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Background: The prevalence of adolescent smoking has been increasing rapidly in China. Theory-based smoking prevention programmes in schools may be an effective approach in preventing smoking among Chinese adolescents.Methods: A school-level cluster randomized controlled trial was conducted among 7th and 8th grade students (N = 2343) in four junior high schools in southern China during 2004-06. The theory-based, multi-level intervention was compared with the standard health curriculum. Outcome measures comprised changes in students' smoking-related knowledge, attitudes and behaviour.Results: The mean knowledge scores from baseline to the 1- and 2-year follow-ups increased more in the intervention group than in the control group, whereas there was little change in attitude scores. At the 1-year follow-up (the total sample), the interventions reduced the probability of baseline experimental smokers' escalating to regular smoker [7.9 vs 18.3%; adjusted odds ratio (OR) 0.34, 95% confidence interval (CI) 0.12-0.97, P = 0.043], but did not reduce the probability of baseline non-smokers' initiating smoking (7.9 vs 10.6%; adjusted OR 0.86, 95% CI 0.54-1.38, P = 0.538). At the 2-year follow-up (only 7th grade students), similar proportions of baseline non-smokers initiated smoking in the intervention group and the control group (13.5 vs 13.1%), while a possibly lower proportion of baseline experimental smokers escalated to regular smoking in the intervention group than the control group (22.6 vs 40.0%; adjusted OR 0.43, 95% CI 0.12-1.57, P = 0.199).Conclusions: This multi-level intervention programme had a moderate effect on inhibiting the escalation from experimental to regular smoking among Chinese adolescents, but had little effect on the initiation of smoking. The programme improved adolescents' smoking-related knowledge, but did not change their attitudes towards smoking. [ABSTRACT FROM AUTHOR]

Background: The prevalence of smoking among Chinese adolescents has dramatically increased in recent years. The purpose of this study was to examine the differences in smoking-related knowledge, attitudes, and behaviors among Chinese students in 3 types of secondary schools. Methods: This cross-sectional study was conducted among 3957 students of seventh, eighth, and ninth grades and 2870 student parents from 3 public, 1 factory, and 2 general-paid private secondary schools at Guangzhou in 2004. Participants were asked to complete self-administered questionnaires about sociodemographic characteristics, smoking-related family and school environments, smoking-related knowledge and attitudes, and smoking behaviors. Results: The average scores of students’ smoking-related knowledge and attitudes (higher score, more against smoking) were highest in the factory school, followed by public schools and private schools. The differences among them were statistically significantly (P < .05). The lifetime smoking prevalence was also significantly different (P < .001) among 3 types of schools: 35.4% in private schools, 17.4% in public schools, and 13.2% in the factory school. The prevalence of students’ weekly smoking was also higher in private schools (6.2%) than in public schools (4.9%) or the factory school (4.0%). Similar disparity was observed in the prevalence of daily smoking (3.9% private, 3.5% public, and 2.7% factory). However, differences in weekly and daily smoking were not statistically significant (P > .05). Conclusions: Compared with students in public and factory schools, those in general-paid private schools had poorer smoking-related knowledge, more supportive attitudes toward smoking, and more popular smoking behaviors. Therefore, more intensive smoking prevention programs should be implemented among them. [ABSTRACT FROM AUTHOR]

Abstract: Objective.: To identify modifiable family and school environmental factors associated with Chinese adolescent smoking behaviors including never-smoking, experimental smoking, regular smoking, and attempting to quit. Methods.: A cross-sectional survey using self-reported questionnaires was conducted in Huangpu, Guangzhou in December of 2004. A total of 3957 pupils agreed to complete the questionnaires. The prevalence odds ratio (risk) of experimental smoking was compared to never-smoking, adjusting for gender and age in unconditional logistic regression analysis. The risk of regular smoking was compared to experimental smoking, and the risk of attempting quitting was analyzed in regular smokers. Results.: The cigarette smoking of peers, mothers, fathers, brothers, and supervising teachers, passive smoking, and seeing someone smoking on campus increased the risk of experimental smoking vs. nonsmoking, while no-smoking signs, perceived anti-tobacco atmosphere in school, and being taught smoking-related health knowledge decreased the risk. The factors associated with regular smoking compared to experimental smoking included the smoking of peers, brothers, fathers and supervising teachers, teacher''s tolerance, and passive smoking. Being taught smoking-related knowledge, perceived anti-tobacco atmosphere and no-smoking signs in school were positively associated with regular smoker''s attempt to quit, while supervising teacher''s smoking, parents'' and teachers'' tolerance could delay it. Conclusions.: These modifiable family and school environmental factors as well as their interaction with gender and age should be highly considered in adolescent smoking prevention in China. [Copyright &y& Elsevier]