.5 per cent between 1990 and 1993, an effect that was more pronounced in boys. On the other hand, the mean number of cigarettes smoked by 12- to 15-year-old current smokers dropped from 23 per week to 19.5, and the reduced consumption was greatest in boys. Furthermore, there was no increase in the proportion of students who smoked on three or more days per week, which suggests the increase was limited to occasional, casual or social smoking.     

A survey of cigarette smoking among middle school students in 1988

A survey of the prevalence of smoking in middle school students aged 13-21 years in Harbin city, China, was undertaken in the Spring of 1988. A random sample of 4712 students was selected using proportional stratified clustering. A self-administered confidential questionnaire relating to smoking habits and certain family and school factors was administered. The results showed that 1.29% of the students (2.21% boys and 0.38% girls) smoked regularly, 5.62% (10.52% boys and 0.76% girls) were light smokers and 13.77% (24.29% boys and 2.92% girls) smoked only occasionally. Smoking habits were related to the type of school and to age, there being a higher proportion of smoking in senior grade students. Students were significantly more likely to smoke if they were male and if their siblings smoked. Prevalence of regular smoking was not related to parental occupation or family income. It is suggested that anti-smoking education in the school curriculum should be directed towards students in middle school.     

Smoking behavior and its influencing factors in a national-representative sample of Iranian adolescents: CASPIAN study

OBJECTIVES: To determine the national prevalence of smoking among Iranian youths and its environmental influencing factors. METHODS: This study was performed in 2003-2004 among 11,966 school students, ages 11-18 years, selected by multi-stage random cluster sampling from 20 provinces in Iran. The participants filled out self-administered anonymous questionnaires. RESULTS: The prevalence of self-reported cigarette smoking was 14.3%, with a higher prevalence in boys than in girls (18.5% vs. 10.1%, respectively, P < 0.001), and in high school than in middle school students (17.4% vs. 10.6%, respectively, P < 0.001). Overall, 42.2% of smokers were daily smoker, and the rest were occasional smoker. The mean age of the first attempt to smoke was 13.2 +/- 2.5 years with no significant gender difference but was significantly lower in daily than in occasional smokers. The place of the first attempt to smoke was mostly in friend parties (41.6%) and traditional teahouses (23.2%) for boys and the family parties (37.1%) and the traditional teahouses (27.4%) for girls. The higher school level and having a tobacco user at home significantly increased the likelihood of smoking in adolescents, with the highest odds ratio (OR) found for having a smoker sister in girls (OR = 4.5, 95%CI, 2.5, 8.2), and having a smoker brother in boys (OR = 2.4, 95%CI, 2.03, 3.05). CONCLUSION: Smoking is becoming as a major public health threat among Iranian youths. Control measures should be considered not only for cigarette smoking, but also for the socially accepted habit of water pipe use that is revived in traditional teahouses.     

Smoking prevalence among students from a metropolitan area in the southern region of Brazil, 1991

A prevalence study on smoking habits was carried out in 1991, among 864 school children from eight municipal schools in Sapiranga, in the State of Rio Grande do Sul, Brazil, from the 6th through 8th grade of primary school. Data was collected in class, using a questionnaire applied by trained teachers. Among students, 3.2% were smokers, although 20.3% had been exposed to tobacco. Males had begun the smoking habit at a mean age of 14.7 years and females at about 15 years old. The prevalence showed an increasing trend by age and individual school grade. As for gender, male smokers outnumbered females (p < 0,05). Smoking by older brothers and fathers seems to be positively associated with acquisition of the habit by school children.     

