Journal of Adolescence 1999, 22, 621±625Article No. jado.1999.0257, available online at http://www.idealibrary.com on

Cigarette smoking among schoolboys in Beijing, China

XIAOMING LI, XIAOYI FANG AND BONITA STANTON

The current study was designed to assess the recent rate of cigarette smoking and toexamine the association of cigarette smoking with individual factors and problembehaviors using data collected in December 1997 from 323 middle school students(43% females) in Beijing, China. About 15% of the study sample (23% males and 5%females) reported having ever smoked. The data in the current study confirmedfindings from our earlier study (Li et al., 1996, Substance Use and Misuse, 31, 545±563)that the prevalence of cigarette smoking among Chinese adolescents was higher amongmales, increased with advancing age and was associated with participation in otherproblem behaviors and with poorer self-perceived academic performance. The dataunderscore the need for smoking-prevention programs targeting Chinese children andadolescents. # 1999 The Association for Professionals in Services for Adolescents

Introduction

While the rates of cigarette smoking have declined over the past three decades in the U.S.A.,Canada, and other western nations, tobacco use rates have remained stable or increased inmany Asian countries, including China (World Health Organization, 1996). In spite of thisalarming trend, the progression and determinants of cigarette smoking among Chinese havenot been well documented (Chapman, 1994). There are few empirical data available regard-ing cigarette smoking among Chinese children and adolescents.

In 1991, as part of a larger, longitudinal study examining cigarette smoking among Chineseadolescents, we administered questionnaires to 1040 sixth, eighth and tenth grade studentsfrom five schools serving the general public in Beijing, China. Based on these data, wereported that (Li et al., 1996): one-fifth of the sample (mean age of 13?65 years) had smoked,although most were occasional smokers; smoking was more prevalent among males thanfemales (29 vs. 11%, p50?00001); more than one-third of males had tried cigarettes by theage of 13; smoking prevalence increased with age (p50?0001); smokers were more likelythan non-smokers to report poor school performance; and smokers were more likely thannon-smokers to report problem behaviors.

Since our collection of the data in 1991, several significant events have occurred in Chinarelated to tobacco use. First, in 1994 China officially opened its tobacco market to majoroverseas tobacco companies (Mackay, 1997). At the same time, the Chinese governmenthas implemented some anti-smoking measures targeting the general population, includingbanning all cigarette advertising in the public media. In addition, numerous local govern-ments, including 71 cities and three provinces, have banned smoking in public areas such astrains, buses, schools, cinemas and theaters (Mackay, 1997).

The confluence of tobacco-related events is associated with both economic and scientificdata indicating an increase in cigarette production and consumption in recent years. Forexample, the tax revenue which Chinese government generated from cigarettes increasedfrom $5 billion in 1993 to $10 billion in 1996 (Chinese Association on Smoking and Health,

Reprint requests and correspondence should be addressed to Xiaoming Li, Ph.D., Department of Pediatrics, WestVirginia University, PO Box 9214, Morgantown, WV 26506-9214, U.S.A. (E-mail: xli@hsc.wvu.edu).

0140-1971/99/050621+05 $30�00/0 # 1999 The Association for Professionals in Services for Adolescents

622 X. Li et al.

1997). A recent Chinese national survey conducted among adults in 1996 indicated that onaverage both males and females started smoking 3 years earlier compared to 1984 data. Thesurvey also indicated that the average daily consumption of tobacco increased from 11cigarettes in 1984 to 15 in 1996 for males, and from 9 to 10 for females (Mackay, 1997).

In light of the changes related to cigarette smoking among the general population inrecent years in China, it would be of interest to see whether (and how) the rate and patternsof cigarette smoking had changed among adolescents residing in China, as well as whetherour previous findings based on the 1991 data can be replicated with another independentsample. Accordingly, the current study was designed to assess the recent rate of cigarettesmoking among adolescents in Beijing and to examine the association of cigarette smokingwith individual factors and problem behaviors.

Method

SampleFollowing recruitment procedures similar to those described for the 1991 survey (Li et al.,1996), data were gathered in December 1997. Subjects were seventh, eighth and ninth gradestudents at a typical public middle school in Beijing. All classes in the seventh gradeparticipated and we randomly selected three classes among five classes in each of grades eightand nine. Permission was received from the school principal before we came to the schooland in writing individually from students. Of the students, 323 gave their consent and 23refused.

A self-administrated questionnaire was distributed to each participant by researchpersonnel during regular class time. The school teachers were asked to leave the classroomduring the survey. The participants were assured of the confidentiality of their responses.

Measures

Cigarette smoking. Two items were used to measure Chinese adolescent cigarettesmoking. The first item asked students to identify their status related to smoking on a three-point scale (``never smoked''; ``ex-smoker''; ``current smoker''). The second item askedhow often students had smoked in the previous year (``never''; ``once''; ``several times'';``often''). Because the correlation between these two questions was high (r � 0?77;p � 0?000), the first question was used as index of adolescent smoking in the analysis.

The responses to the item were recoded to create a dichotomous measure (``never smoked''vs. ``ever smoked''). The correlation between the original response and recoded responsewas 0?85 (p � 0?000).

School performance. Subjects were asked to categorize their school performance ona seven-point scale: 1 � ``mostly below Ds''; 2 � ``mostly Ds''; 3 � ``mostly Cs and Ds'';4 � ``mostly Cs''; 5 � ``mostly Bs and Cs''; 6 � ``mostly As and Bs''; and 7 � ``mostly As''.

