Prevalence in trying smoking behavior among adolescent in rural western China and its relationship with Psychosocial factors: Evidence from Global Youth Tobacco Survey

doi:10.21203/rs.3.rs-2102751/v1

Background: Smoking behavior is a continuous and gradual behavior, and most of the addiction of adult smokers comes from their childhood and adolescence.Once they start trying smoking, if no timely intervention measures are taken, the vast majority of smokers will become lifelong smokers.Adolescent is the most effective group in implementing tobacco control and smoking bans.The study aims to effectively evaluate the characteristics of trying smoking behavior of adolescents in rural western China and identify the key psychosocial factors to provide a scientific basis for preventing and reducing the occurrence of smoking behaviors of adolescents.

Methods: A total of 2671 students from rural middle schools in western China were surveyed using the Adolescent Health Questionnaire including Global Youth Tobacco Survey (GYTS). Structural Equation Model (SEM) was used to analyze the direct or indirect relationship between adolescent's try smoking behavior and psychosocial influencing factors.

Results: (1)Tobacco use: 28.3% of adolescents have tried tobacco products, boys are higher than girls,senior is higher than junior,and the tobacco use rate increases with the increase in monthly living expenses (P<0.05). Among the adolescents who tried to smoke, 99% of adolescents first tried to use tobacco products at the elementary and middle school.59% of adolescents reported that the reason for smoking for the first time was curiosity. 58.0% of adolescents have seen teachers smoking in school, and even 26.2% of adolescents see teachers smoking in school almost every day.(2) Social support had a complete mediating effect on try smoking behavior through mental health problems and life satisfaction (β=-0.022, 95%CI: -0.028 to -0.016).Mental health had a positive and direct effect on try smoking behavior (β=0.112,P<0.05).Life satisfaction had a negative direct impact on try smoking behavior (β=-0.125,P<0.05).Mental health problemshad a partial mediating effect on try smoking behavior through life satisfaction(β=0.016, 95%CI: 0.008 to 0.025),and the mediating effect accounted for 20.7% of the total effect.

Conclusions: Findings of this study highlight that adolescents smoking behavior is a complex psychosocial behavior. Reducing mental health problemsand promoting life satisfaction should be considered as the key target for interventions aiming to the prevalence of adolescents’ smoking behavior.

Rural adolescent

Tobacco Use

Psychosocial Factors

Structural Equation Model(SEM)

Tobacco harm is currently one of the most serious preventable public health problems in the world. According to the data from the “China Smoking Harmful Health Report 2020”, tobacco kills more than 8 million people worldwide each year, of which about 7 million die from diseases caused by smoking. In China, tobacco kills more than 1 million people each year, which is expected to increase to 2 million per year by 2030 and 3 million per year by 2050 without effective action[1]. Meanwhile,more than 90% of smokers try their first cigarette under the age of 18 years[2]. Smoking behavior is a continuous and gradual behavior, and most of the addiction of adult smokers comes from their childhood and adolescence. The adolescent period is the critical period for the development of smoking habit [3]. In addition, adolescents have relatively unstable emotions, are easily affected by the surrounding environment, and their values need to be fully established, therefore, they are prone to a series of health-risk behaviors and suffer from mental health problems, such as smoking behavior and depression[4, 5]. Once they start smoking, if no timely intervention measures are taken, the vast majority of smokers will become lifelong smokers.

A study has shown that in rural areas in western China, living, education, and medical resources are relatively scarce, and adolescent often lack the family support and parental supervision,thus becoming a high-risk group of tobacco use[6]. Meanwhile,other studies have found that adolescents who perceive low social support are more likely to report trying smoking behavior. High level of life satisfaction and quality of life can reduce adolescents’ smoking behavior[7]. Mental health problems such as depression are positively related to adolescent smoking behavior[8]. Therefore, it can be seen that adolescents’ smoking behavior is a complex psychosocial behavior, and the prevention and control situation of tobacco use among rural adolescents is more severe and challenging.Some studies have demonstrated that adolescent is the most effective group in implementing tobacco control and smoking bans.The effect of education and intervention for adolescent in the lower age group and newly exposed to tobacco is better than that of adults, and can obtain better short-term and long-term effects,and the most cost-effective.

