Cigarette smoking among medical college students in Wuhan, People's Republic of China

Prevalence of medical students' burnout and its associated demographics and lifestyle factors in Hong Kong

BACKGROUND

Burnout causes personal suffering and adverse professional consequences. It is prevalent among medical students, although the relationship between burnout and lifestyle factors are understudied in Chinese medical students. Thus, this study aims to (i) estimate the prevalence of burnout among medical students in Hong Kong (HK) and (ii) delineate the relationship between burnout and various lifestyle factors.

METHOD

1,341 students were invited to complete a questionnaire from September to December 2017. Burnout was measured by the Maslach Burnout Inventory. Lifestyle factors including drinking habit, sleep habit and quality, and exercise level were assessed by validated instruments, including Alcohol Use Disorder Identification Test (AUDIT-C), Pittsburgh Sleep Quality Index (PSQI), and Godin-Shephard Leisure-Time Physical Activity (GSLTPA), respectively. Smoking status and use of self-medications were also inquired into, while demographic data was self-reported. Prevalence of burnout with confidence intervals was calculated. Difference in lifestyle and demographic data in students with or without burnout, were compared by t-test and Chi-square/Fisher's exact test. From this, all associations with significant p-value at p<0.1 were entered into the multiple logistic regression model.

RESULTS

731 students (55.6%) responded to the questionnaire. Prevalence of burnout was 27.9% (95%CI: 24.6%-31.5%). Only 3 students in the whole sample smoked; and 6.6% of students drank weekly but rarely drank more than 2 drinks per week. 6.3% and 2.3% self-medicated themselves with medications to improve their sleep and concentration, respectively. Using a multiple logistic regression model, only sleep quality and exercise level were significantly associated with the presence of burnout.

CONCLUSION

Around a quarter of medical students in HK suffered from burnout. Burnout was found to be significantly associated with sleep quality and physical exercise. The study also highlighted that HK medical students lived very different lifestyles from those from other countries. More research is needed to design and establish the effectiveness of lifestyle interventional programs that enhance exercise level and sleep quality.

Predictors of health behaviours among Indian college students: an exploratory study

Purpose

The purpose of this study is to understand the association between health behaviours of diet, physical activity, smoking cigarettes, alcohol consumption, safe sex and sleep quality with demographic (e.g. age, gender) and psychological (i.e. stress, self-esteem and sense of coherence) factors in Indian residential college students.

Design/methodology/approach

Students studying for Bachelor of Technology at residential colleges in India were invited to complete an online questionnaire regarding their health behaviours, demographics and psychological variables. Each health behaviour was regressed onto demographic and psychological factors to determine which of them were associated with performing each behaviour.

Findings

There was no clear pattern of predictors for the health behaviours overall. Self-esteem was related to healthy diet, being single was related to adequate sleep, higher parental income was related to safer sex and being older was related to more alcohol use and safer sex.

Research limitations/implications

This study revealed that health education efforts may need to be designed for specific behaviours and correlates among Indian college students. Interventions regarding (1) healthy eating should target students with lower self-esteem, (2) sleep should target students in a relationship and (3) safer sex should target younger students and those from less affluent backgrounds.

Originality/value

This research is one of the first attempts to study the predictors of health behaviours among Indian college students. The study highlighted that psychological factors (e.g. self-esteem) and demographic factors (e.g. relationship status, parental income, age) affect different health behaviours. These findings can help health educators to design tailored interventions and aid in health education and promotion among Indian college students.

