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ABSTRACT: Previous studies have documented that cognitive attributions are correlated with adolescent smoking. The present study further explored whether cognitive attributions for smoking influenced adolescents' future smoking behaviors, especially transitions to more advanced stages of smoking. Participants were 12,382 middle and high school students (48.5% males and 51.5% females) in seven large cities in China. They completed two waves of surveys one year apart. Cognitive attributions for smoking and three smoking behavior outcomes (lifetime smoking, past 30-day smoking, and daily smoking) were assessed. Changes in smoking, including progression from lower stages to higher stages and regression from higher stages to lower stages, over a one-year period, were defined longitudinally. Polychotomous logistic regression was used to examine associations between cognitive attributions for smoking and changes in smoking status over one year, adjusting for demographic characteristics and other plausible confounders. Seven out of eight cognitive attributions for smoking were associated with subsequent smoking behaviors (p<0.05). Curiosity, autonomy, social image, social belonging, and coping influenced earlier stages of smoking, whereas mental enhancement and engagement influenced later stages of smoking. Curiosity, autonomy, social image, and mental enhancement preceded smoking progression; social belonging prevented smoking regression; and coping and engagement both preceded smoking progression and prevented smoking regression. This study demonstrates that different cognitive attributions influence smoking at different stages in different ways. These findings could inform smoking prevention and cessation programs targeting Chinese adolescents.
Addictive behaviors 08/2012; · 2.25 Impact Factor
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ABSTRACT: To develop more effective anti-smoking programs, it is important to understand the factors that influence people to smoke. Guided by attribution theory, a longitudinal study was conducted to investigate how individuals' cognitive attributions for smoking were associated with subsequent smoking development and through which pathways. Middle and high school students in seven large cities in China (N=12,382; 48.5% boys and 51.5% girls) completed two annual surveys. Associations between cognitive attributions for smoking and subsequent smoking initiation and progression were tested with multilevel analysis, taking into account plausible moderation effects of gender and baseline smoking status. Mediation effects of susceptibility to smoking were investigated using statistical mediation analysis (MacKinnon, 2008). Six out of eight tested themes of cognitive attributions were associated with subsequent smoking development. Curiosity (β=0.11, p<0.001) and autonomy (β=0.08, p=0.019) were associated with smoking initiation among baseline non-smokers. Coping (β=0.07, p<0.001) and social image (β=0.10, p=<.0001) were associated with smoking progression among baseline lifetime smokers. Social image (β=0.05, p=0.043), engagement (β=0.07, p=0.003), and mental enhancement (β=0.15, p<0.001) were associated with smoking progression among baseline past 30-day smokers. More attributions were associated with smoking development among males than among females. Susceptibility to smoking partially mediated most of the associations, with the proportion of mediated effects ranging from 4.3% to 30.8%. This study identifies the roles that cognitive attributions for smoking play in subsequent smoking development. These attributions could be addressed in smoking prevention programs.
Addictive behaviors 11/2011; 37(3):273-9. · 2.25 Impact Factor
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ABSTRACT: Previous studies of genetic and environmental influences on adolescent substance use have been limited to Western samples.
This study assesses genetic and environmental contributions to cigarette smoking, alcohol use, and psychological variables (depression, anxiety, aggression, hostility) among 602 pairs of adolescent twins, 11 to 19 years old, in Qingdao, China.
Heritable influences were more pronounced for alcohol use than cigarette smoking. In univariate analyses, no heritable effects were found for depression or aggression, and modest heritability was found for anxiety. Hostility was relatively more heritable in girls than boys. Bivariate associations between substance use and psychological measures could be attributed to a combination of common genetic and environmental factors.
Among Chinese adolescents, experimentation with tobacco is familial, and experimentation with alcohol is heritable. The genetic and environmental architecture of hostility differs by gender. Consistency of univariate results with Western adolescent samples appears limited to the alcohol use measures.
Asia-Pacific Journal of Public Health 07/2011; 23(4):568-80. · 1.06 Impact Factor
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ABSTRACT: Tobacco use among Chinese adolescents is increasing at approximately 80,000 new smokers per day. Assessing the causes for initiating tobacco use in China will be important in developing effective interventions and policies to stem rising prevalence rates. This study tested predictors of Resilience Theory in a sample of 602 Chinese adolescents. Results revealed that prior adversity, measured through school and family-related events, was significantly associated with increased smoking in females. Family factors (i.e., family cohesion, family adaptability, parental monitoring) and one personal factor (i.e., academic score) were associated with lower odds for smoking due to prior adversity and negative disposition.