Parental education. Education levels for both father (or male guardian) and mother(or female guardian) were assessed on a five-point scale: 1 � ``junior high school or less''; 2 �``some high school or completed high school''; 3 � ``vocational school''; 4 � ``some college orcompleted college''; 5 � ``graduate school or more''. The higher level achieved by father ormother was retained as an index of parental education.

Cigarette smoking in Beijing 623

Educational expectation. The subjects were asked how much schooling they thoughtthey would complete in the future on a five-point scale: 1 � ``junior high school''; 2 � ``highschool''; 3 � ``vocational school''; 4 � ``college''; and 5 � ``graduate school''.

Pubertal development. Students were asked to describe the stage of their pubertaldevelopment on a four-point scale: 1 � ``not yet begun''; 2 � ``just started''; 3 � ``under wayfor less than 6 months''; 4 � ``under way for more than 6 months''.

Perceived peer smoking. Each students was asked to list up to nine close or goodfriends and provide a description of smoking status for each friend they listed on a three-point scale (``never smoked''; ``ex-smoker''; ``current smoker''). Similar to the mainadolescent smoking index, these responses were re-coded to create a dichotomous measure(``never smoked'' vs. ``ever smoked'').

Problem behaviors. Students were asked to describe on a four-point scale how oftenthey had engaged in 20 problem behaviors in the previous year: 1 � ``never''; 2 � ``once'';3 � ``several times''; 4 � ``often''. The responses to these items were recoded to createdichotomous measures (``never'' vs. ``at least once''). The Cronbach's alpha for 20 items withmodified response choice was 0?84, indicating a good internal consistency. Total number ofpositive responses (i.e. ``at least once'') was retained as a overall measure of the involvementin problem behaviors.

Results

About 15% of the sample reported having ever smoked cigarettes. Smoking was moreprevalent among males than females (23 vs. 5%; p50?00001); as the number of smokingfemales was so small, analysis was restricted to males.

As is shown in Table 1, cigarette smoking among male students was associated with olderage, poorer school achievement, lower educational expectation, higher level of pubertaldevelopment and more tobacco use among friends. Parental education was not related tocigarette smoking.

As is shown in Table 2, cigarette smoking was significantly associated with all problembehaviors.

Table 1 Association between cigarette smoking and individual factors among schoolboys inBeijing, China

Never smoked Ever smoked

N (%) 135 (77) 40 (23)Age (years) 13?33 (0?99) 13?79 (1?06)*School achievement 3?68 (1.77) 2?33 (1?56)***Educational expectation 4?17 (1?04) 3?21 (1?13)***Pubertal development 2?11 (0?93) 2?66 (0?87)**Parental education 2?23 (0?86) 2?05 (0?88)Perceived peer smoking 0?07 (0?15) 0?31 (0?32)***

*p50?05; **p50?01; ***p50?0001.

Table 2 Association between cigarette smoking and problem behaviors

Never smoked Ever smoked

N (%) 135 (77) 40 (23)Drank beer 42 (31) 32 (80)****Drank wine 39 (29) 18 (46)*Drank hard liquor 3 (2) 14 (35)****Rode bike dangerously 44 (33) 21 (53)*Fought 54 (40) 27 (68)**Mischief at school 70 (52) 29 (73)*Suspended or expelled 6 (5) 6 (15)*Detained by teacher after school 62 (47) 26 (67)*Cheated on test 29 (22) 19 (49)**Plagiarized on homework 50 (38) 31 (82)****Cut school for a whole day 3 (2) 9 (23)****Missed classes 7 (5) 15 (39)****Lied to parents about activities 28 (31) 26 (67)****Forged signature 14 (10) 15 (39)****Damaged property on purpose 9 (7) 13 (33)****Doodled on public buildings 9 (7) 15 (39)****Threatened to hurt someone 21 (16) 17 (44)***Shoplifted 2 (2) 5 (13)**Stolen 1 (1) 5 (13)**Arrested by police 1 (1) 4 (10)**Mean (S.D.) of problem behaviors 3?66 (3?10) 8?68 (4?57)****

*p50?05; **p50?01; ***p50?001; ****p50?0001.

624 X. Li et al.

Discussion

The data in the current study confirmed findings from our 1991 data that the prevalence ofcigarette smoking among Chinese adolescents was higher among males, increased withadvancing age, and was associated with participation in other problem behaviors and withpoorer self-perceived academic performance. There is no consistent relationship betweensmoking and educational level of the parents. In contrast to our earlier findings, a significantassociation between smoking and the educational aspirations of the youth was found in thissample. In addition, the current data indicate that cigarette smoking is associated withincreased perception of peer smoking and advanced pubertal development.

While efforts were taken to ensure a representative sample of the study population,the fact that the sample was recruited from a single school in Beijing limits thegeneralizability of findings. However, the similarity of the findings between the current studyand our previous study (Li et al., 1996) strengthened the current study.

Among comparably aged youth (i.e. 12±15 years old), the prevalence of smoking wassomewhat lower in the present study than in our previous sample (Li et al., 1996) (i.e. 20% in1991 and 15% in 1997). However, this decrease reaches statistical significance only amongfemales (11% at 1991 and 5% at 1997, p�0?021). The smoking rate among male studentsremained similar between 1991 and 1997 (28 vs. 23%). Coupled with our earlier findings, thedata in the current study again underscore the importance of prevention/intervention effortsamong adolescents residing in China.

Cigarette smoking in Beijing 625

Acknowledgements

We are grateful to our colleagues at the West City District Institute of Educational Research,Beijing, and the Institute of Developmental Psychology at the Beijing Normal University,Beijing, China for their assistance in collecting the data for this study.

References

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