Tobacco Smoking, Lung Cancer, and Therapy in Iraq: Current Perspective

Tobacco smoking is a research topic of high interest to the public health in Iraq. Although Iraq is a country with a high percentage of smokers, we noticed the dearth of adequate studies and programs to deal with this problem. The percentage of smokers exceed 30% of the population and smoking problem becomes a permanent habit in adults and young people. The problems associated with tobacco smoking behavior related to individuals' post-traumatic stress disorder following post-war conflicts, and the social and cultural environment. The health consequences of tobacco smoking can harm almost every organ in the body, and there are reports confirmed the tobacco smoking is a high-risk factor for lung cancer and other diseases. The relative risk of lung cancer increases with increasing duration and intensity of smoking. Also, smoking associated with bladder, prostate, and head and neck cancers, in addition to respiratory diseases. Intervention efforts should focus on reducing the prevalence of cigarette smoking, introduce effective treatments for cancer and quit smoking. In this perspective article, we present our viewpoint and three scenarios to deal with the problem of tobacco smoking in Iraq. We recommend introducing educational, health and legislative policies for quitting smoking and using effective treatments for cancer.

Current Smoking Behavior Among Medical Students in Mainland China: A Systematic Review and Meta-Analysis

This study aimed to estimate the prevalence of current smoking among medical students in mainland China through a systematic search across 6 electronic databases for English or Chinese studies published before May 25, 2018. A total of 79 studies were included; 26 had a high risk of bias. The overall pooled prevalence of current smoking was 10.93% (7460/68 253; 95% confidence interval = 0.09%, 13.08%, I² = 98.6%). This study found a decreasing prevalence of current smoking over the period studied (survey year range of 1988-2014). More specifically, the current smoking prevalence in males decreased progressively across time, while the prevalence in females remained relatively constant. The overall prevalence in the west was higher than in the middle or east of mainland China ( P = .0061). The overall prevalence of current smoking increased with year in school ( P = .0028). The present study provides a comprehensive synthesis of current smoking prevalence among medical students in mainland China. Although there have been some improvements in the status of tobacco use among medical students, given the leading role of physicians in tobacco control, sustained efforts are needed to curb the tobacco epidemic among medical students.

Implementation of the Tobacco-Free Campus Policy on College Campuses: Evidence From a Survey of College Students in Beijing

OBJECTIVE

China issued a nationwide "Tobacco-Free Campus" Policy (TFCP) in January 2014, but it is unclear how well it was implemented across China's 2138 college campuses. We conducted an Internet survey of Beijing college students to evaluate the implementation of the TFCP in Beijing.

METHODS

An Internet survey of 711 students from 37 colleges in Beijing was conducted in May 2015. Respondents reported on secondhand smoking (SHS) exposure on campus, knowledge on and actions taken against SHS, and tobacco marketing exposure on campus.

RESULTS

Almost 90% of respondents were exposed to SHS on campus at least once in the past month. Approximately 37% of nonsmokers and 61% of smokers reported seeing a teacher smoking, and the majority of both smokers and nonsmokers reported seeing a classmate smoking in campus buildings. The likelihood and location of SHS exposure depend on the participant's demographics and own smoking behavior. Nonsmokers were more likely to be aware of the health risk of SHS than smokers. Although most participants were aware of the harms, only 13% and 9% tried to stop their last SHS exposure indoors and outdoors, respectively. Forty-seven students from 14 colleges noticed tobacco marketing activities on campus.

CONCLUSIONS

The TFCP on Chinese college campuses was only partially enforced, particularly with regard to SHS.

IMPLICATIONS

On January 29, 2014, the Chinese Ministry of Education issued the TFCP. A major barrier to effective tobacco control in China is the difficulty in implementing policies issued by the central government. At this point, it is unclear whether the TFCP was successfully implemented on China's college campuses. Major tobacco use monitoring efforts do not include college students. The present research describes the current tobacco control environment on Beijing's college campuses 15 months after the TFCP took effect. To our knowledge, this is the first paper in the English literature on tobacco environment and exposure (rather than a prevalence survey) of college students in China.

