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

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.     

Parental,family, and home characteristics associated with cigarette smoking among adolescents

PURPOSE: This study examines the relationship between smoking-related parental, family, and home factors with adolescents' cigarette use. DESIGN: Cross-sectional surveys of adolescents, via a self-administered questionnaire in classrooms, and their parents, via a telephone interview, were conducted. SETTING: Fifteen suburban and rural communities within Minnesota. SUBJECTS: The study sample included 8th, 9th, and 10th grade public school students and their parents. MEASURES: The dependent variable was monthly tobacco use among students. The independent measures were parental, family, and home smoking-related characteristics. There were 1343 parent-child dyads with completed surveys. RESULTS: The final, multivariate logistic regression model found the following variables to be independently related to higher smoking rates among adolescents: child's grade (odds ratio [OR] = 3.03 for 10th vs. 8th), parents' permissiveness of adult smoking (OR = 1.80), parents' having higher normative estimates of how many people smoke (OR = 1.70), parents' decreased likelihood of punishing their teenager for smoking (OR = 1.65), smoking by an adult living in the home (OR = 1.99), and sibling smoking (OR = 8.95). Lack of communication about consequences for breaking family smoking rules was associated with lower smoking rates among adolescents (OR = .49). CONCLUSION: The results of this study highlight the importance of parental smoking norms and attitudes and smoking role models in the home. It is important that smoking prevention strategies target and include the entire family. Limitations of the study are its cross-sectional design and that the sample was primarily white.     

Risk factors for smoking among school adolescents in Greece

Objective We conducted this study among school adolescents to identify factors, which influence schoolchildren to smoke. Methods We carried out a cross‐sectional study in a sample of 924 students of all classes (ages 12–18 years old) in 15 public high schools in a semi‐urban area in Crete, Greece, using a questionnaire. The questionnaire comprised of 46 questions covering children's lifestyle habits regarding daily activities and leisure time, frequency of risk‐taking behaviour, knowledge about the hazards and long‐term consequences of smoking. Results 23.9% of participants were experimental smokers and 18.6% were current smokers. 11.4% of the total population was daily smokers. There was a significant increase in the prevalence of experimental and current smokers with school grades, while peaks in last grades were observed. Boys started smoking earlier than girls, mean (standard error) age 13.4 (2.3) years vs. 14.1 (2.3) years, P = 0.01. Stepwise logistic regression analysis showed a positive relationship between current smoking and having brother or sister smoking [odds ratio (95% confidence interval) 2.7 (1.7–4.4) and 1.8 (1.1–3.3) respectively], having more than three friends who were smokers [2.6 (2–3.4)] and last school grade [1.4 (1.2–1.7)]. Students appeared to be informed about long‐term smoking hazards and had negative views on children who smoke especially in the lower grades. Conclusions Prevention programmes should be imposed early in elementary schools while cessation policies should target at all grades, in particular at critical grades depending on population‐specific characteristics.     

Physical activity and associated socio-demographic factors among school adolescents in Jiangsu Province, China

BACKGROUND: Obesity prevalence is increasing among adolescents in China, especially in urban areas and among higher socio-economic strata. Physical inactivity may be one of the causes. We examined socio-demographic differences in physical activity among school adolescents in Jiangsu Province. METHODS: In 2002, 824 adolescents (12-14 years) in 8 schools filled in a self administered questionnaire on physical activity, sedentary behaviors and socio-demographic characteristics. RESULTS.: In girls, low SES elicited the highest physical activity score, mainly derived from housework. More boys (49.1%) than girls (41%) had vigorous physical activity (VPA) >or=3 times/week. Associations between VPA and residence, age, SES were not significant. 88% of the adolescents were actively commuting to schools. Boys with high SES or high education fathers had the lowest percentage walking to school. The students spent daily on average 10.8 h on studying, however, little time was spent on watching TV or playing PC games. CONCLUSIONS: Active commuting to school was common among the adolescents. However, the sedentary activity level is high. Physical activity was negatively associated with SES.     