Despite previous studies which have demonstrated the relationships between social support and the try smoking behavior as well as mental health problems and the try smoking behavior, few studies have included these varibles in one study [7–12]. We do so here in order to understand the interrelationships and potential mechanisms of social support,mental health problems,life satisfaction and the try smoking behavior. We examined the influence of social support ,mental health problems and life satisfaction on adolescent’s try smoking behavior in rural western China. Based on the above description,we hypothesise a mediator model as shown in Fig. 1. Specifically,social support would be positively associated with life satisfaction (Hypothesis 1) and negatively associated with mental health problems (Hypothesis 2) and the try smoking behavior (Hypothesis 3).We also hypothsise that mental health problems would be negatively associated with life satisfaction (Hypothesis 4) and positively associated with the try smoking behavior (Hypothesis 5). Furthermore,we suggested that life satisfaction would be negatively associated with the try smoking behavior (Hypothesis 6).The study aims to effectively evaluate the characteristics of trying smoking behavior of adolescents in rural western China and identify the key psychosocial factors to provide a scientific basis for preventing and reducing the occurrence of smoking behaviors of adolescents.

Participants

The data of this study came from the baseline survey, first and second follow-up surveys of the 2-year longitudinal study in Zizhong county of Sichuan Province, China[13]. In brief, two middle schools were selected by using a combination of typical sampling and cluster sampling method. The first stage was a typical sampling. Zizhong County was selected because of its typical economic development and demographic characteristics, for example, the proportion of migrant workers, were similar to those of the other rural areas in Sichuan province. The second stage was cluster random sampling. Two middle schools are randomly selected from 17 rural middle schools in Zizhong County. In the baseline survey in October , 2015, grade 7 students from the junior high school and grade 10 students from the senior high school were included. Then, follow-up surveys were conducted very half a year till to October, 2017. In this study, 2671 students from the first follow-up (April, 2016) and second follow-up survey (October, 2016) who participated in three surveys and had no missing were included.Study was carried out in accordance with ethical guidelines of Sichuan University. Informed written consent was obtained from parents and the students then provided verbal and written consent to participate.

Adolescent Health Questionnaire

This research uses a self-filled anonymous survey method and self-compiled questionnaires, which includes sociodemographic characteristics (from baseline survey), Social Support Rating Scale(SSRS) (from baseline survey), Life Satisfaction Scales Applicable to Chinese Adolescent Students(CASLSS) (from first follow-up survey), Global Youth Tobacco Survey (GYTS) (from second follow-up survey) and Mental Health Inventory of Middle-School Students(MMHI-60) (from second follow-up survey).

Global Youth Tobacco Survey (GYTS)[14-16]

GYTS is a tobacco survey of middle and high school students sponsored by the WHO and the U.S. Centers for Disease Control and Prevention. In the survey,try smoking behavior is defined as the behavior of trying to smoke as long as adolescents have used tobacco products in the past (including smoked tobacco and smokeless tobacco), even if it was only one or two puffs. In our study, Cronbach’ s alpha coefficient was 0.810.

Mental Health Inventory of Middle-School Students(MMHI-60) [17]

MMHI is a 60-item Likert scale developed by the Institute of Psychology, Chinese Academy of Sciences to analyze the mental health problems of Chinese middle school students, including depression, anxiety, learning pressure, hostility, self-compulsion, paranoia, interpersonal tension and sensitivity, maladjustment, psychological imbalance and emotional instability.The higher the total score represents, the more serious the mental health problems of middle school students.In our study, Cronbach’ s alpha coefficient was 0.973.