Substance Use & Misuse 07/2010; 45(9):1367-89. · 1.10 Impact Factor
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ABSTRACT: 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.
Addictive behaviors 09/2009; 35(2):95-101. · 2.25 Impact Factor
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Huiyan Ma,
Jennifer B Unger,
Chih-Ping Chou,
Ping Sun,
Paula H Palmer,
Yan Zhou,
Jie Yao,
Bin Xie,
Peggy E Gallaher, Qian Guo,
Yonglan Wei,
Bin Chen,
Zhanju Wang,
Xu Wang,
Haiping Duan,
Yu Song,
Jie Gong,
Stanley P Azen,
Liming Lee,
C Anderson Johnson
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ABSTRACT: Cigarette smoking is rising among urban Chinese adolescents and poses a significant public health concern. The majority of Chinese youth live in rural areas, but most research on the risk factors for smoking has been conducted in urban areas of China. This study examined the associations between parental smoking, peer smoking, and low refusal self-efficacy and smoking among urban and rural Chinese youth. This analysis used a cross-sectional sample of 3412 ninth grade students in urban and rural areas under the administrative jurisdiction of seven large cities in China. Multilevel logistic regression models were used to associate the risk factors with lifetime and current smoking, separately in boys and girls. Adolescent smoking was not strongly associated with parental smoking. However it was strongly associated with peer smoking and low refusal self-efficacy across both the urban and rural samples. Students with lower refusal self-efficacy were approximately 5-17 times more likely to be lifetime or current smokers than those with higher refusal self-efficacy. Smoking prevention interventions in China may need to focus on raising adolescents' refusal self-efficacy.
Addictive Behaviors 09/2008; 33(8):1081-5. · 2.09 Impact Factor
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Chunhong Liu,
Bin Xie,
Chih-Ping Chou,
Carol Koprowski,
Dunjin Zhou,
Paula Palmer,
Ping Sun, Qian Guo,
Lei Duan,
Xiufa Sun,
C Anderson Johnson
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ABSTRACT: The aim of the study was to explore the association between perceived stress, depression and food consumption frequency. A self-administered questionnaire that included the perceived stress scale, the depression scale and dietary intake was used in the baseline survey of a cohort study of 2579 local college students over 7 cities in China. Gender and city differences were found in perceived stress scores and depression scores. There were also significant differences among diverse smoking levels and among perceived weight categories in perceived stress and depression scores. Stepwise logistic regression models found that frequency of consumption of fresh fruit, ready-to-eat food and snack food had apparently independent effects on perceived stress, whereas the intake level of fresh fruit, ready-to-eat food and fast food was significantly associated with depression. The link between food consumption frequency, perceived stress and depression suggests that diet intervention may be considered a mediate strategy integrated in psychology prevention program among normal population of the college.
Physiology & Behavior 12/2007; 92(4):748-54. · 2.87 Impact Factor
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Ping Sun,
Jennifer B Unger, Qian Guo,
Jie Gong,
Huiyan Ma,
Paula H Palmer,
Chih-Ping Chou,
Yan Li,
Steve Sussman,
Anamara Ritt-Olson,
Lin Xiao,
Carl Anderson Johnson
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ABSTRACT: Smoking prevention programs based on social influences have reduced smoking prevalence among youth. However, these effects have not been replicated consistently. It is possible that individuals and populations with different dispositional and behavioral characteristics will experience different program effects. This study explored a possible moderation of program effect by comorbidity between depression and smoking (CoM). Data for this analysis were from 2,450 seventh-grade youth (51% boys) who participated in the Wuhan (China) Smoking Prevention Trial (WSPT). WSPT was a randomized, controlled, 14-session, middle-school-based smoking prevention trial. Baseline and 1-year follow-up surveys were administered. The moderation effect between the program and CoM was tested on 1-year change in recent smoking. The CoM indicator was defined dichotomously as monthly cigarette use and high in depression level (among the top 20% in the sample). At baseline, a total of 26 girls and 60 boys were identified to have CoM. Among boys (but not girls), CoM significantly moderated the program effect on recent smoking (p = .01). The program effect among boys with CoM was 4.17 (95% CI 1.47-11.76) times larger than those without CoM. Among boys with CoM, the odds ratio of recent smoking was 0.18 (95% CI 0.06-0.55) for program vs. control condition. Among those without CoM, the program did not reduce the odds of recent smoking significantly (OR = 0.74, 95% CI 0.37-1.48). The study demonstrated that smoking prevention program effects can vary with individual characteristics, in this case comorbidity between depression and smoking. These findings may help explain the inconsistency in program effects across studies and populations. The findings also may contribute to the design of future programs to address the needs of defined populations and individuals with specific characteristics.
