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Differences in students' smoking-related knowledge, attitudes, and behaviors among public, factory, and private secondary schools in Guangzhou, China.

LITERATURE REVIEW

The prevalence of smoking among adolescents in China has increased dramatically in recent years. The latest National Survey on Risk Factors of Health Behaviors indicated that the overall smoking prevalence declined slightly from 1996 to 2002, while the smoking prevalence of males aged 15-19 and females aged 15-24 in 2002 were higher than that of their counterparts in 1996. (1,2) How to delay or reverse the increasing tendency of adolescent smoking is a major challenge for public health. Accordingly, all kinds of adolescent smoking prevention programs have been carried out nationwide and many of them choose schools as the intervention settings. These school-based programs cannot achieve full success until they are carefully designed to fit the target schools' characteristics, one of which is the school type.

According to financial sources, the secondary schools in China can be mainly classified into 3 types: public, factory, and private schools. Similar to public schools in western countries, Chinese public schools are managed by governments and funded mostly from taxes. With strong financial and policy support from local governments, public schools have had good prestige in teaching quality and health care for a long time. But almost all of the public schools have strict residency-based enrollment policy, which means that children must go to the assigned local public schools according to their permanent residency.

The factory schools have their own special history with the development of China. (3) At the beginning of the establishment of the Peoples' Republic of China, many new heavy industrial factories (eg, steel, oil, mine, power) needed to be built in this new country. These factories often were located in the countryside, mountainous regions, or even in deserts far from cities. Numerous factory workers and their families moved into these areas. The number of local public schools around these big factories was too limited (or nonexistent) to accept all of the workers' children. Therefore, most of these factories were empowered to set up their own schools with encouragement from the government. All of these schools were funded and managed by the factories themselves. They usually only enrolled children whose parent(s) (1 or both) were factory workers. These factory school always owned better teachers and facilities than local public schools. Unfortunately, more and more factory schools are going to be closed down or recombined into local public schools with current reformation of Chinese state-owned factories. (4,5)

Comparatively, Chinese private schools have a shorter history. They were founded in the 1980s with the reformation of a market economic system in China. Currently, there are 2 main kinds: high-paid and general-paid private schools. The high-paid private schools are characterized by excellent physical condition and full accommodation. They are usually attended by children whose parents are company owners or businessmen with high salaries but little time to take care of their children. On the contrary, the general-paid private schools with tuition fees that are similar to public schools are mainly open to those children who are not born locally. Most of their parents are poor farmers migrating from the countryside to the cities to find new jobs. Being away from their birthplaces, these children face many barriers to enter the public schools in new places. (6) As a result, only a few immigrant farmers' children have opportunities to be enrolled in the public schools. Alternatively, most of them have to go to general-paid private schools owed by individuals or social organizations. Solely depending on students' tuitions, these general-paid private schools cannot afford experienced teachers and quality facilities. Regularly with small size and poor environment, some of them are even illegal in some places. Despite these problems, with the fast speed of urbanization in China, general-paid private schools have seen a rapid rise in number during recent years and have been playing a more and more important role in the Chinese education system. (7)

Due to their history, as noted above, there are large differences among the 3 types of schools in their critical characteristics including financial support, student source, physical environment, organizational structure, and school culture. These differences may have effects on students' smoking-related knowledge (K), attitudes (A), and behaviors (B). Rare smoking studies focusing on this issue can be found either in Chinese or in English literature. To identify factors associated with smoking-related KAB, we conducted a cross-sectional tobacco survey at 6 secondary schools and examined the role of individual, family, and school factors.