Social Support Rating Scale(SSRS)[18]

SSRS includes subjective support, objective support and utilization of support. The higher the total score is, the higher the social support the individual receives. In our study, Cronbach’ s alpha coefficient was 0.746.

Life Satisfaction Scales Applicable to Chinese Adolescent Students(CASLSS)[19]

CASLSS has 2 levels, namely "self-satisfaction, life environment satisfaction", and 6 dimensions, namely "academic satisfaction, friendship satisfaction, family satisfaction, freedom satisfaction, school satisfaction, and environmental satisfaction. The higher the score represents, the higher life satisfaction. Cronbach’ s alpha coefficient in our study was 0.934.

Procedure

All investigations were performed by public health professionals. Informed written consent was obtained from parents. The research assistants verbally explained the students’ rights as participants in the study, and the students then provided verbal and written consent to participate. Different classes in the same school were surveyed at the same time.

Data analysis

Firstly, the valid questionnaires were uniformly numbered, using EpiData 3.1 for data entry, SPSS 22.0 for data sorting, statistical description and analysis.Secondly, Mplus 7.0 was used to fit the Structural Equation Model(SEM) [20].

The construction of structural equation model in this study was divided into five steps: model assumption, model identification, model fitting, model evaluation, and model modification.When RMSEA<0.08, CFI>0.90, TLI>0.90 and WRMR≤1.0, it meant that the model fitted well.

In total, 2671 adolescents with an average age of 15.7 years (SD 1.4, from 11 to 19 years) were included in this study.There were 1,236 boys and 1,435 girls, 586 from junior high school and 2085 from senior high school, and 1238 left-behind children and 1433 non-left-behind children.

28.3% of rural adolescents had tried tobacco products. 9.5% of adolescents reported using tobacco products in the past 30 days. 9.7% of adolescents reported that they had tried other tobacco products (such as e-cigarettes, snuff, chewing tobacco, etc). Among the adolescents who tried to smoke, 99% of adolescents first tried to use tobacco products at the elementary. 59% of adolescents reported that the reason for smoking for the first time was curiosity.In the past 30 days,78.2% of adolescents had seen someone smoking in school. 58.0% of adolescents had seen teachers smoking in school, and even 26.2% of adolescents saw teachers smoking in school almost every day. 88.2 % of smokers who bought cigarettes in the past 30 days were not rejected.

Table 1 describes the trying smoking behavior among rural adolescents. Boys (38.3%) was higher than girls (19.7%), senior high school(30.4%) was higher than junior high school (20.6%), and the monthly living expenses increase was positively associated with trying tobacco use (all P<0.05); There was no statistically significant difference in the trial tobacco use rate between left-behind and non-left-behind adolescents (P>0.05).

Table 1 Trying tobacco use among adolescents in rural western China,n(%)

Variable		Have you used tobacco products in the past , even if only one or two mouthfuls		χ²	P
Variable		No	Yes	χ²	P
Total		1916（71.7）	755（28.3）
Sex	Boys	763（61.7）	473（38.3）	113.507	＜0.05
Sex	Girls	1153（80.3）	282（19.7）	113.507	＜0.05
Left-behind children	No	1043（72.8）	390（27.2）	1.684	0.194
Left-behind children	Yes	873（70.5）	365（29.5）	1.684	0.194
Grade	Junior	465（79.4）	121（20.6）	21.486	＜0.05
Grade	Senior	1451（69.6）	634（30.4）	21.486	＜0.05
Family source	Rural	1414（72.6）	533（27.4）	0.130	0.749
Family source	Urban	261（71.7）	103（28.3）	0.130	0.749
Housing type	Earthen house	66（76.7）	20（23.3）	0.817	0.665
	Brick house	558（72.4）	213（27.6）
	Garden House	1051（72.3）	403（27.7）
Monthly allowance（RMB）	≤200	113（75.8）	36（24.2）	17.599	0.003
	201～300	90（80.4）	22（19.6）
	301～500	363（75.9）	115（24.1）
	501～700	674（73.0）	249（27.0）
	701～1000	379（67.6）	182（32.4）
	>1000	56（63.6）	32（36.4）