Can We Afford Better Health? A Study of the Health Differentials in China

Using survey data collected in eight provinces of China, this study examines the relationship between income disparities and adult physical health outcomes. It also explores the mechanisms underlying these income differentials in health. Our results show that the association between income and health can be explained largely by income differences in other areas. In the Chinese social context, we find that living conditions, access to health care services and community development are important mediating factors. These findings generally agree with earlier explanations on socioeconomic differentials in health. We also find that the factors that are most important in explaining income differentials in health vary by rural/urban residence. However, the results show that these factors are unable to fully explain income differentials in reported illness and disability. Moreover, we do not find consistent effects of lifestyle and health-related behaviors, such as drinking and smoking, on the link between income and health.

Cigarette smoking behavior and the related factors among the students of mashhad university of medical sciences in iran

Background:

Tobacco consumption is the second major cause of death and the fourth most common risk factor for diseases, worldwide. Epidemiologic studies have traced the use of alcohol, tobacco, and illicit substances among medical students and physicians.

Objectives:

The current study aimed to investigate the prevalence of cigarette smoking and the related factors among the students of medical sciences in Mashhad University of Medical Sciences, Mashhad, Iran.

Patients and Methods:

This cross-sectional study was conducted on 946 health professional students in Mashhad University of Medical Sciences (MUMS, Iran) in autumn 2008. A standard self-administered questionnaire consisting of socio-demographic data, participant smoking status, family and peer smoking, attitudes and beliefs about smoking, awareness of cigarette negative effects and reasons for smoking cessation was used in the current study.

Results:

Among the students, 18.3% reported having ever tried or experienced with cigarette smoking. The overall prevalence of cigarette smoking was 9.8% with significant differences in prevalence rates by gender, 17.6% among males and 4.2% among females. Starting and continuing smoking was significantly correlated with the family cigarette consumption habits. The most common reason to start smoking was friends (24.9%) and the most important reason to continue smoking was personal life distress (17.6%). The majority of participants (92.3%) reported that they were aware of the hazards of smoking. A significant difference regarding awareness of smoking hazards was observed between smokers and non-smokers. The most important preventive factor for cigarette smoking was religious beliefs (69.1%).

Conclusions:

Although the prevalence of regular smokers among health professions students of MUMS was lower than general populations, but this level is still alarming and points at the rapid growth of cigarette use, especially among female students. Medical schools should work harder to tackle this phenomenon and address it more efficiently in their curricula.

Prevalence of and factors influencing smoking among medical and non-medical students in Tbilisi, Georgia

OBJECTIVE:

Smoking is a serious problem that has a devastating impact on health. The objective of this study was to describe the prevalence of and factors influencing smoking among medical and non-medical students in Tbilisi, Georgia, as well as to determine whether medical education has an impact on smoking.

METHODS:

A cross-sectional study was carried out at Tbilisi State Medical University and Tbilisi State University, both of which are located in Tbilisi, Georgia. A total of 400 4th-year students (200 students at each university) were asked to complete standardized questionnaires.

RESULTS:

Of the sample as a whole, 48.75% were identified as smokers and 51.25% were identified as nonsmokers. The mean age was 20.24 years among smokers and 20.26 years among nonsmokers. Of the medical students, 49.5% were smokers, as were 48.0% of the non-medical students. The male-to-female ratio in the study population was 0.9:1.1. Smoking was found to have a strong relationship with gender, males accounting for 65% of all smokers. Of the smokers, 56.9% stated that they would like to quit smoking (for health or financial reasons). Of the medical students, 59.5% expressed a willingness to quit smoking, as did 54.2% of the non-medical students.

CONCLUSIONS:

There is a need to improve smoking education for undergraduate students. Special attention should be given to the inclusion of anti-smoking education in undergraduate curricula, as well as to the implementation of smoking prevention campaigns at institutions of higher education. However, such measures will be effective only if tobacco control policies are strictly enforced on the national level as well.