Nicotine & Tobacco Research 11/2007; 9 Suppl 4:S599-609. · 2.58 Impact Factor
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ABSTRACT: To investigate over-weight prevalence and socio-demographic and economic correlates in Chinese adolescents. METHODs: Weight, height, waist circumference, and socio-demo-graphic and economic variables of 6863 middle and high school students were measured.
10% of girls and 17% of boys were overweight. Waist circumference and overweight risk were significantly associated with pubertal status (P<0.05). High levels of parental education and family income were significant risk factors for overweight (P<0.05).
Our findings underscore the need for development of evidence-based and culturally appropriate public health programs to prevent and treat pediatric obesity in China.
American journal of health behavior 06/2007; 31(4):339-52. · 1.31 Impact Factor
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ABSTRACT: One third of smokers worldwide live in China. Identifying predictors of smoking is important for prevention program development. This study explored whether the Theory of Reasoned Action (TRA) and Theory of Planned Behavior (TPB) predict adolescent smoking in China. Data were obtained from 14,434 middle and high school students (48.6% boys, 51.4% girls) in seven geographically varied cities in China. TRA and TPB were tested by multilevel mediation modeling, and compared by multilevel analyses and likelihood ratio tests. Perceived behavioral control was tested as a main effect in TPB and a moderation effect in TRA. The mediation effects of smoking intention were supported in both models (p<0.001). TPB accounted for significantly more variance than TRA (p<0.001). Perceived behavioral control significantly interacted with attitudes and social norms in TRA (p<0.001). Therefore, TRA and TPB are applicable to China to predict adolescent smoking. TPB is superior to TRA for the prediction and TRA can better predict smoking among students with lower than higher perceived behavioral control.
Addictive Behaviors 06/2007; 32(5):1066-81. · 2.09 Impact Factor
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ABSTRACT: With the changing patterns of morbidity and mortality in China, noncommunicable chronic diseases have become the major threats to the health of the Chinese population. The causes of chronic diseases include genetic factors and behavioral risk factors such as the use of tobacco, alcohol, and other drugs, unhealthy dietary behaviors, and lack of physical activity. Twin studies offer a unique opportunity to disentangle the genetic and environmental risk and protective factors for chronic disease. The Qingdao Twin Registry (QTR) was initiated in 1998 as part of the National Chinese Twin Registry. Over 11,000 pairs of twins and multiples of all ages have been recruited into the registry. Several studies of physical and mental health are underway. Many of the adult twins have completed health and behavioral risk factor surveys, and the adolescent twins are participating in a study of gene-environment interactions in tobacco and alcohol use. Studies of the heritability of personality factors have been conducted. In 2002, Qingdao established the Qingdao Twin Health Promotion Association, a nonprofit organization that supports health services for twins and their parents, organizes special events and health-related activities for twins, and raises funds to conduct twin health examinations. The QTR will be a useful resource for future studies of population genetics in human health and disease.
Twin Research and Human Genetics 01/2007; 9(6):758-62. · 1.70 Impact Factor
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C Anderson Johnson,
Paula H Palmer,
Chih-Ping Chou,
Zengchang Pang,
Dunjin Zhou,
Lijun Dong,
Haiqing Xiang,
Peijun Yang,
Hongjie Xu,
Jian Wang,
Xiaolu Fu, Qian Guo,
Ping Sun,
Huiyan Ma,
Peggy E Gallaher,
Bin Xie,
Liming Lee,
Tianren Fang,
Jennifer B Unger
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ABSTRACT: 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.
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.
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.
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.