Tobacco use among Australin secondary students in 1996

OBJECTIVES: To estimate smoking prevalence among Australian secondary students in 1996 and to examine trends in smoking prevalence since 1984. METHOD: A randomly selected representative sample of 434 secondary schools from across Australia participated in the study. At each school 80 randomly selected students completed a pencil-and-paper questionnaire anonymously. Data from 29,850 students aged between 12 and 17 years are reported. RESULTS: Current smoking (smoking in the week before the survey) was 8% in boys and 7% in girls aged 12, and rose to a peak prevalence among 17 year olds of 28% for boys and 34% for girls. The mean number of cigarettes smoked per week among current smokers rose from 11 for boys and six for girls aged 12 to 37 for boys and 34 for girls aged 17. Comparisons across survey years showed that while fewer 12 to 15 year olds were current smokers in 1996 than in 1984, the proportion in 1996 was greater than that in 1987 or 1990. Among 16 and 17 year olds, the proportion of current smokers in 1996 was greater than that seen in 1987 or 1990. An aggregate measure of tobacco involvement suggested that involvement with tobacco had remained stable since 1993 among 12 to 15 year olds. CONCLUSION: The decline in adolescent smoking seen in the late 1980s has stopped. IMPLICATIONS: Extrapolating from this survey, we estimate that more than 276,000 12-17 year old students were current smokers in 1996. If they all continue to smoke, 138,000 would die prematurely.     

When and why children first start to smoke

Most investigations of smoking in children focus on prevalence in which uptake and maintenance are confounded. This paper reports an analysis of pure incidence data in a cohort of over 6000 Derbyshire schoolchildren followed for ten years investigated using survival data analysis techniques. Over 70% of the cohort tried at least one cigarette before the end of the fifth year of secondary school. Some 40% identified themselves as regular smokers while at school. The risks of taking up regular smoking were higher if, at the age of 11.7-12.7 years, the children had smoking siblings, opposite sex friends, were dismissive of the health hazards and susceptible to peer pressure. More girls than boys in that age range spent time with opposite sex companions and in organized social activities which in turn were significantly associated with the risk of taking up smoking. Thus the earlier physical and emotional development of girls may help explain recent findings that adolescent girls are now more likely to smoke than boys of the same age. The greatest incidence of regular smoking occurred when the average age was increasing from 14.2 to 15.2 years. This has very clear implications for the timing of anti-smoking interventions.     

Smoking habits in school-children with 2 years follow-up

The proportion of smokers among Swedish school-children between 12 and 15 years of age and their short- and long-term attitudes and reactions towards smoking during an antismoking campaign was studied. Of a total of 413 pupils interviewed, 13.3% of the boys and 9.5% of the girls were smokers. Among the 15-year-old pupils 21% were smokers, whereas none of the 12-13-year-old pupils smoked at all. Everyday smoking was twice as common in boys as in girls but on follow-up there was no difference. Our study confirms a trend of diminishing smoking habits in boys but not among girls. Antitobacco campaigns may have a long-term positive effect in supporting changed attitudes towards smoking.     

Cardiovascular and pulmonary risk factors in Berlin (West) schoolchildren: Findings of an exploratory study

In preparation for a comprehensive intervention project concerned with smoking behavior, physical activity, nutrition, and alcohol, an exploratory study of 800 public school and gymnasium pupils in the seventh and ninth grades (12–16 years old) was undertaken. The median of total serum cholesterol dropped from 4.8 mmol/liter in 12-year-old pupils to 4.2 mmol/liter in 16-year-olds. The decrease was greater in boys than in girls (0.7 versus 0.4 mmol/liter). The systolic and diastolic blood pressures rose slightly with age in boys and girls. The prevalence of occasional and daily smokers was 19.8 and 21%, respectively. The proportion of daily smokers was 36.4% among public school students (lower socioeconomic status) versus 4.1% among gymnasium pupils (higher socioeconomic status). Similar differences were found for the serum thiocyanate levels.     