A study of the perception of health risks among college students in China

The present survey was designed to investigate the perception of health risks among college students in China. The data are the responses of a sample of 3,069 college students at one university to surveys that include measures of several dimensions of public judgments about fifteen specific hazards. Chinese college students conveyed their concerns as falling into three broad categories: Environmental (e.g., global warming, natural catastrophes, the ozone hole, air pollution, chemical pollution, pesticides in food), Technological (e.g., nuclear power stations, thermal power, genetically modified food, medical X-rays), and Social (cigarette smoking, drinking alcohol, overtime study or work, mental stress, motor vehicle accidents). The data were collected with a self-report questionnaire. Descriptive statistics were used to illustrate the levels of perceived risk according to the percent of "high risk" responses as well as the mean response values. Generally, the hazards that were perceived as posing the greatest health risk were those belonging to the social health risks; items related to technology risks received the lowest percentage of "high health risk" rankings. Traditional environmental risks such as natural catastrophes, pollution issues (chemical pollution, air pollution), and pesticides in food were ranked as being relatively high risks. The respondents were less concerned about new emerging issues and long-term environmental risks (global warming). In this survey, motor vehicle accidents were considered to be a "high health risk" by the greatest percentage of respondents. Generally speaking, the female respondents' degree of recognition of health risks is higher than that of male respondents. Only for the item of smoking was the male respondents' degree higher than that of females. There is also a geographic imbalance in the health risk perceptions. The degree of recognition of health risks from respondents in municipalities is generally lower than that of respondents from other areas except for items such as natural disasters, smoking, medical X-rays, and mental stress, which are exceptions.

Tobacco smoking among doctors in mainland China: a study from Shandong province and review of the literature

BACKGROUND

Tobacco control represents a key area in which doctors can make a significant positive impact on their patients' lives. Despite this fact, however, doctors in certain regions of China are known to smoke tobacco at rates similar to or even exceeding those seen within the general population.

OBJECTIVE

This study sought to investigate the smoking habits of doctors at a teaching hospital in Shandong province, as well as providing a brief review of smoking research that has been conducted among doctors elsewhere in China.

METHOD

An anonymous questionnaire survey was distributed to doctors working at a university teaching hospital in 2008, as part of a larger study of occupational health issues in the healthcare profession.

RESULTS

The overall smoking prevalence rate of doctors in this study was 36.3% with significant differences observed between the genders (males: 46.7% and females: 5.3%). Age and total career length were also correlated with smoking habit, although no significant associations were found with department of employment.

CONCLUSIONS

Overall, our study suggests that smoking rates among doctors in Shandong province are higher than those documented in many other countries, a finding which is consistent with previous research conducted in some other Chinese provinces. Addressing this issue from an intrinsic cultural perspective will clearly need to form the cornerstone of tobacco control efforts within the Chinese medical community in future years.

Differences of smoking knowledge, attitudes, and behaviors between medical and non-medical students

BACKGROUND

Previous studies in the world reported inconsistent results about the relationship of medical professional education with medical students' smoking behaviors, and no similar research had been published in China.

PURPOSE

This paper aims to explore whether the differences of smoking-related knowledge, attitudes, and behaviors existed between medical and non-medical undergraduate students.

METHODS

Eight thousand one hundred thirty-eight undergraduate students sampled from a university in Guangzhou were investigated with a self-administered structured questionnaire about their smoking-related knowledge, attitude and behaviors, and other relevant factors. General linear model and multinomial logistic regression were conducted to test the differences in smoking-related knowledge, attitude, and behaviors between medical and non-medical students while controlling for potential confounding variables.

RESULTS

There was no difference in smoking-related knowledge scores between medical and non-medical freshmen, but medical sophomores and juniors had higher scores of smoking-related knowledge than their non-medical counterparts. The medical sophomores had higher mean score of attitudes towards smoking than non-medical ones. Before entering university, the difference in the prevalence of experimental and regular smoking between medical and non-medical college students was not significant. After entering university, in contrast, the overall prevalence of regular smoking was significantly higher among male non-medical college students than among male medical students. Stratified by current academic year, this difference was significant only among male sophomores.

CONCLUSIONS

Medical students have higher smoking-related knowledge, stronger anti-smoking attitude, and lower prevalence of regular smoking than non-medical college students of similar age, which may be associated with medical professional education.