METHODS

Subjects

This cross-sectional study was conducted in Guangzhou, a central city of the Pearl River Delta, which is the leading commercial region in southern China. The method of stepwise sampling was applied to obtain study subjects. Step 1, Huangpu District was selected randomly among 4 districts (Huangpu, Baiyuan, Haizhu, and Fangcun) that contained all 3 kinds of schools. Step 2, according to their financial sources, 18 secondary schools in Huangpu District were classified into 3 strata, including 10 public, 3 factory, and 5 general-paid private ones. Then, 3 public, 1 factory, and 2 general-paid private schools were randomly sampled as the target schools. All of the 6 schools agreed to participate in the survey. Step 3, all the seventh, eighth, and ninth grade students and their parents in the 6 schools were sampled in this survey. The expected sample included 4138 pairs of subjects (students-parents). A consent statement was provided with each questionnaire for every subject. Those who submitted their consent and questionnaire simultaneously were considered as agreeing to participate in this survey. Finally, 3957 (95.6%) students agreed to participate and 2870 (72.5%) parents of these students completed the survey. Among the students, 2691 (68.0%) of them came from 3 public schools, 790 (20.0%) from 2 private schools, and 476 (12.0%) from a factory school.

Instruments

A self-administered questionnaire on smoking-related issues was developed by a research team based on reviewing previous publications both in Chinese and in International journals. (8-11) The final questionnaire consisted of 5 parts: demographic characteristics, environment related to smoking, knowledge related to smoking and health, attitudes toward smoking and health, and cigarette smoking behaviors.

Five variables were developed to address the smoking-related school environment as perceived by students. They included "Do your peers smoke?" "Does your supervising teacher smoke?" "Have you ever seen someone smoking in your school?" "Have you ever seen the signs of no smoking in your school?" and "Can you feel the antitobacco atmosphere in your school?"

To measure the students' smoking-related knowledge, 20 items were used in the student questionnaire (Table 1). If a respondent's answer to 1 item was right, he could get 1 point. A wrong or unknown answer equaled to 0 point. The total knowledge score was the summary points of all items, with a maximum of 20 points.

A 16-item standardized scale was applied to measure the students' attitudes toward smoking and health (Table 1). The options to each item were designed as 5 ranks of a Likert-type scale. A quantitative method was used to summarize the participants' responses to all of the attitude items. For every positive attitude item, the response of "extremely agree" was scored as 5 points, "agree" as 4 points, "unclear" as 3 points, "disagree" as 2 points, and "extremely disagree" as 1 point. For every negative attitude item, the score rank above was reversed as 1, 2, 3, 4, and 5 points. All the items' scores were summed as the total score of the attitude scale and the maximum score was 80 points. A higher score means holding attitudes more against smoking. The reliability of the attitude scale was tested in the pilot survey (n = 125, Cronbach' [alpha] = .82, test-retest, r = .67). (12)

The measurement of smoking behaviors in this study was referred to WHO Guidelines for the Conduct of Tobacco Smoking Surveys of the General Population. (13) The status of adolescents' smoking was defined as follows: (1) daily smoking: smoking at least 1 cigarette per day and having smoked for 3 months or more continuously/ accumulatively, (2) weekly smoking: smoking at least 1 cigarette per week and having smoked for 3 months or more continuously/accumulatively, (3) lifetime smoking: having ever smoked at least 1 cigarette, (4) nonsmoking: having not yet smoked until now, even 1 cigarette.

Procedure

The student participants were asked to fill out questionnaires in the classroom during class time. The whole process of the survey was under the supervision of experienced investigators who were trained medical graduate students. The questionnaires for parents were taken home in envelopes by their children. Because all the questionnaires were anonymous, each pair of questionnaires (student/parent) were coded before distribution with the same 7-digit ID number to make sure that they could be matched later. If the last digit of the ID number was odd, the student's father completed the parent questionnaire; if the last digit of the ID number was even, the student's mother completed the parent questionnaire.

Data Analysis

Valid questionnaires were included in final statistical analysis. Data were entered into computers by the software of Epi-data (3.0 version, The EpiData Association, Odense, Denmark) and analyzed by the statistical software of SPSS (11.0 version, SPSS, Inc, Chicago, Ill). A chi-square test was used for categorical data, and an analysis of variance was used for quantitative data with homogeneous variances or a Kruskal-Wallis rank sum test for quantitative data with heterogeneous variances. The statistical significance level was set at .05.