广州市属技工院校学生主动参加HIV检测情况及影响因素

目的了解广州市属技工院校学生艾滋病检测情况,为校内艾滋病防控工作提供数据支持。方法 2018年10月,使用分层整群随机抽样方法对广州市属10所技工院校1 112名学生进行艾滋病知识、态度、行为及人类免疫缺陷病毒(HIV)检测情况调查,采用多因素Logistic回归分析学生主动参与HIV检测的影响因素。结果广州市属技工院校学生主动进行HIV检测率为10.3%。男性、<18岁、每月生活费>3 000元和家庭氛围较差学生的HIV主动检测率(12.1%～24.3%)高于对应组别(6.6%～8.4%),差异均有统计学意义(χ2值分别为12.07,7.25,10.73,9.77,P值均<0.05)。多因素Logistic回归分析显示,<18岁、愿意参加相关预防艾滋病宣传活动、同性恋、支持多个性伴侣和发生过性行为等因素与学生主动进行HIV检测呈正相关(P值均<0.05)。结论广州市属技工院校学生性行为发生率较高、主动进行HIV检测率较低,尤其是男男同性恋。卫生和教育部门应加强学生的艾滋病咨询检测服务和提高学生艾滋病危险感认知,提高学生检测的覆盖率。     

广州市中学生脊柱侧弯现状及影响因素分析

  目的  了解广州市中学生脊柱侧弯现状及影响因素,为制定脊柱侧弯行为干预措施提供依据。  方法  采取分层整群随机抽样方法,抽取广州市城郊共8所中学2 121名中学生开展脊柱侧弯筛查和问卷调查。  结果  广州市中学生脊柱侧弯检出率为8.20%,女生(9.50%)高于男生(7.00%),城区(10.45%)高于郊区(4.77%),高中生(10.08%)高于初中生(6.39%),差异均有统计学意义(χ2值分别为4.40,21.76,9.54,P值均＜0.05)。检出阳性的174名中学生中,胸段侧弯最多(65例),右凸略多于左凸,中度侧弯女生明显多于男生。多因素Logistic回归分析显示,城区(OR=2.56,95%CI=1.71~3.82)、每天使用移动电子设备时间≥3 h(OR=1.59,95%CI=1.12~2.27)、近距离用眼≥1 h休息一次(OR=1.40,95%CI=1.00~1.95)、每天户外活动时间＜2 h(OR=1.82,95%CI=1.24~2.67)的中学生脊柱侧弯检出率较高(P值均 < 0.05)。  结论  广州市中学生脊柱侧弯检出率较高,与地区、每天使用移动电子设备时间、近距离持续用眼时间、每天户外活动时间有关,应加强脊柱健康知识宣教。     

Psychosocial, school, and parent factors associated with recent smoking among early-adolescent boys and girls

BACKGROUND: Experimentation with smoking often begins during adolescence, but an adequate understanding of the factors associated with early initiation remains elusive. METHODS: Sixth- to eighth-grade students (n = 4,263, 67.1% white, 23.5% black, 7.2% other) from seven middle schools were surveyed. RESULTS: The overall prevalence of recent smoking (past 30 days) of 10.4% was similar for boys and girls and by race, but increased from 3.7% in sixth to 17.8% in eighth grade. In multiple logistic regression analyses positive outcome expectations, high perceived prevalence, deviance acceptance, and trouble at school were independently associated with smoking for both boys and girls. Among boys, problem-behaving friends, peer pressure, authoritative parenting, and mother's education and among girls, self-control problems, knowledgeable parents, and grade were independently associated with smoking. CONCLUSIONS: This is one of the few studies to report an independent association between smoking and outcome expectations, the first study to report an independent effect for peer influences among boys only, and one of several to find a negative association between smoking and positive parenting behavior. These findings suggest that the effectiveness of preventive interventions might be improved by targeting parent, school, and student outcomes, including outcome expectations, deviance acceptance, and social norms for both boys and girls, peer influences among boys, and self-control among girls.     

Cognitive factors associated with smoking initiation in adolescents

OBJECTIVE: To study the association between cognitive factors of the behavioral change model "Attitude Self Efficacy" (ASE) at different phases of smoking initiation among adolescents. METHODS: We carried out a cross-sectional survey among students in the second grade of Compulsory Secondary Education (13-14 years old) from Cornellà de Llobregat (Barcelona, Spain) in 2000 to obtain information on cognitive factors and smoking. Logistic regression analysis was used to investigate the variables associated with smoking (odds ratio [OR] of experimenters vs. non-smokers and of smokers vs. experimenters). RESULTS: The prevalence of daily smoking was 22.9% (95% CI, 16.5%-29.3%) among boys and 36.2% (95% CI, 29.7%-42.6%) among girls. Factors associated with experimenting (vs. non-smoking) were: attitudes to smoking (disagreement with smoke-free areas [OR = 3.46; 95% CI, 1.65-7.24], agreement with smoking promotion [OR = 3.42; 95% CI, 1.42-8.28]), and subjective norms (perceiving friends as smokers [OR = 2.50; 95% CI, 1.17-5.35]). The variables associated with regular smoking (vs experimenting) belong to: self-efficacy and attitudes to smoking. CONCLUSIONS: Focussing on subjective norms and smoking attitudes with programs targetted younger ages seems appropriate, since these factors are more closely associated with the experimenting phase. Encouraging skills to refuse cigarettes offered by friends is appropriate at a more advanced age, since this determinant is associated with the change from experimenting to regular smoking.     