Table 2 describes that the subjective support and social support scores of trying smokers were lower than those of non-smokers (P<0.05).The life satisfaction and scores of all dimensions of trying smokers were lower than those of non-smokers (P＜0.05).The mental health scale and scores of total and all dimensions of smokers were higher than those of non-smokers (P<0.05).The correlation between social support, life satisfaction and mental health problems of rural adolescents (P＜0.05).There is a positive correlation between life satisfaction and social support (r =0.292).The mental health problems of middle school students is negatively correlated with social support and life satisfaction (r = -0.183, r = -0.276).

Table 2 The scale scores of adolescents who tried different smoking status (X̅ ± S）

Variable	Try smoker	Non-smoker	t	P
Social Support (SSRS)	34.2±5.5	35.0±5.2	3.3	＜0.05
Objective support	8.8±2.4	8.9±2.3	0.6	0.575
Subjective support	18.0±3.0	18.5±2.8	4.7	＜0.05
Support utilization	7.5±1.7	7.6±1.7	1.5	0.130
Life Satisfaction(CASLSS)	147.9±26.7	153.9±28.5	5.1	＜0.05
Friendship satisfaction	27.0±5.8	27.7±5.9	2.6	0.008
Family satisfaction	32.7±7.6	34.4±7.9	5.1	＜0.05
Academic satisfaction	22.1±6.4	22.9±6.8	3.0	0.003
Free satisfaction	22.1±5.0	22.7±5.4	2.9	0.004
School satisfaction	21.5±4.4	24.7±6.2	4.6	＜0.05
Environmental satisfaction	20.5±4.3	21.5±4.4	5.3	＜0.05
Mental Health Of Middle School Students(MMHI-60)	2.4±0.8	2.2±0.7	-6.2	＜0.05
Feeling of learning pressure	2.6±1.0	2.4±0.9	-5.2	＜0.05
Paranoid	2.3±0.9	2.1±0.8	-6.3	＜0.05
Hostility	2.2±0.9	1.9±0.8	-7.4	＜0.05
Interpersonal tension and sensitivity	2.4±0.9	2.2±0.8	-5.0	＜0.05
Depression	2.2±0.9	2.1±0.8	-5.3	＜0.05
Anxiety	2.5±1.0	2.3±0.9	-3.2	＜0.05
Self-compulsion	2.4±0.8	2.3±0.7	-3.2	0.002
Maladaptation	2.4±0.8	2.3±0.8	-5.0	＜0.05
Unstable emotion	2.5±0.9	2.3±0.8	-5.6	＜0.05
Psychological imbalance	2.1±0.9	1.9±0.8	-6.4	＜0.05

To explore the relationship between adolescents try smoking behavior and psychosocial factors. Firstly, based on the domestic and foreign literature research and the above-mentioned single factor analysis results, a multi-factor Logistic regression analysis was carried out. Taking whether to try smoking as the dependent variable, the statistically significant demographic variables and social support, life satisfaction and mental health problems of single factor analysis were incorporated into the model. The results showed that the scales of various psychosocial factors were still statistically significant after adjusting the demographic data. Secondly,based on literature research and the above path hypotheses(Fig.1),the hypothesis 1 to 6 were put forward when setting up the initial model[21-27].Then according to the model discriminant rule, the model was discriminated between the measurement model and the structure model.The fitting results of the initial model showed that social support had no direct effect on adolescent try smoking behavior,so this pathway was removed(P＞0.05). As a result,evaluate model: RMSEA[95%CI]=0.040[0.038, 0.043], CFI= 0.950, TLI= 0.942, and WRMR=1.474. The fitting results of the final model showed that the path coefficients between the significant and latent variables and between the latent variables were statistically significant (P<0.05). As shown in Fig.2.