RESULTS

Demographic Characteristics

Among the students, 202i (51.1%) were males, 1850 (46.8%) were females, and 86 (2.2%) did not report their gender. Their ages ranged from 11 to 17 years (mean = 13.7 and median = 14). Among the parents, 1391 (48.5%) were fathers, 1275 (44.4%) were mothers, and 204 (7.1%) did not report their parental status. The age of the youngest parent was 30 years and that of the oldest was 58 years (mean = 40.7 and median = 40).

The distribution of the students' genders and birthplaces was significantly different among public, factory, and private schools. After being stratified by grades, the students' average age was highest in private schools, followed by those in the public schools and in the factory school (Table 2).

Students' family characteristics were based on their parents' report (Table 3). Nearly, all of the families were intact, and there was no difference in marital status among those parents in public, factory, and private schools. The distribution of parental education levels was significantly different among the 3 types of schools (P < .001). The difference between student monthly family incomes among the 3 types of schools was also statistically significant (P < .001).

Smoking-Related Family Environment

Combining students' and their parents' report, family environment was contrasted among students in factory, public, and private schools (Table 4). There were no significant differences in father's smoking, in mother's smoking, or in parents' educating children not to smoke (P > .05). However, the difference in sibling's smoking was statistically significant (P < .05). For the sibling's smoking, the highest prevalence was reported by the students in private schools (10.5%), followed by that in public schools (9.3%) and in the factory school (5.5%). In contrast, 78.7% of the parents in the factory school reported that they had taught their children smoking-related knowledge, higher than that in public schools (75.1%) and in private schools (72.6%).

Smoking-Related School Environment

According to their own reports, 64.3% of the factory school students, 54.0% of the public school students, and 48.6% of the private school students could sense the antitobacco atmosphere in their schools (Table 4).

The rate of peers' smoking was highest in private schools (17.7%), followed by public schools (15.1%) and the factory school (9.9%). Similarly, the largest percentage (12.8%) of private school students reported their supervising teachers' smoking compared with that in the factory school (10.3%) and public schools (6.6%). The signs of no smoking had been seen by 67.8% of the students in public schools, by 59.7% in the factory school, and by 53.9% in the private schools.

Smoking-Related Knowledge and Attitudes

Because of the gender disproportion, the smoking-related knowledge and attitude scores were examined for differences among the 3 types of schools and between boys or girls, respectively. For the smoking-related knowledge, the average score of boys in the factory school was the highest (10.3 [+ or -] 2.8), followed by that in public schools (9.8 [+ or -] 2.9) and in private schools (9.7 [+ or -] 2.8) (Table 5). The difference among them was statistically significant (P < .05). Similarly, significant differences (P < .05) in average knowledge score could be found among the girls in 3 types of schools: 10.5 for the factory school, 10 for public schools, and 9.6 for private schools, respectively (Table 5). Among the boys, the rank of average attitude scores was as follows: highest in the factory school (67.4 [+ or -] 11.5), lower in public schools (66.5 [+ or -] 10.4), and lowest in private schools (65.2 [+ or -] 9.5), and significant (P < .05) differences were found among them. But the average attitude scores were close among the girls in the 3 types of schools with no significant difference (P > .05).

Smoking Behaviors

The smoking prevalence among students was examined by 3 measurements: lifetime smoking, weekly smoking, and daily smoking. The prevalence of students' lifetime smoking in private schools (35.4%) was twice of that in public schools (17.4%) and that in the factory school (13.2%). The differences among them were statistically significant (P < .001). The prevalence of students' weekly smoking was highest in private schools (6.2%), lower in public schools (4.9%), and lowest in the factory school (4.0%). Similar rank was also found for the prevalence of daily smoking (3.9% private, 3.5% public, and 2.7% factory), but both the differences in the prevalence of weekly smoking and daily smoking were not significant (P > .05) among the 3 types of schools. Considering the gender disproportion among the 3 types of schools, the smoking rates were further stratified by gender (male and female) (Table 6).