Cognitive attributions for smoking among adolescents in China

To design more effective health communication messages for smoking cessation and prevention, it is important to understand people's own perceptions of the factors that influence their decisions to smoke. Studies have examined cognitive attributions for smoking in Western countries but not in the Chinese cultural context. In a study of 14,434 Chinese adolescents, exploratory factor analysis grouped 17 cognitive attributions into 8 factors: curiosity, coping, social image, social belonging, engagement, autonomy, mental enhancement, and weight control. The factors were ranked based on the participants' self-reports of importance and by the strength of their associations with smoking behavior. Among all smokers, curiosity was the most frequently-ranked attribution factor at the early stages of smoking but not for daily smoking. Coping was highly-ranked across smoking stages. Social image and social belonging were more highly-ranked at earlier stages, whereas engagement and mental enhancement were ranked more highly at later stages of smoking. More attributions were associated with smoking among males than among females. This information could be useful for the development of evidence-based anti-smoking programs in China.

Cigarette smoking among university students in Greece: a comparison between medical and other students

OBJECTIVES

The purpose of the study was to investigate the smoking habits of medical and other students and to explore the most important factors associated with students' smoking.

METHODS

University students were surveyed in late spring 2006 regarding their smoking status and additional health- and behavior-related characteristics.

RESULTS

A total of 1205 (269 medical and 936 nonmedical) students participated in the study. Of these 47% reported being current smokers (35% among medical students), and 30% of the smokers had already started smoking at the age of 16 years. Smokers reported a significantly higher prevalence of cough and respiratory infections and a decrease in physical fitness. The most important factor associated with smoking prevalence was friendship with smokers and maternal smoking. A better knowledge of harmful effects showed a strong association with nonsmokers. Although nonmedical students exhibited a greater possibility to be a smoker, awareness of harmful effects among medical students was not as significant as factor against smoking compared with among nonmedical students.

CONCLUSIONS

This study shows that smoking prevalence among medical and other students in Greece is extremely high. A lack of effective education against smoking in medical students was evident and this underlines the need to identify the factors to be included in planning effective antismoking programs.

Psychosocial correlates of cigarette smoking among college students in China

The objectives are to examine the smoking practice and intention among Chinese college students and to explore the association between cigarette smoking and individual and psychosocial factors. Cross-sectional data were collected from 1874 students from 19 college campuses in Jiangsu province, China. Both bivariate and multivariate analyses were performed to assess the associations of smoking practice and smoking intention with various individual and psychosocial factors. There was a significant gender difference in both smoking practice and smoking intention. Overall, 53% of the participants (70% male and 31% female) reported ever having smoked in their lifetime and 29% of the sample (49% male and 5% female) reported having smoked in the past 30 days. About one-fourth of the sample (44% male and 6% female) thought they were likely to smoke in the next 6 months. Male gender, low family socioeconomic status, perception of more peer smoking, more perceived benefits of smoking, higher level of pro-smoking attitude, higher level of perceived cost of non-smoking and more involvement in other health risk were positively associated with being a past or current smoker. Likewise, male gender, older age, more friends smoking, greater perceived benefits of smoking, higher pro-smoking attitudes and more health risk involvement were associated with the likelihood to smoke in the next 6 months. The data suggest a substantial smoking experimentation among college students in China, which presents both a challenge and an opportunity to prevent a large proportion of experimenters from progressing to regular smokers. The findings in the current study can be used to inform the development of effective smoking intervention prevention programs among college students in China.

Prevalence of smoking and environmental tobacco smoke exposure, and attitudes and beliefs towards tobacco control among Hong Kong medical students

OBJECTIVES

To investigate the prevalence of active smoking and environmental tobacco smoke (ETS) exposure among medical students in Hong Kong, and their attitudes and beliefs towards tobacco control.

STUDY DESIGN

A cross-sectional survey with a self-administrated questionnaire.