学生网络成瘾与家庭类型关系分析

  目的  了解城乡差异与中小学生网络成瘾的关系。  方法  于2017年9月分层整群抽样方法抽取辽宁省城市4 254名、郊县3 881名中小学生进行问卷调查。  结果  网络成瘾报告率：乡村小学4～6年级男生（3.57 %）高于城市男生（0.89 %）,差异有统计学意义（P < 0.001）,乡村小学女生（1.77 %）与城市女生（1.36 %）差异无统计学意义（P > 0.05）;乡村初中男生（9.04 %）高于城市男生（4.10 %）,差异有统计学意义（P < 0.001）,乡村初中女生（4.08 %）与城市女生（3.55 %）差异无统计学意义（P > 0.05）;乡村高中男生（7.67 %）与城市男生（7.22 %）差异无统计学意义（P > 0.05）,乡村高中女生（4.44 %）低于城市女生（9.54 %）,差异有统计学意义（P < 0.001）。  结论  网络成瘾报告率,小学高年级与初中阶段,乡村男生高于城市,城乡女生无差异;至高中阶段逆转,城市女生高于乡村,城乡男生无差异;高中生高于初中生又高于小学生;需要重点关注的是城市高中女生和乡村初中男生。     

广州市中学生生活质量状况及影响因素分析

了解广州市中学生生活质量及其影响因素,为促进中学生身心全面发展提供理论依据.方法 采用分层随机整群抽样方法,对广州市14所中学共5 781名学生使用儿童少年生活质量量表、中学生学习压力源量表进行匿名问卷调查.结果 不同学校类型、学段和父母文化程度的学生生活质量得分差异均有统计学意义(t/F值分别为-2.24,4.59,4.17,3.29,P值均<0.05),男生生活环境状况得分高于女生(P值均<0.05);女生社会心理功能得分高于男生(P值均<0.05);重点中学学生得分高于普通中学学生(P值均<0.01);初中生比高中生得分高(P值均<0.01).多元线性回归分析结果显示,学习压力源总分及各维度、年龄、性别等因素与生活质量有密切关系(P值均<0.05).结论 广州市中学生生活质量不容乐观.应采取相关策略,有效提高生活质量.     

西藏青少年2019年吸烟行为现状及相关因素分析

  目的  了解西藏青少年烟草使用现状及影响因素, 为开展有针对性的控烟干预提供技术依据。  方法  于2019年8—10月, 采用与人口数量规模成比例的整群抽样方法抽取西藏4 983名学生进行问卷调查, 采用χ2检验和非条件Logistic回归分析探讨西藏青少年现在吸烟率的相关因素。  结果  2019年西藏青少年现在吸烟率为11.3%(563/4 983), 尝试吸烟率为21.8%(1 086/4 983), 二手烟暴露率为62.4%(3 111/4 983)。82.9%的吸烟者表示想要戒烟, 79.9%的吸烟者在过去12个月内有过尝试戒烟行为, 仅有11.7%的吸烟者表示受到过专业人员的戒烟帮助或建议。Logistic回归分析结果显示, 城市(OR=2.38)、三年级(OR=1.51)、学校类型为普通高中(OR=2.90)或职业高中(OR=3.53)、男生(OR=16.93)、每周零花钱≥50元(OR=1.93)、暴露于二手烟(OR=16.12)、认为二手烟可能会(OR=1.40)或可能不会(OR=4.89)产生危害、暴露于烟草广告(OR=1.83)、朋友吸烟(OR=7.47)、几乎每天能看到教师吸烟(OR=1.79)与青少年现在吸烟行为均呈正相关; 认为吸烟行为能减少吸引力(OR=0.54)与青少年现在吸烟行为呈负相关(P值均 < 0.05)。  结论  2019年西藏青少年吸烟及尝试吸烟行为较普遍, 二手烟暴露问题较严重, 职业高中学生是开展控烟干预的重点人群, 学校为控烟干预的重点场所。     