DISCUSSION

The smoking measurement in this study, proposed by World Health Organization on 1982, is of little difference from that used in the Global Youth Tobacco Survey (GYTS). (14) The definitions for ever smoking are the same, while the GYTS lacks related variables to evaluate the prevalence of weekly and daily smoking. In contrast, this study does not involve information about current cigarette smoking, which is defined as "smoked cigarettes on one or more days in the 30 days preceding the survey" as is done in GYTS. Therefore, it is not appropriate to compare or contrast the smoking prevalence of GYTS and this survey.

The above results support our prior hypothesis for this study. It is true that there are significant differences in student's smoking-related knowledge, attitudes, and behaviors among factory, public, and private schools. A serious problem of tobacco use among adolescents exists in private schools, which is consistent with the results of another previous survey in China. (15) Moreover, students in the 3 types of schools have different demographic characteristics, family socioeconomic status, and smoking-related family and school environments, which may contribute to the different smoking prevalence among their students.

The students' demographic imbalance partly leads to the differences of smoking prevalence in the factory, public, and private schools. Specifically, the demographic imbalance is most obvious in private schools. For genders, there are remarkably more boys than girls (58.4% vs 41.6%) in private schools compared with the close percentages of boys and girls (half and half) in both the factory and the public schools. It is easy to understand that this disproportion of gender contributes to the high prevalence of smoking because numerous previous surveys have shown that Chinese boys are far more likely to smoke than Chinese girls. (16-18) Another important characteristic, the average age of private school students, is significantly higher than in either public or factory schools even after being stratified by grade. This indicates that many students in private schools have delayed their normal initiation age of entering secondary schools due to the migration with their parents. Because age is an important predictor of smoking among adolescents, the prevalence of smoking in private schools will increase with more students of older ages.

At the individual level, health skills also contribute to the different prevalence of smoking among the 3 types of students. According to the Procede-Proceed theory of health promotion, health knowledge and proper attitudes are the predisposed factors for people to adopt healthy behaviors or avoid risky behaviors. (19) The same ranks are found for the scores of knowledge and attitudes among boys and for the scores of knowledge among girls: highest in the factory school, lower in public schools, and lowest in private schools. This indicate that students in private schools lacking the necessary knowledge about smoking and health and their attitudes tend to be accepting smoking. They have a weaker ability to resist the temptation of cigarettes, and as a result, they find it easier to light their first cigarettes and become regular smokers in the future. (20,21)

Meanwhile, we should not ignore the family's effects on the smoking behavior of adolescents. (22,23) The parental socioeconomic status is one of the most important family factors associated with adolescent smoking. (24) In this study, the parents of children who study in the factory school are more likely to be of high socioeconomic status, which may have indirect effects on students' smoking behaviors. Evidence shows that more of those worker parents have taught their children the knowledge about smoking and health, besides educating them not to smoke in a similar frequency with other parents in private and public schools. In contrast, the family environment is partly blamed for the high prevalence of smoking among private school students. The results show that most of those students in the 2 sampled private schools (general paid) migrate from other places. Unfortunately, most of their parents are not well educated and can only get unstable, time-consuming jobs with lower incomes. It is hard for those children to receive good family education and adequate parental care. This may indirectly increase the risk for those children to begin smoking. Another risky environment is that some of their elder siblings have become current smokers, which may partly add to this risk. (25)

The school environment can provide direct clues for us to look closely into the differences of smoking prevalence among the students in the 3 types of schools. It has been reported that the school environment also has some effects on the students' smoking. (26,27) Students in the private schools seem to live in a riskier school environment, which encourages smoking. Most of them have seen someone smoking in school areas, sometimes peers, and supervising teachers smoking. They find comparatively fewer signs of not smoking in their schools. As a result, only less than half of them can sense an antitobacco atmosphere in school. In contrast, a better environment in the factory school makes more students feel that tobacco use is not allowed in their school.

