Correlates of Cigarette Smoking among Male Chinese College Students in China--A Preliminary Study.

Introduction The adverse health effects of cigarette smoking have been widely studied and determined. Cigarette smoking is the major cause of many chronic and deadly diseases, such as heart disease, stroke, chronic obstructive pulmonary disease, peripheral vascular disease, periodontal disease, pneumonia, and many cancers. (1-3) Despite a dramatic reduction in smoking prevalence in some countries, (4) there is still a high prevalence among adults, young adults and even adolescents in China. Of the 1.28 billion people in China, 60.2% men and 6.9% women were smokers in 2001. (5) Sixteen percent of 13 to 18 year old adolescents (25.7% boys, 5.4% girls) reported having ever smoked.6 Twenty-four percent and 9% of school adolescents in another study reported having smoked in the past and in the last 30 days, respectively. (7) Furthermore, 12.1% male nonsmokers and 51.3% female nonsmokers were suffering from environmental tobacco smoking (ETS) exposure at home, 26.7% male and 26.2% female exposed to ETS at worksites, (7) and 53.0% of young people were exposed to passive smoking at home. (8) A 1990 survey demonstrated that 13% of all deaths in Chinese men over 35 years old were attributable to smoking. (9) Analysis by Niu et al. (10) predicted that the situation would get much worse by 2030, resulting in a 33% rise in the Chinese male mortality rate. Although smoking prevalence (37.7%) of male college students was lower than the overall smoking rate (63%) among Chinese adult males, (11,12) special attention should be given to college students due to their vulnerability during this important transition period in the development of lifetime smoking habits. The college years appear to be a critical time for the transformation and development of lifetime unhealthy behaviors from adolescence among Chinese students. For example, some students who had never tried smoking in the past started to experiment with cigarettes and those who smoked occasionally in high school were more likely to become frequent and heavier smokers when they are in college. (13) In order to prevent college students from potential adverse health consequences from smoking and improve healthy lifestyles, it would be important to understand the factors that may impact the students' smoking behavior. Predictors and correlates of cigarette smoking among college students have been studied and examined in the United States and other western countries. Many factors associated with cigarette smoking among college students have been studied, including depression, social normative beliefs, being men, high-risk behaviors (e.g. marijuana use), lifestyles choices (e.g. nonparticipation in athletics), family and peer smoking, being students in public schools, low socioeconomic status (SES), and poor academic performance at school. (4,6,14-16) Despite the high and increasing prevalence of cigarette smoking in China, little attention has been paid to the examination of influential factors of cigarette smoking among college students. In two studies, stress, curiosity, and loneliness were reported being associated with smoking initiation among medical students in Wuhan, China (11) and perceived benefits of smoking were associated with cigarette smoking among Chinese college students in three cities. (17) However, these studies did not address important factors that may significantly correlated with cigarette smoking. (18) For example, in the most recent study, Mao et al. (18) explored the association between cigarette smoking and a number of individual and psychosocial correlates including subjective norms of family and peer smoking, personal attitudes and perception toward smoking, depressive symptoms, social relations, and engagement in other health risk behaviors. Although this study was comprehensive, some issues were still unaddressed or underdeveloped. Some predictors (e.g. depression), which had been shown to have significant associations with smoking in previous studies (11,17) were not statistically associated with smoking in this study. …