METHODS

All medical students from a university in Hong Kong were invited to participate in this survey and completed structured questionnaires. Descriptive data analyses were performed.

RESULT

In total, 313 medical students participated in this study (response rate 44.7%). Only 7.2% [95% confidence interval (CI) 4.3-10.1] reported having ever smoked and 0.7% (95% CI 0-1.6%) were current smokers. ETS exposure at home was reported by 19.3% (95% CI 14.9-23.8) of students, but the proportion of ETS exposure in public places was much higher (61.6%, 95% CI 56.2-67.1%). More than 85% of students had positive attitudes towards tobacco control, but 30.8% (95% CI 25.6-36.0) disagreed with banning smoking in disco/bars/pubs. Although the majority (93.1%, 95% CI 90.3-96.0) of students thought that health professionals should receive specific training for counselling on smoking cessation, only 38.0% (95% CI 32.5-43.5) reported having received any formal training in this area.

CONCLUSIONS

This study suggests that a specific professional training programme, including counselling on smoking cessation and actions on legislation and tobacco tax policy, should be built into the undergraduate medical curriculum.

Cigarette smoking status and smoking cessation counseling of Chinese physicians in Wuhan, Hubei province

Among the 347 physicians surveyed, 58% of the male physicians and 18.8% of the female physicians were current cigarette smokers; 54.4% of the male and 70.4% of the female physicians often or always provided smoking cessation counseling for patients; 37.5% of the physicians thought that for a Chinese smoker, cigarette smoking served as a social lubricant; 31.5% thought it a habit; 21.7% thought it a stress reliever; and 9.2% thought it a social status symbol. The following 5 variables were significantly associated with physicians' smoking cessation counseling frequency: their smoking status, perceived success in their past counseling, perceived influence, perceived exemplary role, and perceived responsibility. To increase physicians' smoking cessation counseling, the Chinese Ministry of Health would need to discourage physicians to smoke and appeal to their sense of responsibility to help patients quit smoking.

Tobacco use among youth and adults in Mainland China: the China Seven Cities Study

OBJECTIVE

The China Seven Cities Study (CSCS) monitors geographic and temporal trends in tobacco use among adolescents and adults in seven cities throughout Mainland China: Harbin, Shenyang, Wuhan, Chengdu, Kunming, Hangzhou, and Qingdao. This article presents the methodology and prevalence data from the baseline survey of the CSCS, conducted in 2002.

METHODS

Stratified random samples of middle schools, high schools, and colleges were selected within each city. Students and their parents completed self-report surveys of their tobacco use. Data were obtained from 6138 middle school students, 5848 academic high school students, 2448 vocational high school students, 2556 college students, and 25 697 parents.

RESULTS

Smoking prevalence varied across age groups, school types, genders, and cities. Past-month smoking prevalence was 9% among middle school students, 8% among academic high school students, 26% among vocational high school students, 21% among college students, and 40% among parents. Smoking prevalence was higher among males than among females, with larger gender disparities among adults than among youth. Smoking also varied across cities, with higher smoking prevalence in southwestern cities and lower prevalence in coastal cities. Intraclass correlations of students within schools are presented to inform statistical power estimates for further research in China.

CONCLUSIONS

These results provide a baseline for future longitudinal studies of smoking in these cities and identify demographic groups at risk for tobacco-related disease. Effective smoking prevention programmes for youth and smoking cessation programmes for adults are needed in China, especially in the lower-income southwestern cities and in vocational high schools throughout the country.

Determination of Smoking Habits and Personality Traits Among Nursing Students

The purpose of this research was to determine the smoking habits of students who receive nursing education in universities and their personality traits. We found that 29.2% of the students were habitual smokers, and the average score on the Fagerström Nicotine Dependence Test was 3.4 +/- 2.3. A significant difference in statistical terms was marked between the participants' smoking habits and the self-control factor. Because we found that the level of smoking among individuals with high self-control is rather low, providing information to students on quitting smoking and periodically assessing smoking status are recommended. In addition, individual improvement programs focused on the development of self-control can be added to nursing curricula.