Tobacco use among Iranian men, women and adolescents

The aim of this study was to evaluate the self-reported and serum cotinine based prevalence rates of smoking among Iranian men, women and adolescents. The study was carried out on 2626 men and women aged 19 years and above and 836 high school students aged 14-18 years, randomly selected from different clusters and schools in Isfahan. The WHO smoking standard questionnaire was completed for all samples and serum cotinine level was measured using high-performance liquid chromatography in 10% and 20% of the original adult and adolescent samples, respectively. The prevalence of self-reported smoking among Iranian men and women aged 19 years and above was 18.7% and 1.3%, respectively, compared to 21.2% and 6.7% based on serum cotinine level. Nearly 10.6% and 14.6% of claimed nonsmoker girls and boys were classified as current smokers by serum cotinine level. More than 80% of male smokers started the habit before the age of 20 years and the effect of smoker friends was the most important factor for smoking initiation among smokers. Using self-reported prevalence data for smoking among women or adolescents in special populations like Iranians can give invalid measurements, therefore, data based on biochemical tests are suggested.     

Adolescent occasional smokers, a target group for smoking cessation? the Nord-Trøndelag Health Study, Norway, 1995-1997

BACKGROUND: Adolescent smokers are often unsuccessful in quitting and difficult to retain in cessation programs. In health promotion, focusing on the right target groups is essential. Aim. The aim was to examine if adolescent occasional smokers differ from daily smokers, and if possible differences could be useful for targeted smoking cessation programs. METHODS: Ninety-one percent of all teenagers attending junior high or high schools participated in a cross-sectional study, conducted in Nord-Tr?ndelag County, Norway, 1995-1997, including 8,460 students 13-18 years old. Information on smoking habits, education, after school activities, and parents was obtained by self-administered questionnaires. RESULTS: Fifty-four percent of boys and 57% of girls had tried at least one cigarette. Of these, 36% of boys and 41% of girls were current smokers, half of whom reported occasional smoking. Students who had quit smoking had more often been occasional than daily smokers. Compared to daily smokers, occasional smokers participated in higher academic courses, were more engaged in organized activities and sports, had been drunk less often, and had better family role models. CONCLUSION: Differences support potential utility of focusing on occasional smokers as a special target group in smoking cessation programs.     

Cigarette smoking among Beijing (Peking) high schoolers

Students smoking at 2 key middle schools and 6 ordinary middle schools in Beijing, China were surveyed to determine the form in which high schoolers start smoking, and how long they have smoked. The patterns and causes of smoking were analyzed. The investigation was made from March to May 1981. 430 boys and 423 girls were selected from key schools and 1396 boys and 1394 girls from ordinary schools. Ages ranged from 13-17. All subjects completed a questionnaire in the classroom. To increase the reliability of the survey, names were kept secret. The students surveyed were classified into groups according to their smoking status: current regular smokers; occasional smokers; ex-smokers; and nonsmokers. In the key schools, there were only 4 smokers among 430 students, accounting for 0.9% of the total. Of these, 1 was Senior Class 2, 2 Senior Class 1, and 1 Junior Class 3. In the ordinary schools, 10% were smokers. 19.7% of the boys and 0.4% of the girls smoked. Among the boys, the higher the class, the more numerous the smokers. The smoking rate was 8.2% in the 1st year of junior high but rose to 34% in senior class 2; the difference was statistically significant. "Special occasion" smokers were few, only 5.5% of the students. In junior class, the number of regular smokers was about 2/3 to 4/5 that of occasional smokers. And by senior class 2 the number of regular smokers had risen to about 3 times that of the occasional smokers. In every grade, there were students who had given up smoking. Most had been occasional smokers. Some high schoolers had started to smoke in primary school and had a 4-5 year history of smoking, but most had only picked up smoking for 1-2 years after announcement of the Rules for High School Students prohibiting smoking. There were 3 smoking patterns: smoking without inhaling; inhaling the smoke deeply into the lungs, then expiring through the mouth or nostrils; and combining patterns 1 and 2. Of 265 students, 128 used the 1st pattern, 121 the second, and only 16 combined both patterns. The most common cause of smoking was curiosity. Next was lack of high ideals and dedication followed by boredom. The smoking rate in students whose parents were smokers was significantly higher than in those whose parents were nonsmokers. The difference was significant among all classes except junior class 1. To reduce smoking among high school students, it is necessary to go beyond the existing rules which prohibit smoking and emphasize political and ideologic education. Students must be taught about the dangers of smoking as early as possible, preferably in primary schools.     

