Adolescent smoking in Beijing: Prevalence, affecting factors and school-based preventions

Abstract Background: With 15 million of its 130 million adolescents aged 13-18 addicted to smoking, China has the highest rate of adolescent smokers in the world. Yet despite the increasing prevalence of adolescent smoking, the amount of research and research-based preventions that focus on this population is scarce and fragmented compared to its Western counterparts. Methods: Health-related Behaviors Questionnaires (HRBQ) were collected from 2,445 11th grade students in Beijing between October 2006 and May 2007. Descriptive statistics and logistic regression analyses were used to estimate the prevalence of adolescent smoking and to identify affecting factors from both individual domains (self-esteem, academic aspirations, health locus of control) and contextual levels (family, peers, schools, and extracurricular/leisure activities). Interviews with 11 adolescents investigated their daily lives, perceptions of smoking and school-based preventions. Results: The findings gained from interviews triangulated and gave more insights to interpret the survey data. According to the survey data, 15.9% of boys and 4.2% of girls smoked at least one cigarette within seven days. Among the adolescents who did not smoke at the time, even having tried just one or two cigarettes significantly increased the possibility of smoking in the future (OR=5.1). Males and students enrolled in lower-levels school are more likely to smoke. After controlling demographics, the importance of the affecting factors varies between genders. According to the interviews, the adolescents interpreted smoking in their daily lives by attaching personal meanings to the behavior, and they generally perceived that school-based preventions are either unavailable or ineffective. Conclusions: The findings from the quantitative and qualitative studies depict a comprehensive and vivid picture of adolescent smoking in Beijing. Synthesizing the results from this study and the larger body of literature on smoking preventions has revealed implications and suggestions for developing more adolescent-centered school-based preventions.