Factors associated with smoking among children and adolescents in Connecticut

Introduction: The age of smoking initiation has dropped over the past four decades. Since behaviors and attitudes adopted in late childhood or early adolescence predict future smoking, it is important to understand the smoking and other risk-taking behaviors and attitudes of children aged 12 and younger. The goal of the analyses presented here was to describe behavioral and attitudinal factors associated with smoking among elementary school (grades 4–6), middle school (grades 7–8), and high school (grades 9–12) students in Connecticut.Methods: We have used data from 8 years (1988–1996) of an anonymous, self-administered health risk appraisal survey given to children and adolescents in self-selected public and private schools. We compared the proportion of smokers and nonsmokers who reported various behaviors and attitudes and compared them with the chi-square test.Results: Fifteen percent (n = 4,884) of the total population (n = 31,861) were current smokers. At all grade levels, current smokers were more likely than nonsmokers to engage in risk-taking behaviors, and to report more stress and depression. Indicators of risk-taking and stress were also associated with the intent to smoke among children in grades 4–6.Conclusions: Smoking occurs within the context of other risk-taking behavior and psychological distress, among both children and older adolescents. Our data provide support for the idea of early identification and targeting of children at high risk of smoking in elementary school, possibly as early as grade four.     

Factors associated with smoking progression among Spanish adolescents

Smoking onset takes place in the early years of adolescence, and can be seen as a progression through stages of preparation, trying, experimentation, regular smoking and nicotine dependence or addiction. The objective of this study is to identify 1-year predictors of smoking consolidation among occasional smokers (experimenters) and of cessation among all smokers. A questionnaire developed to monitor trends in smoking and other health-related behaviors was administered in the spring of 1992 and again 1 year later (1993). The survey was carried out in six large, private schools in Barcelona and Raimat, in the Lleida province, in Catalonia (Spain). In total, 1460 schoolchildren aged 12-19 responded to both the baseline and follow-up questionnaires; 1236 questionnaires (84.7%) were matched through a personal code and were used for the longitudinal study. At the baseline survey 28% of the schoolchildren were regular smokers and 17.1 % were occasional smokers, with no differences by gender. At the follow-up survey, progression from occasional to regular smoking was observed in 42% of the girls and 22.7% of the boys. Other predictors of consolidation included drinking alcohol (OR = 3.1; 95% CI = 1.1-10.1) and reporting the intention to smoke in the future (OR = 2.5; 95% CI = 1.3-4.9). Among all the smokers at the baseline, predictors of cessation were smoking occasionally (versus regularly) (OR = 4.9; 95% CI = 2.8-8.6), negative attitudes regarding smoking (OR = 3.3; 95% CI = 1.9-5.4), reporting no intention to smoke in the future (OR = 2.2; 95% CI = 1.3-3.8), gender (OR for boys = 2.1; 95% CI = 1.2-3.6), receiving weekly pocket less than 1000 ptas (OR = 1.7; 95% CI = 1.1-5.3) and age (OR for being 15 and younger = 1.6; 95% CI = 1.1-4.9). We conclude that consolidation of smoking is twice as likely among girls than among boys. Intention to smoke seems to be a good predictor of future behavior, while attitudes may predict cessation, but not consolidation. Available pocket money seems to be a strong risk factor for smoking at this age.     

Individual and family household smoking habits as risk factors for wheezing among adolescents

BACKGROUND: The study aimed to evaluate the household smoking habits as risk factors for wheezing in adolescents. METHODS: During a 2-month period, the study was performed by applying the standardized ISAAC phase 1 questionnaire to 3474 adolescents attending a random sample of secondary public schools located at the southeast of Mexico City. Adolescents were grouped as "cases" if they had at least one episode of wheezing in the year prior to the study, or as "controls" if they did not. Positive individual and family (father, mother or other persons living in the home) smoking habits at home were evaluated as potential risk factors. RESULTS: More than 98% of respondents in the two groups reported that the father smoked in the house. More mothers who smoked were reported among cases than controls (OR 2.42; 95% CI 1.60-3.68). More adolescents in the group of cases had history of ever having rhinitis, rash or wheezing. Fifty-four percent of adolescents in the group of cases had ever smoked versus 38.8% of controls (OR 1.89; 95% CI 1.33-2.67). Sex-adjusted logistic regression analysis identified a "protective" role for wheezing when the number of smokers at home was < or =2 (OR 0.44; 95% CI 0.27-0.71). CONCLUSION: Individual, maternal and other family members' indoor smoking habits may increase the risk of wheezing among adolescents.     