Public Health 01/2007; 120(12):1156-69. · 1.35 Impact Factor
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C Anderson Johnson,
Bin Xie,
Chunhong Liu,
Kim D Reynolds,
Chih-Ping Chou,
Carol Koprowski,
Peggy Gallaher,
Donna Spruitj-Metz, Qian Guo,
Ping Sun,
Jie Gong,
Paula Palmer
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ABSTRACT: This study performed parallel analyses on two large samples of seventh graders living in Los Angeles, California and in Wuhan, China to make direct comparisons of overweight and obesity risks in Western and Eastern cultural environments.
Two representative samples of 1772 and 1896 seventh grade students were randomly selected from the public or parochial middle schools in the greater Los Angeles area of Southern California in the United States, and public schools in Wuhan city of China. Two body mass index (BMI) references recently established by the U.S. National Center for Health Statistics (NCHS) and the International Obesity Task Force (IOTF), respectively, were used to define overweight (85th < or = BMI < 95th percentile) and obesity (BMI > or = 95th percentile). Logistic regressions were conducted to examine relationships between socioeconomic status (SES) and obesity risk.
The prevalence rates of combined overweight and obesity in Los Angeles and in Wuhan were 43.1% and 12.1%, respectively, by the US-NCHS reference, and 45.8% and 11.9%, respectively, by the IOTF reference. Chinese-American adolescents had higher prevalence rates for overweight and obesity than those from China. SES was positively related to the risk of overweight and obesity in the Chinese sample, whereas a negative association was found in Southern California adolescents. Urbanicity was significantly positively related to higher overweight and obesity prevalence.
Different overweight and obesity prevalence estimates and SES effects were observed for American and Chinese adolescent samples. Research on the underlying mechanisms is needed to help us to set up a tailored program for obesity prevention in Eastern and Western cultural environments.
Journal of Adolescent Health 12/2006; 39(6):925.e1-8. · 3.33 Impact Factor
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ABSTRACT: China has the world's largest concentration of smokers (350 million) and rising alcohol consumption, yet little is known about tobacco and alcohol use aetiology. In 2000, the Chinese National Twin Registry was established to provide a genetically informative resource for investigation of health behaviour including tobacco and alcohol use.
Using standard twin methodology, this study aimed to examine the relative contribution of genetic and environmental influences on cigarette smoking and alcohol drinking in a sample of adult Chinese twins (n = 1010 individual twins). More than half of the male twins were smokers (58%), and 32.5% reported alcohol consumption. Among male smokers, 46.4% smoked 20 or more cigarettes per day (heavy smokers) and among drinkers, 32.8% consumed one or more drinks per day. Nearly all female twins were non-smokers (99.2%) and non-drinkers (98.7%); therefore, genetic analysis was limited to male data.
In men, current smoking was significantly heritable [75.1%, 95% confidence interval (CI) 56.7-87.5] with no evidence for a significant contribution of shared environmental effects. Heavy smoking was more strongly influenced by genes (66.2%, 95% CI 0-88.4) than shared environment (8.7%, 95% CI 0-71.0). Similarly, current drinking was more strongly influenced by genetic effects (59.5%, 95% CI 0-87.8) than by shared environmental effects (15.3%, 95% CI 0-72.1). Amount of alcohol consumed was influenced to a similar degree by genetic (42.4%, 95% CI 0-91.8) and shared environmental factors (39.2%, 95% CI 0-82.7).
These results support findings from twins of Western origin on the aetiology of tobacco and alcohol use and encourage further work in Chinese twins.
International Journal of Epidemiology 11/2006; 35(5):1278-85. · 6.41 Impact Factor
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Chih-Ping Chou,
Yan Li,
Jennifer B Unger,
Jiang Xia,
Ping Sun, Qian Guo,
Sohaila Shakib,
Jie Gong,
Bin Xie,
Chunghong Liu,
Stanley Azen,
Jianguo Shan,
Huiyan Ma,
Paula Palmer,
Peggy Gallaher,
C Anderson Johnson
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ABSTRACT: Tobacco use is a significant public health problem in China. Culturally specific smoking prevention programs are needed for Chinese adolescents. This study evaluated a school-based smoking prevention curriculum with a social normative approach developed in the United States for adolescents in urban Wuhan, China.
As a randomized trial, the intervention was implemented in 1998 with 7th grade students in seven schools with seven matched control schools. Multilevel logistic regression models were used to compare ever and recent (past-month) smoking behaviors for the control and program conditions.