Table 3 and Fig.2 shows that social support had a complete mediating effect on try smoking behavior through mental health problems and life satisfaction. The non-standardized mediation total effect and its confidence interval are -0.022 [-0.028,-0.016] (P<0.05). The non-standardized mediating effect of mental health problems on try smoking behavior and its confidence interval were 0.016 [0.008, 0.025] (P<0.05), and the mediating effect accounted for 20.7% of the total effect.

Table 3 Parameter estimation of main path coefficients among various variables in Model(n=2671)

Independent variable	relation	Dependent variable	Standardized regression coefficient	P
SSRS	direct	CASLSS	0.360	<0.05
MMHI-60	direct	CASLSS	-0.265	<0.05
SSRS	direct	MMHI-60	-0.231	<0.05
MMHI-60	direct	Try smoking behavior	0.112	<0.05
CASLSS	direct	Try smoking behavior	-0.125	<0.05
SSRS	indirect	Try smoking behavior	-0.022	<0.05
MMHI-60	indirect	Try smoking behavior	0.016	<0.05

This study aimed to investigate the relationship between try smoking behavior and psychosocial influencing factors of adolescents in rural areas in western China.to our knowledge,this is the first study to report the complex relationship between try smoking behavior and life satisfaction,mental health problems and social support.

The findings of this study give important implications of development and implementation of interventions to rural adolescents’ try smoking behavior.

The survey found that the trial tobacco use rate of adolescents was 28.3% ,which was much higher than the national average level reported in the 2014 China Youth Tobacco Survey(19.9%) [10]. At the same time,this study showed that life satisfaction has a negative direct impact on try smoking behavior. Mental health problems had a negative and indirect effect on try smoking behavior through life satisfaction. Social support had no direct effect on try smoking behavior, but was fully mediated through mental health problems and life satisfaction.

The trial tobacco use rate of adolescents was much higher than the national and global average level.which can be seen that the tobacco use among rural youth in western China is more serious. This may be due to the fact that all the subjects of this survey were rural adolescents, while the national average was for adolescents in all cities and rural areas.This also fully showed that the tobacco control situation in rural areas was more severe than in urban areas. The survey also found that the boy’s try smoking rate were significantly higher than those of girls. From a sociological point of view, men smoking behavior was more easily accepted by the public, while women smoking behavior was not easy to be accepted by the public, and they may be condemned and abused [28, 29]. This study found that 66.6% of the students who tried smoking were those younger than 13 years old who tried smoking for the first time.It can be seen that most students try tobacco products for the first time in elementary. Therefore, it is necessary to strengthen the health education of tobacco harm and the prevention and control of smoking behavior for elementary students[30].This study found that in the past 30 days, 78.2% of the students had seen someone smoking in the school. 58.0% of the students had seen the teacher smoking in the school, and even 26.2% of the students had seen the teacher smoking every day, which reminded us that we need to pay more attention to the implementation of the smoke-free school policy and the obvious demonstration effect of teacher behavior on students[31, 32]. At the same time, 88.2% of adolescents reported that they were not rejected when buying cigarettes, which was significantly higher than the national level in 2014.The Protection of Minors clearly stipulates that vendors prohibit the sale of tobacco and alcohol to minors and should set up eye-catching signs not to sell tobacco and alcohol to minors. However, the above regulations had not been effectively and timely supervised and implemented in rural areas[33].

This study showed that life satisfaction has a negative direct impact on try smoking behavior. Mental health problems had a negative and indirect effect on try smoking behavior through life satisfaction. Social support had no direct effect on try smoking behavior, but was fully mediated through mental health problems and life satisfaction. This can also indicate that social support mainly affects the individual's mental health status and life satisfaction, and thus indirectly affects the individual's behavior, such as try smoking behavior.The above path directions are approximately consistent with the actual theory and other research [24–27]. For individuals, internal mental health problems are effectively addressed, and life satisfaction increases, and external health-risk behaviors decrease, such as smoking. The higher the level of social support an individual received, the better their mental health and the less likely to try smoking. Meanwhile, the higher the level of social support, the higher the life satisfaction and the less likely to try smoking[34–37]. Reducing mental health problems and promoting life satisfaction should be considered as the key target for interventions aiming to the prevalence of adolescents’smoking behavior.

