Social, Psychological, and Environmental-Structural Factors Associated with Tobacco Experimentation among Adolescents in Shanghai, China

OBJECTIVE To estimate the prevalence and social, psychological and environmental-structural determinants of tobacco experimentation among adolescents in Shanghai, China. METHODS We conducted a cross-sectional study based on a two-stage cluster sample design by using the Chinese version of the Global Youth Tobacco Survey (GYTS) to investigate smoking behavior among 19,117 students from 41 junior and senior high schools in Shanghai, China. The association between potential factors and tobacco experimentation were assessed using complex samples procedure logistic regression. RESULTS Of the 19,117 respondents, 10.5% (15.3% boys and 6.2% girls) reported the tobacco experimentation. The main social, psychological, and environmental-structural factors associated with tobacco experimentation were having close friends who smoke (AOR = 8.21; 95% CI: 6.49-10.39); one or both parents smoking (AOR 1.57; CI: 1.39-1.77); a poor school tobacco control environment (AOR 1.53; CI: 1.37-1.83); a high acceptance level of tobacco use (AOR 1.44; CI: 1.28-1.82); and a high level of media tobacco exposure (AOR 1.23; CI: 1.10-1.37). Peer smoking might contribute to smoking experimentation among girls (AOR 8.93; CI: 5.84-13.66) more so than among boys (AOR 7.79; CI: 5.97-9.94) and media tobacco exposure had no association with tobacco experimentation among female students. CONCLUSIONS Social, psychological, and environmental factors are closely associated with tobacco experimentation among adolescents. Prevention programs aimed at reducing teen tobacco experimentation should be conducted at home and school with support by parents, peers and teachers. Our findings should prove useful for future development of intervention strategies among adolescents in Shanghai, China.