At the 1-year follow-up, smoking had increased more rapidly in the control schools than in the program schools. The odds of baseline nonsmokers initiating smoking did not differ between the program and control groups (OR=1.08 with 95% CI=0.71, 1.64). The program prevented progression to recent smoking among boys who were baseline ever smokers. Among boys who were recent smokers at baseline, the prevention program significantly reduced risk of remaining recent smokers at follow-up (OR=0.45 with 95% CI=0.23, 0.88).
This social normative smoking prevention curriculum did not demonstrate a significant primary prevention effect but showed potential for secondary prevention. Culturally specific smoking prevention programs are needed for Chinese adolescents.
Preventive Medicine 05/2006; 42(4):280-5. · 3.22 Impact Factor
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ABSTRACT: This study examined multiple influences on the use of tobacco by adolescents in China. Using the theory of triadic influences as a guide, we selected interpersonal, attitudinal/cultural, and intrapersonal constructs from baseline data to predict adolescent smoking 1 year later. We used prospective data from middle and high school students (N = 11,583) and their parents from the China Seven Cities Study, a longitudinal study that is evaluating the effects of changing economic and social factors on health behaviors including tobacco use. A multilevel regression analysis provided some support that each of the influences in the theory of triadic influences affects adolescent smoking in China. After adjusting for important confounders including age, gender, socioeconomic status, and smoking behaviors (lifetime and past 30-day) at baseline, we found significant risk factors within each of the three categories, including interpersonal influences (parental monitoring, good friend smoking, and peer smoking), attitudinal/cultural influences (school academic ranking, initial liking of smoking, and the meaning of smoking), and intrapersonal influences (susceptibility to smoking, and low self-confidence to quit smoking). Results suggest that the etiology of smoking among adolescents in China might be similar to that observed in western countries and that some of the techniques used successfully in prevention programs in those countries might be useful guides when developing prevention programs in China.
Nicotine & Tobacco Research 05/2006; 8(2):245-55. · 2.58 Impact Factor
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ABSTRACT: Rapid economic development accompanied by imported Western media, advertising, fashion, and lifestyle in mainland China has resulted in shifts in cultural beliefs and beauty ideals in adolescents. The present study focused on understanding relationships among weight perception and weight-related sociocultural and behavioral factors in Chinese adolescents.
Data collected in 2002 from 6863 middle and high school students and their parents from four large cities in mainland China were used. Weight status was determined by measured weight and height. Weight perception, media exposure, attitudes, and health behaviors were assessed by a structured questionnaire survey.
Boys were more likely to describe themselves as either too thin or relatively thin than girls (37.32% vs. 18.79%), while girls more often considered themselves either relatively heavy or too heavy than boys (50.83% vs. 26.54%). Girls who were actually normal or underweight were more likely than boys to describe themselves as either relatively heavy or very heavy (41.6% vs. 11.6%), while boys who were actually normal or overweight were more likely than girls to believe themselves as underweight (30.9% vs. 15.7%). Girls who were frequently exposed to media from Japan, Korea, Hong Kong, and Taiwan, and placed high value on their physical appearance, were more likely to be dissatisfied with their body weight, which in turn were more likely to restrict consumption of certain foods, smoke cigarettes, and drink alcohol. Similar results were not observed in boys.
Weight dissatisfaction was prevalent in Chinese adolescents and was significantly related to media exposure, attitudes towards physical appearance, and adoption of certain health-risk behaviors in girls. Our findings underscore the importance of sociocultural influences in shaping realistic body image and have implications for prevention and early intervention for establishing health behavioral practices during adolescence.
Preventive Medicine 04/2006; 42(3):229-34. · 3.22 Impact Factor
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ABSTRACT: To investigate weight perception and related psychological factors in Chinese adolescents.
A questionnaire on weight perception, academic performance, stress, hostility, and depression was completed by 6863 middle and high school students. Weight and height were measured.
Overweight perception was related to school-related stress and depression in both girls and boys (P<0.01) and to hostility in boys (P<0.01). Perceived over-weight was related to lower GPA in girls only (P<0.05).
Distorted weight perception has a detrimental psychological impact on Chinese adolescents. These findings may contribute to the obesity research and to the development of future effective intervention programs in China.
American journal of health behavior 02/2006; 30(2):115-24. · 1.31 Impact Factor
