Students' Attitudes, Knowledge, and Behaviors towards Tobacco Use, Passive Smoking, and Smoking Cessation across Three Cities in China: an Evaluation of School Smoke-free Interventions Open Access

Abstract

Objective: This study was designed to measure the effectiveness of the one-year GHI-CTP smoke-free interventions (school intervention, social media intervention, and technical assistance); to examine students' attitudes, knowledge, and behaviors towards smoking, passive smoking and smoking cessation; and to identify indicators associated with students' current smoking status.

Methods: A pooled sample of students aged 12 to 17 (N=8,419 for baseline survey and N=8,967 for evaluation survey) was drawn from the Emory Global Health Institute China Tobacco Control Partnership (GHI-CTP) data that were collected from 54 schools in Bayannouer, Changchun, and Dalian during 2011-2012. Tetrachoric Principal component analysis was used to group variables regarding students' attitudes of smoking, media message exposure, and school curriculum. Logistic regression models were built to examine the significant change of variables of interest between two phases, as well as the associations between students' current smoking status and their smoking attitudes, media message exposure, and school curriculum in both phases.

Results: After the intervention, the pooled students across these three cities were more likely to be non-smokers [AOR=1.23, 95% CI (1.07, 1.41)]. More students reported that they would refuse to smoke if cigarettes offered [AOR=1.36, 95% CI (1.21, 1.54)], would not smoke in next 12 months [AOR=1.45, 95% CI (1.28, 1.65)] or 5 years [AOR=1.38, 95% CI (1.22, 1.55)], and were in favor of banning smoking [AOR=2.58, 95% CI (2.41, 2.77] than before. More students would be prevented from parent smoking [AOR=1.32, 95% CI (1.24, 1.41)] or friend smoking [AOR=1.13, 95% CI (1.06, 1.21)], and exposed to anti-smoking media messages [AOR=1.88, 95% CI (1.73, 2.05)] than before. Factors associated with students' current smoking status after the intervention included: negative attitudes of smoking, media message exposure, and having school curriculum.

Conclusion: There was a regional difference in tobacco use for students in the three cities. In general, families, media, and school curriculum helped to establish a smoke-free environment for students. However, continuous cigarette access and existing smoking habits on campus indicated poor enforcement of the smoke-free interventions that were introduced to students. The enforcement of smoke-free interventions should be strengthened in the future.

Table of Contents

Chapter One: Introduction 1
Introduction and rationale 1
Smoking prevalence 1
Tobacco control implementation in China 2
Secondhand smoke exposure among school students in China 4
The importance of implementing smoke-free interventions among school students 5
Purpose statement 7
Research questions 7
Significance statement 10
Definition of terms 11
Chapter Two: Review of the Literature 13
Studies on current smoking prevalence among teenagers 13
Studies on current secondhand smoking exposure among teenagers 16
Current tobacco control policies and smoke-free interventions implemented in China 19
Studies on the implementation of smoke-free interventions for school students 20
Studies on risk factors that associated with teenagers' smoking behaviors and the implementation of smoke-free interventions in schools 23
Summary and Knowledge gaps 26
Chapter Three: Methodology 29
Objectives 29
Study Setting and Sample 29
Procedures 32
Data Analysis 33
Data Cleaning and Recoding 33
Statistical Analysis 40
Chapter Four: Results 45
Demographic information of study participants 45
Tobacco use 47
Secondhand smoke (SHS) exposure 52
Attitudes and knowledge level towards smoking and passive smoking 54
Attitudes and experience of quitting smoking 57
Social environment of tobacco control 61
Regional differences in students' attitudes, knowledge, and experience of smoking, SHS, and smoking cessation, as well as family, peer, media factors across three cities 63
Factors associated with students' current smoking status 70
Chapter Five: Discussion 75
Major Findings 75
Challenges and barriers 85
Limitations 86
Strengths 88
Recommendations 89
References: 92
Appendix: List of Acronyms 95

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	smoke-free intervention China students tobacco control
Committee Chair / Thesis Advisor	Argeseanu, Solveig, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Non-US governmental agency (e.g., Minister of Health in Haiti)

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