Elsevier

Addictive Behaviors

Volume 33, Issue 8, August 2008, Pages 1081-1085
Addictive Behaviors

Short communication
Risk factors for adolescent smoking in urban and rural China: Findings from the China seven cities study

https://doi.org/10.1016/j.addbeh.2008.04.004Get rights and content

Abstract

Cigarette smoking is rising among urban Chinese adolescents and poses a significant public health concern. The majority of Chinese youth live in rural areas, but most research on the risk factors for smoking has been conducted in urban areas of China. This study examined the associations between parental smoking, peer smoking, and low refusal self-efficacy and smoking among urban and rural Chinese youth.

This analysis used a cross-sectional sample of 3412 ninth grade students in urban and rural areas under the administrative jurisdiction of seven large cities in China. Multilevel logistic regression models were used to associate the risk factors with lifetime and current smoking, separately in boys and girls.

Adolescent smoking was not strongly associated with parental smoking. However it was strongly associated with peer smoking and low refusal self-efficacy across both the urban and rural samples. Students with lower refusal self-efficacy were approximately 5–17 times more likely to be lifetime or current smokers than those with higher refusal self-efficacy.

Smoking prevention interventions in China may need to focus on raising adolescents' refusal self-efficacy.

Introduction

Cigarette smoking is rising among urban Chinese adolescents and poses a significant public health concern. While the majority of Chinese youth live in rural areas, there have been no studies that address whether risk and protective factors for smoking are similar or different between urban and rural adolescents in China. Clarification of this question is crucial to inform the development of smoking prevention programs appropriate for both groups. Therefore, the primary focus of this study is to assess whether risk factors for smoking that have been identified in Western studies (Hoffman, Sussman, Unger, & Valente, 2006) are also risk factors for smoking in urban and rural areas of China. Such factors include parental smoking, peer smoking, and low refusal self-efficacy. This study also compares and contrasts the strength of these risk factors in urban and rural areas.

Section snippets

Data sources and sample selection

Cross-sectional data for the current study were obtained during the third-year survey (in 2004) of the China Seven Cities Study (CSCS). The CSCS is a longitudinal, school-based cohort study of health-related behaviors conducted by a consortium of researchers and public health officials in each of the seven cities and at the University of Southern California (USC). The seven participating cities are located in four regions across China: Northeast (Harbin, Shenyang), Center (Wuhan), Southwest

Comparison of demographics and predictors between urban and rural areas

Parental smoking rates were similar in urban (63.01%) and rural (63.43%) areas (Table 2). Compared to urban boys, rural boys were more likely to report that their friend(s) smoked at least one cigarette per month (P < 0.0001), perceived a higher percentage of smoking prevalence among their same gendered best friends (P = 0.03), and were more likely to have low smoking refusal self-efficacy (P < 0.0001). In comparison to urban girls, rural girls perceived a lower percentage of smoking among their same

Discussion

Overall, the influence of parental smoking on the smoking behavior of ninth grade students was relatively weak in both urban and rural areas of China. Parental influences on adolescent smoking were similarly weak in studies in urban Guangzhou, China (Wen et al., 2007), and in Western countries (Hoffman et al., 2006).

Friends' smoking and perceived smoking prevalence were risk factors for adolescent smoking in both urban and rural areas of China. These effects are similar in direction and

Acknowledgment

This research was supported by the USC Pacific Rim Transdisciplinary Tobacco and Alcohol Use Research Center (NIH grant 1 P50 CA84735-01) and the Sidney R. Garfield Endowment. The authors are deeply grateful to the CSCS steering committee and team members.

References (10)

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