This study suggests that, on the one hand,in order to protect rural adolescents from tobacco poisoning, we should give full play to the importance of a good external environment. Gradually form a good atmosphere of refusal to smoke among adolescents,and in-depth development of the creation of smoke-free schools and health promotion schools,comprehensive protection of rural adolescents in western China from the harm of tobacco. On the other hand, we should pay much attention to the psychological factors of adolescents. Tobacco use among adolescents can be reduced by improving adolescents' social support and life satisfaction, maintaining mental health.

Features and deficiencies

Research features: (1) For the first time, a globally unified youth smoking questionnaire was adopted to comprehensively reflect the current situation of youth tobacco use in rural areas in western China, which is conducive to in-depth comparative research with youths in the whole country and other countries. (2)Structural equation modeling was used to analyze the direct and indirect relationships between adolescent smoking attempts and related psychosocial factors. Insufficient research: Although this research has a certain value and innovation, it also has shortcomings. (1)Since this survey is the first baseline survey of a three-year longitudinal study, no intervention measures have been implemented. (2)all the participants’ health risk behaviors were self-reported and thus subject to reporting bias. (3)The subjects of this study are all school students, excluding adolescents who have dropped out of school.

Informed conxent

The ethics approval of this study was obtained from Medical Ethical Committee of Sichuan University, China (No.20140307). Informed written consent was obtained from parents and the students then provided verbal and written consent to participate.

Consent for publication

Not applicable

Acknowledgments

We thank all the participants for taking part in this research and the teachers in the surveyed schools for helping us to administer the survey.We gratefully thank China National Natural Science Foundation and Sichuan University for funding the research.

Funding

This study was supported by the National Natural Science Foundation of China (No:81472994 and 30972546).

Competing interests

The authors have declared that no competing interests exist.

Availability of data and materials

The qualitative datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

Author contributions

JY wrote the initial draft of the paper,YT collected data,DJ and ZJ analyzed and verified data, LQ revised the initial draft of the paper.All authors assisted in second stage of thematic analysis and made a major contribution to writing the manuscript.

All authors read and approved the final manuscript.

