Tobacco use and factors related tobacco use among middle school students in China based on ecological model

Abstract

The purpose of this cross-sectional study was to identify tobacco use and ecological factors related to tobacco use among middle school students. 3,231 students 12-17 years old were selected by three stage stratified cluster sampling. The study was conducted during December 2009. The ecological model was applied to formulate the conceptual framework of the study. The data were collected by self-administered questionnaires, interviews and observation. Chi-square, multinomial logistic regression, and structural equation modeling were used for the data analysis. Results revealed that the prevalence of current tobacco use was 10.6%, 16.2% among the males and 4.3% among the females respectively; the prevalence of ever having used tobacco was 19.7%, 25.3% among males and 13.4% among females respectively. The factors that had a significant statistical association with tobacco use were intrapersonal level factors: gender, age, knowledge, attitude, self esteem, life skill and self-concept; interpersonal level factors: parental smoking, parental attitude, friends smoking, friends attitude, peer pressure, family rules; organizational level factors: tobacco-free school environment, tobacco-free school policies and systems, anti-smoking campaign; community level factors: community tobacco control activity, minor's access and availability of cigarettes; public policy: tobacco control policy. A hypothesized model of the quantity of smoking cigarettes among secondary school students smokers was adequately fitted to the data. These findings suggest that there are multiple levels of influence on tobacco use among middle school students. The intervention of tobacco use should focus on five levels: intrapersonal level, interpersonal level, organizational level, community level, and public policy.