Risk factors associated with smoking initiation among Chinese adolescents: A matched case-control study

A longitudinal school-based smoking prevention trail with a social normative approach developed in the western culture was implemented with 7th grade students in Wuhan, China. A nested matched case-control study was used to examine the risk factors and their associations with adolescents' smoking initiation, and whether the intervention effect on follow-up smoking behaviors is dependent on different levels of baseline risk factors. Data were obtained from 817 baseline non-smoking 7th grade students in Wuhan. Both conditional and unconditional logistic regression analyses were performed to assess the associations of various risk factors with smoking initiation. Non-smoking students who had high intention to smoke, negative knowledge toward to smoking addiction and low smoking refusal self-efficacy were more likely to become smokers at the follow-up survey. We did not detect the effect of the intervention program in preventing smoking initiation. Neither did we find the interaction effect of intervention program with individual's baseline risk factor profile. Future tobacco prevention interventions should focus on reducing smoking intention, empowering non-smoking adolescents with the self-efficacy and knowledge on the harm of nicotine to prevent smoking initiation.