Wang Chen, Xiao Dan, Chi Hui. Summary of "China Smoking Harmful Health Report 2020" [J]. China Circulation Journal, 2021, 36(10): 937-952.
Global Youth Tabacco Survey Collaborative Group.Tobacco use among youth: a cross country comparison[J]Tob Control, 2002.11(3):252-270.DOI:10.1136/tc.11.3.252.
Sweitzer,M.M.,Donny,E.C.,Dierker，L.C.，et al. Delay discounting and smoking: Association with the Fagerstrom Test for Nicotine Dependence but not cigarettes smoked per day[J]. Nicotine Tob Res. 2008,10(10):1571-1575. DOI:10.1080/14622200802323274.
Gulnoza Usmanova, ,and Ali H. Mokdad.Results of the Global Youth Tobacco Survey and implementation of WHO Framework Convention on Tobacco Control in former Soviet Union countries[J].International Journal of Public Health 58.2(2013).DOI:10.1007/s00038-012-0433-2.
WHO. Global accelerated action for the health of adolescents: guidance to support country implementation. Geneva.2017.
Logo DD, Oppong FB, Singh A, et,al. Profile and predictors of adolescent tobacco use in Ghana: evidence from the 2017 Global Youth Tobacco Survey (GYTS)[J].J Prev Med Hyg. 2021 Sep 15;62(3):E664-E672. doi: 10.15167/2421-4248/jpmh2021.62.3.2035.
Ma Haixia. Research on the relationship between health risk behavior and mental health status of rural junior high school students in Xiangxi Prefecture[D]. Jishou University, 2021.
Tao FB,Huang K,Gao M,et al. Smoking behavior and subjective quality of life evaluation of middle school students in Hefei area[J].Chinese Journal of Epidemiology,2006(02):132-136.
World Health Origination.Tobacco[EB/OL].(2021-07-26)[2021-09-24].https://www.who.int/news-room/fact-sheets/detail/tobacco.
Ma Jin. Commentary on Global Youth Tobacco Survey and Shanghai youth tobacco survey[J].Journal of Shanghai Jiaotong University (Medical Science).2012,32(07):823-826.DOI:10.3969/j.issn.1674-8115.2012.07.001.
Huang SL, Lin IF, Chen CY. Impact of tobacco control policies on adolescent smoking: findings from the Global Youth Tobacco Survey in Taiwan[J].Addiction. 2013 Oct;108(10):1829-35. doi: 10.1111/add.12259.
Tibor Baška, et al."Findings from the Global Youth Tobacco Survey (GYTS) in Czech Republic, Hungary, Poland and Slovakia-smoking initiation, prevalence of tobacco use and cessation"[J]. Sozial-und Präventivmedizin SPM 51.2(2006).DOI:10.1007/s00038-005-0022-8.
Lai S, Zhou J, Ji Y, et,al. Subjective well-being among AIDS orphans in southwest China: the role of school connectedness, peer support, and resilience[J].BMC Psychiatry. 2022 Mar 18;22(1):197.
Gulnoza Usmanova, Ali H. Mokdad. Results of the Global Youth Tobacco Survey and implementation of WHO Framework Convention on Tobacco Control in former Soviet Union countries[J]. International Journal of Public Health,2013,58(2):217-226. DOI:10.1007/s00038-012-0433-2.
Xiao Lin.Current status of tobacco use among Chinese adolescents[J].China Youth Studies.2016(09):85-89.DOI:10.19633/j.cnki.11-2579/d.2016.09.012.
Baška T, Sovinová H, Németh A, et al. Findings from the Global Youth Tobacco Survey (GYTS) in Czech Republic, Hungary, Poland and Slovakia-smoking initiation, prevalence of tobacco use and cessation[J]. Sozial- und Präventivmedizin SPM,2006,51(2):110-116.
Wang Jisheng,Li Yan,He Ershi. Reliability and validity test and Norm establishment of SCL-90 for Middle school students[J].Chinese Mental Health Journal.1999(01).
Liu Yanlin,Fang Maosheng. The Relation ship between Social Support and the Utilization of It and Adolescent Depression: a Retrospective Case-control Study[J].Chinese Journal of Social Medicine.2014.31(2):98-99.DOI:10.3969/j.issn.1673-5625.2014.02.009.
Zhang Xingui,He Liguo,Zheng Xue,et, al. The structure and scale of life satisfaction of adolescent students[J].Journal Of Psychological Science.2004,(05):1257-1260.DOI:10.16719/j.cnki.1671-6981.2004.05.068.
