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

OBJECTIVE: To identify modifiable family and school environmental factors associated with Chinese adolescent smoking behaviors including never-smoking, experimental smoking, regular smoking, and attempting to quit. METHODS: A cross-sectional survey using self-reported questionnaires was conducted in Huangpu, Guangzhou in December of 2004. A total of 3957 pupils agreed to complete the questionnaires. The prevalence odds ratio (risk) of experimental smoking was compared to never-smoking, adjusting for gender and age in unconditional logistic regression analysis. The risk of regular smoking was compared to experimental smoking, and the risk of attempting quitting was analyzed in regular smokers. RESULTS: The cigarette smoking of peers, mothers, fathers, brothers, and supervising teachers, passive smoking, and seeing someone smoking on campus increased the risk of experimental smoking vs. nonsmoking, while no-smoking signs, perceived anti-tobacco atmosphere in school, and being taught smoking-related health knowledge decreased the risk. The factors associated with regular smoking compared to experimental smoking included the smoking of peers, brothers, fathers and supervising teachers, teacher's tolerance, and passive smoking. Being taught smoking-related knowledge, perceived anti-tobacco atmosphere and no-smoking signs in school were positively associated with regular smoker's attempt to quit, while supervising teacher's smoking, parents' and teachers' tolerance could delay it. CONCLUSIONS: These modifiable family and school environmental factors as well as their interaction with gender and age should be highly considered in adolescent smoking prevention in China.