Patterns of cigarette smoking among students from 19 colleges and universities in Jiangsu Province, China: a latent class analysis

Entrance into college may be associated with elevated risk of progression in cigarette use among Chinese students. The purpose of this study was to examine patterns and dynamics of cigarette smoking by age and grade among college students in China. Cross-sectional data from 1845 students (44% females) in 19 colleges and universities in Jiangsu Province were derived from the Chinese Youth Health Risk Behavior Survey in 2001. Data were analyzed using latent class analysis (LCA). Overall 11 mutually exclusive types (latent classes) of cigarette users were derived and their proportions estimated from four variables: lifetime smoking, past 30-day smoking, attempting to quit in the past, and intention to smoke in the future. Two types (resistant never-smokers, self-stopped resistant nonsmokers) were observed across age groups and grades for both males and females while other smoking types varied with gender, age and grade. Advanced cigarette smoking types appeared in older age groups and higher grades. The cross-sectional age and grade trend suggests substantial progression in cigarette smoking among Chinese college students, underscoring the need for prevention among these students. Results also suggest that LCA may be an effective methodology for analyzing behavioral types and their dynamics with a limited number of variables.

Smoking in Colombian medical schools: the hidden curriculum

BACKGROUND

Tobacco companies are focusing their interest in less developed countries. In the absence of governmental opposition, physicians are expected to lead tobacco control efforts. We studied Colombian medical students' smoking prevalence and tobacco attitudes.

METHODS

First- and fifth-year students from 11 medical schools in seven Colombian cities answered anonymous, self-administered, 38-item questionnaires. Additionally, smokers answered the Fagerström Test for Nicotine Dependence (FTND).

RESULTS

Two thousand twenty-one students (males 50.6%; age 15-44, median 19) completed the survey; average response rate was 89.9%. Globally 25.9% of students were current smokers (males 27.9%, females 24.0%). Living at higher altitude and attending private universities were associated with higher prevalence (P < 0.001). Males had a higher chance of having given up smoking (P < 0.05); 91.3% of current smokers would like to quit; 67.3% of all smokers and 44.8% of daily smokers scored 0 in the FTND. Prevalence was similar among first- and fifth-years, but fifth-year students were more complacent with smoking in health centers and showed a lesser desire to quit.

CONCLUSIONS

Medical students' smoking prevalence is similar to that of the general population. Tobacco control strategies need to be included in the curriculum. Nicotine addiction does not seem to be the main perpetuating factor.

Hazard of smoking initiation by age among adolescents in Wuhan, China

BACKGROUND

Knowledge about age of smoking initiation among adolescents in China is helpful for exploring cultural differences in adolescent smoking behavior and informative for global tobacco control. However, little has been documented on this issue.

METHOD

Adolescents (6,473) attending grades 7, 8, and 9 completed the baseline survey of a longitudinal, randomized smoking prevention trial. Data were collected in classrooms with a paper-and-pencil questionnaire. A survival model was used in the statistical analysis.

RESULTS

The hazard of smoking initiation for boys showed a pattern previously observed in the United States: very low (<2%) before 7 years of age, increasing rapidly after age 10, and peaking at 14-15 years of age. The hazard for girls was below or around 1% until 12 years of age before it increased. The hazard levels were similar for adolescents both in urban and in rural areas, but higher for those in grade 7 than in grades 8 and 9.

CONCLUSIONS

Chinese boys in Wuhan, China, experienced a hazard pattern of smoking initiation by age similar to those observed in the United States, while Chinese girls there experienced a rather low risk of smoking initiation. The hazard pattern suggests that the best time for smoking prevention is between 10 and 15 years of age. Adolescents in lower grades are at higher risk of early smoking initiation, suggesting a potential cohort effect in adolescent smoking initiation in Wuhan, China.