Wang Mengcheng. Latent variable Modeling and Mplus Applications Fundamentals[J].Chongqing University Press.2014.
Yang Zehong,Wei Yan,Ou Yang,et al.Prevalence study of tobacco among teenagers in Guizhou Province,2013[J].Chinese Journal of Health Education,2016,32(02):104-106.DOI:10.16168/j.cnki.issn.1002-9982.2016.02.002.
Tang Wenjing,Zheng Xiaobing.Analysis on smoking behavior and its influencing factor among adolescents in Ningxia Province[J].Modern Preventive Medicine.2015,42(15):2741-2743.
Ma C,Xi B,Li Z,et,al. Prevalence and trends in tobacco use among adolescents aged 13-15 years in 143 countries, 1999-2018: findings from the Global Youth Tobacco Surveys[J].Lancet Child Adolesc Health. 2021 Apr;5(4):245-255. doi: 10.1016/S2352-4642(20)30390-4.
Ji Yuanyi,Zhang Yu,Yin Fei,et al. The prevalence of depressive symptoms and the relationships between depressive symptoms, self-esteem and social support among rural left-behind children in Sichuan province[J].Modern Preventive Medicine.2017,44(02):239-242.
Chinese Center for Disease Control and Prevention. Report of the 2010 Global Adult Tobacco Survey on China[M].Beijing: China Three Gorges Press. 2011.
Yang GH, Wang Y, Zeng YX et al. Rapid health transition in China, 1990-2010: findings from the global burden of disease study 2010[J]. Lancet, 2013, 381: 1987-2015.
World Health Organization.WHO report on the global tobacco epidemic, 2008: the MPOWER package. Geneva, 2008.
Saqib MAN, Rafique I, Qureshi H, et,al. Burden of Tobacco in Pakistan: Findings From Global Adult Tobacco Survey 2014[J].Nicotine Tob Res. 2018 Aug 14;20(9):1138-1143. doi: 10.1093/ntr/ntx179.
GBD 2019 Viewpoint Collaborators. Five insights from the Global Burden of Disease Study 2019[J]. Lancet.2020,17(396):1135-1159.DOI:10.1016/S0140-6736(20)31404-5.
Ranjit A,Buchwald J,Latvala A,et al.Predictive Association of Smoking with Depressive Symptoms: a Longitudinal Study of Adolescent Twins[J].Prev Sci.2019.20(7):1021-1030.DOI:10.1007/s11121-019-01020-6.
Sheng XP,Juan XM,Xi LZ.Prevalence of smoking among adolescents in China:an updated systematic review and meta-analysis[J].Public Health.2020,182:26-31.DOI:10.1016/j.puhe.2020.01.011.
Zhang M,Liu S,Yang L,et al.Prevalence of Smoking and Knowledge About the Hazards of Smoking Among 170 000 Chinese Adults, 2013-2014[J].Nicotine Tob Res.2019,19:21(12):1644-1651.DOI:10.1093/ntr/ntz020.
Xiao D,Wang C.Rising smoking epidemic among adolescents in China[J].Lancet Respir Med.2019,7(1):3-5.DOI:10.1016/S2213-2600(18)30509-5.
Jones ME,Schoemaker MJ,Wright LB,et al.Smoking and risk of breast cancer in the Generations Study cohort[J].Breast Cancer Res. 2017,22,19(1):118.DOI:10.1186/s13058-017-0908-4.
Xi B,Liang Y,Liu Y,et al.Tobacco use and second-hand smoke exposure in young adolescents aged 12-15 years: data from 68 low-income and middle-income countries[J].Lancet Glob Health.2016,4(11):795-805.DOI:10.1016/S2214-109X(16)30187-5.
Healey B, Hoek J, Wilson N,et al.Youth exposure to in-vehicle second-hand smoke and their smoking behaviours:trends and associations in repeated national surveys (2006-2012)[J].Tob Control.2015,24(2):146-52.DOI:10.1136/tobaccocontrol-2013-051124.
Jawad M,Al-Houqani M,Ali R,et al. Prevalence,attitudes,behaviours and policy evaluation of midwakh smoking among young people in the United Arab Emirates:Cross-sectional analysis of the Global Youth Tobacco Survey[J].PLoS One. 2019 Apr 24;14(4):e0215899. doi: 10.1371/journal.pone.0215899.

No competing interests reported.

Prevalence in trying smoking behavior among adolescent in rural western China and its relationship with Psychosocial factors: Evidence from Global Youth Tobacco Survey

Status:

Version 1

Abstract

Figures

Introduction

Methods

Results

Discussion

Conclusions

Features and deficiencies

Declarations

References

Additional Declarations

Status:

Version 1