title: Smoking related attitudes, motives, and behaviors of male secondary school students in an urban setting of China.
abstract: BACKGROUND
  Most smokers have their first experience of cigarette use when they are teenagers (i.e. at schools). Aiming tobacco control initiatives at secondary school students offers preventive measures to eliminate or reduce tobacco use initiation by students. This study assessed smoking-related attitudes, motives and behavior as well as other factors associated with smoking among male secondary school students in an urban setting in China.
  
  
  METHODS
  A cross-sectional survey was conducted in urban areas of Chongqing using a structured questionnaire administered to 1297 male secondary school students. Logistic regression analysis was employed to investigate the factors that affect smoking.
  
  
  RESULTS
  Of the participants (n = 1297), 27.7% were secondary and 72.3% were middle school students. Overall, 30.5% of the participants were smokers. The majority of the students procured their first cigarette from friends. The motivations of middle school students to smoke their first cigarette were curiosity (70.5%) and imitation (13.1%). The motivations of high school students for smoking their first cigarette were to satisfy their curiosity (51.8%), relief of stress and social pressures (17.1%), and imitation of smoker friends (15.9%). Respondents from poor family financial conditions were more likely to smoke than those from rich family financial conditions [odds ratio (OR) 1.59, 95% confidence intervals (CI) 1.00, 2.52]. Respondents whose fathers were smokers were more likely to smoke than those whose fathers were non-smokers (OR 1.65, 95% CI 1.25, 2.17). Respondents who had one or two smoker friends (OR 2.98, 95% CI 1.93, 4.60) and three or more smoker friends (OR 5.92, 95% CI 4.35, 8.05) were more likely to smoke than those who did not have any. Respondents who were neutral (OR 0.43, 95% CI 0.20, 0.91) and disagreed about the item "friends smoking" (OR 0.18, 95% CI 0.08, 0.39) were less likely to smoke than those who agreed with the item.
  
  
  CONCLUSIONS
  This study indicates that male students who have negative attitudes toward smoking, who do not have a father or friends who smoke, and are from affluent backgrounds exhibit low tendency to start smoking at a young age. This study provides some implications for tobacco control policies among male secondary school students in urban settings.
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, 400016 China.|Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016 China.|Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China.
authors.forename: Xianglong
authors.initials: X
authors.lastname: Xu
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, 400016 China.|Xiangya School of Public Health, Central South University, Changsha, 410001 Hunan Province China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Chen
authors.affiliation: Global Health Program, Duke Kunshan University, Kunshan, 215347 Jiangsu Province China.|Duke Global Health Institute, Duke University, Durham, NC 27710 USA.|Department of General Internal Medicine, School of Medicine, Boston University Medical Center, Boston, MA 02118 USA.
authors.forename: Abu S
authors.initials: AS
authors.lastname: Abdullah
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, 400016 China.|Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016 China.|Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China.
authors.forename: Lingli
authors.initials: L
authors.lastname: Liu
authors.affiliation: Behavioral and Environmental Health, School of Public Health, Jackson State University, Jackson, MS 39213 USA.
authors.forename: Manoj
authors.initials: M
authors.lastname: Sharma
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, 400016 China.|Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016 China.|Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China.
authors.forename: Yaping
authors.initials: Y
authors.lastname: Li
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, 400016 China.|Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016 China.|Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhao
keywords: Attitudes; Male; Secondary school students; Smoking behaviors; Urban