Influence des parents sur le tabagisme de leurs enfants

A survey carried out in autumn 1978 in a Paris state secondary school (2266 pupils) enabled us to study the precocity and prevalence of smoking habits in boys and girls aged 14.9 years on average, according to their parents' smoking habits and attitudes.The proportions of smokers were 21.8% in boys and 31.2% in girls. These proportions were lower if parents forbade smoking and higher if they allowed it, or simply advised their children against it. The proportion of smokers and precocity of smoking increased with parents' smoking habits. This result was confirmed by a stepping-up discriminant analysis.We also found that the influence of peers entailed a greater precocity in smoking and that those who smoked to assume a countenance smoked a greater number of cigarettes.     

2006年龙岩市部分高中学生吸烟情况调查

[目的]了解龙岩市高中学生吸烟情况以及对控制吸烟的态度，为今后教育和干预措施提供科学理论依据。[方法]采取整群随机抽样方法，通过现场问卷的方式对两所中学4个高中班的221名学生进行调查。[结果]男生吸烟率14．1％，女生吸烟率3．7％。男生吸烟率高于女生（P〈0．05）。尝试吸第一口烟者占调查者总数的27．8％，半数以上小于10岁，尝试吸烟者成为当前吸烟者的比率为31．0％。说明尝试吸烟者近I／3成为当前吸烟者。[结论]个人认识与社会、家庭、学校影响成为影响青少年吸烟的主要因素，影响着青少年对控制吸烟的态度。应采取教育与行政干预相结合的办法，才能有效地改变学生的不健康行为，控制吸烟。     

Tobacco smoking among Portuguese high-school students.

The aim of this study was to evaluate the prevalence, behavioural patterns, and determinants of smoking among a large sample of high-school students from Porto, the second largest city in Portugal, information on sociodemographic characteristics and personal history of tobacco, alcohol, coffee, and illicit drug use was obtained from 2974 students, aged 12-19 years (48.7% female, 51.3% male), using an anonymous self-administered questionnaire. Crude and adjusted odds ratios (OR) were calculated by logistic regression analysis to estimate the association between smoking and the characteristics evaluated. Overall, 35.8% students had never smoked, 39.4% had tried it ("experimental" smokers) but were not smokers, 3.3% were former smokers, 6.6% occasional smokers, and 14.9% regular smokers. The mean age for starting smoking was 13.4 +/- 2.1 years for males and 13.4 +/- 1.6 years for females. The prevalence of current smoking was higher among males than females, but the difference was not significant. Male students were significantly more likely to smoke more cigarettes per day than were females. The prevalence of smoking was significantly associated with the following variables: being aged > 12 years; having parents who had attended school for < 4 years; having a mother (OR = 1.88), siblings (OR = 1.96) or friends (OR = 1.75) who smoked; low academic performance (OR = 1.74 for one or two failures and OR = 2.27 for more than two failures at school); and consumption of coffee (OR = 2.90), alcohol (OR = 3.53), or illicit drugs (OR = 6.69). The prevalence of smoking among adolescents increased with age. There is therefore a need for school-based tobacco prevention programmes which also deal with family influences on smoking.     