上海市杨浦区职校学生吸烟现状及影响因素分析

目的 了解上海杨浦区职校学生吸烟现况及其影响因素。方法 通过整群抽样方法,选择杨浦区一所职校233名学生进行此项调查。结果 调查人群的尝试吸烟率是22.32%,现在使用卷烟制品率为9.01%,现在吸烟率为6.44%,不同人群的男生发生率均显著高于女生,差异有统计学意义(P<0.05);家人吸烟的学生尝试吸烟率高于家人不吸烟的学生,差异无统计学意义。任课老师吸烟的学生尝试吸烟率和现在使用卷烟制品率高于老师不吸烟的学生,差异无统计学意义;好朋友吸烟的学生尝试吸烟率、现在使用卷烟制品率和现在吸烟率均高于好朋友不吸烟的学生,差异有统计学意义(P<0.05);学习成绩中等以下的学生现在使用卷烟制品率显著高于成绩中等及以上的学生,差异有统计学意义(P<0.05);接触烟制品的人群对烟草危害的知晓率低于不接触烟制品的学生,差异无统计学意义。Logistic回归分析显示,男生是吸烟行为的危险因素,好朋友吸烟是尝试吸烟行为的危险因素,学习成绩中等及以上是现在使用卷烟制品行为的保护因素。结论 吸烟严重危害着学生的身心健康,我们要关注不同的类型的学生,特别是职业技术类学校的学生,要做好宣传教育工作,把吸烟行为控制在初始状态。     

Social environmental and individual factors associated with smoking among a panel of adolescent girls

This study assessed changes in the influence of social environmental and individual factors-and the interaction of these factors with time-on smoking prevalence for girls. Longitudinal panel surveys of adolescent girls (N = 921 in both 2000 and 2004) from schools in Louisiana were completed in the ninth grade (2000) and then again in the twelfth grade (2004). A fixed effects hierarchical multiple regression model assessed the relation of changes in social environmental and individual factors to smoking prevalence. Increases in smoking prevalence over time among adolescent girls were associated with their perceptions of themselves as overweight and perceiving low risk associated with smoking. Increases in smoking prevalence over time were also associated with having friends who smoked, perceptions of friends' approval of smoking, having family members who smoked, and having monetary discretionary spending. Having friends who smoked was more strongly associated with smoking in the twelfth grade than in the ninth grade. While more black adolescent girls smoked than did white girls in the ninth grade, by the twelfth grade, more white adolescents girls smoked than did black girls. Interventions that target adolescent girls should consider the temporal variability of individual and social environmental factors.     

少年儿童行为问题与家庭、学校因素关系

目的 了解合肥市城区儿童少年行为问题的现状，分析儿童少年行为问题与家庭及学校社会环境因素的关系。方法采用Achenbach儿童行为量表（家长用表）对合肥市6～18岁的1978名儿童少年及其家庭和学校环境因素进行调查，并用SPSS软件进行统计分析。结果检出有行为问题的儿童少年194名，检出率为9．8％。其中中学组检出率为10．5％，小学组为8．7％；男生检出率为10．1％，女生为9．4％，中、小学及男、女生间行为问题检出率差异无统计学意义。检出率较高的行为是分裂样、交往不良、攻击性、违纪、多动等。影响儿童少年行为问题的家庭危险因素主要有：单亲抚养，家庭中其他孩子有行为、学业问题，父母有心理问题，家庭氛围差，家长对孩子学业不满意等；学校危险因素主要为：不喜欢上学、与同学关系不融洽、与成人相处有问题、孩子完成作业有困难等。结论家庭和学校环境中的多种因素与儿童少年行为问题相关。     

The role of family factors and school achievement in the progression of adolescents to regular smoking

This study examines whether parental smoking and single parenting were related to adolescents' school achievement and anti-smoking parental practices as well as how these factors predicted later smoking. The sample comprised 1163 Finnish students in Grades 7 through 9. Results show that at the beginning of the seventh grade, parental smoking and single parenting were related to adolescents' lower levels of school achievement. Moreover, parental smoking had moderate association with lack of house smoking rules. At the beginning of the ninth grade, these associations were strengthened and lack of house smoking rules as well as loosened perceived parental punishment for smoking was related to both parental smoking and single parenting. The likelihood of ninth grade regular smoking was greater among adolescents whose parents smoked, who had no smoking rules in their homes and had substandard school achievement. These results suggest that smoking parents and single parents had similar anti-smoking regulations for their children at the baseline but once children became older smoking parents were not able to maintain these rules as successfully as non-smoking parents and families with two parents. Motivating parents to uphold these anti-smoking regulations offers a prospective intervention opportunity.