Smoking and its associated factors in Portuguese adolescent students

OBJECTIVE: To describe smoking habits and to identify their determinants in adolescent students. METHODS: A cross-sectional study was carried out on smoking habits comprising 1,052 girls and 984 boys aged 13 years attending public and private schools in the city of Porto, Portugal. The proportion of participation was 77.5%. Information on sociodemographic and behavioral characteristics was obtained from a questionnaire filled out at home by participants and their parents. At school, another self-administered questionnaire was used to obtain information about tobacco use. Several independent samples were compared using the Kruskal-Wallis test and proportions were compared by Chi-square test. Odds ratio and 95% confidence intervals were calculated by unconditional logistic regression. RESULTS: Overall, 19.9% (22.4% of girls and 17.1% of boys) students only had ever experimented smoking but were not smokers; 1.8% (2.0% of girls and 1.5% of boys) were occasional smokers and 1.3% (2.0% of girls and 0.4% of boys) smoked at least one cigarette/day. Curiosity was the main reason given by adolescents to experiment smoking (48.4% of girls and 45.6% of boys). After adjustment to parental, siblings' and friends' smoking habits, the stronger association was with the smoking habits of their friends for both girls (OR=4.03; 95% CI: 2.69-6.04) and boys (OR=5.39; 95% CI: 3.34-8.70). CONCLUSIONS: A high proportion of students had ever experimented smoking. Smoking habits among peers proved to be the strongest determinant of smoking during adolescence.     

Smoking and weight control in teenagers

In a Cancer Research Campaign-funded survey of smoking habits and opinions of 16,000students aged 9–19 years in northern England in December 1982, the respondents were asked if they thought that smoking keeps the weight down.The heaviest regular smokers (42·2%) were the most likely to agree that smokingcontrols weight, whilst those who had never smoked were least likely to agree (16·6%). Agreement increased with increasing smoking. More girls than boys agreed. The most significant differences between smokers' and non-smokers' opinions occurred in 13-, 14- and 16-year-old girls. In this age group more girls than boys reported regular smoking. Up to the age of 12 years, smokers were extremely unlikely to agree that smoking keeps the weight down.It is suggested that the intention of weight control might be influential in causing the high incidence of smoking in teenage girls.     

Cigarette smoking among adolescents in Thessaloniki, Greece

OBJECTIVES: Epidemiological characteristics in tobacco smoking among adolescents were investigated in Thessaloniki, Greece. METHODS: The target sample was 1,221 students coming from 15 high schools. RESULTS: Cigarette smoking was higher among girls than boys (40.9 % vs. 34.3 %). However, the percentage of boys who were smoking more than 20 cigarettes per day was found larger than the relevant percentage of girls (81.2 % vs. 75 % of total smokers). The boys also reported an earlier initiation of tobacco use (12.7 years vs. 12.9 years in girls). Physical activity was negatively correlated with smoking, whereas drinking alcohol and low parental education were positively correlated with smoking. CONCLUSIONS: Health promotion programs should be instituted not only during adolescence, but rather before the age of 14.     

Characterization of the smoking habit among high school students in Syria

Objectives: To establish an accurate estimate of the prevalence of smoking among high school students in Aleppo–Syria and to characterize the smoking habit in this age group. Design: A cross-sectional survey was performed, in which a self-administered questionnaire was distributed to 10th, 11th and 12th graders. Subjects: A sample of 1587 students (784 males; mean age 16 years, and 803 females; mean age 15.9 years) was studied. This sample was drawn from 16 schools randomly selected from a total of 73 schools in the city. Results: The prevalence of current smoking was 15.9% for males and 6.6% for females. The prevalence of daily smoking was 2.4% for males and 0.5% for females. Almost all smoking categories increased with age and grade. Forty seven percent of male daily smokers were heavy smokers. Peer influence was evident in all stages of the smoking process, especially for males. Parental smoking was also an important associated factor. The combination of parental and siblings smoking was the strongest predictor of the smoking status of the surveyed (OR: 4.4; 95% CI: 2.7–7). Thirty eight percent of male smokers and 47.2% of female smokers smoke out of boredom. Fifty one percent of male smokers were introduced to smoking by a friend. Forty percent of male smokers buy their cigarettes, while 56.6% of female smokers obtain their cigarettes from home. Logistic regression analyses showed that parental and siblings smoking were the most important predictors of ever trying to smoke or current smoking among male and female students. Conclusions: Our study shows that smoking is more frequent in male than female students. Parental and sibling smoking are the most important factors associated with smoking in this population, and peer influence is important particularly in the smoking initiation stage. Pattern of smoking and associated factors differed substantially between males and females in this study.