The school policy and management may be another potential factor associated with the different prevalences of smoking. (27-29) Because of changeable government policies and sole financial resources (tuition), general-paid private schools have been experiencing numerous problems such as unclear direction, inadequate funds, incomplete facilities, and the interim employment system. (30) These problems have direct or indirect effects on private school owners' attitudes toward health education. Generally, health education does not get the attention it deserves in these private schools. Necessary curriculum and teachers for health education cannot be guaranteed, which creates difficulties for students to adequately learn the scientific knowledge about smoking and health.

As for the high-paid private schools, previous similar surveys in other parts of China may be helpful in learning more about them. In 2001, the University of Southern California conducted a cross-sectional study in 8 high-paid private secondary schools at Wuhai, a big city in central China. (15) The results showed that despite sufficient financial support and better physical school environments, high-paid private schools were still suffering from a high prevalence of lifetime smoking among their students compared with local public schools (male: 64.1% vs 32.5% and female: 37.9% vs 13%). We are not sure whether this phenomenon also exists in high-paid private schools in Guangzhou or other cities.

Several limitations in this study must be noted here. First, the study subjects were just sampled within Huangpu District, a county of southern China. It is appropriate to assume that the sampled population represents the secondary school students in the City of Guangzhou but is far from being a good sample at the provincial or the national level. In addition, the number of schools sampled was relatively small, which limits the strength of conclusions somewhat. Given the area and size of the sample, we must be very careful in generalizing the findings obtained in this study. Fortunately, the results were internally consistent and also similar with another study in Wuhan of central China. (15)

Second, several variables in the questionnaire are not enough to identify smoking-related school health education, policy, and management. It is necessary to address the details about health education, including the frequency, methods, effectiveness of health education, and the school financial budget for it. In addition, some other important information on smoking-related school policy and management cannot be obtained from this study, for example, the school ban of students' smoking and the extent of enforcing it, whether teachers and guest visitors are allowed to smoke in school or in the presence of students, (28) how teachers deal with student smokers, and specific services or programs for assisting student smokers to quit.

CONCLUSIONS

The students in general-paid private secondary schools had less smoking-related knowledge and held more supportive attitudes toward smoking than their counterparts in public and factory schools. The prevalence of student smoking was highest in general-paid private schools, which may be associated with various potential factors at individual, family, and school levels. Therefore, Chinese general-paid private schools should become one of the focus places for tobacco control among the adolescents. Given the high risk of student smoking, these schools deserve more resources (per student) allocated to tobacco control from the governments.

REFERENCES

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(19.) Green LW, Kreuter MW. Health Promotion Planning: An Education and Environment Approach. 2nd ed. Mountain View, Calif: Mayfield Publishing Company; 1991.

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(28.) Griesbach D, Inchley J, Currie C. More than words? The status and impact of smoking policies in Scottish schools. Health Promot Int. 2002;17:31-41.

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XIAOZHONG WEN, MSc (a)

WEIQING CHEN, PhD (b)

ZHENGMIH QIAN, PhD (c)

JOSHUA E. MUSCAT, PhD (d)

CIYONG LU, PhD (e)

WENHUA LING, PhD (f)

(a) Research Assistant, (xiaozhongwen@hotmail.com), Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.

(b)professor of Epidemiology, Deputy Dean, (chenwq@mail.sysu.edu.cn), Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Rd, Guangzhou 510080, China.

(c) Assistant Professor, (zqian@hes.hmc.psu.edu), Health Evaluation Science, Penn State College of Medicine, Hershey, PA 17033.

(d) Associate Professor, (jmuscat@hmc.psu.edu), Health Evaluation Science, Penn State College of Medicine, 500 University Blvd, Hershey, PA 17033.

(e) Associate Professor, (luciyong@mail.sysu.edu.cn), Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou S 10080, China.

(f) Professor, Dean, (lingwh@maiil.sysu.edu.cn), Department of Clinical Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.

Address correspondence to: Weiqing Chert, Professor of Epidemiology, Deputy Dean, (chenwq@mail.sysu.edu.cn), Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Rd, Guangzhou 510080, China. This is the baseline survey for the project of Evaluation on the Effectiveness of Smoking Prevention and Control among Primary and Secondary School Students, which is funded by Chinese Medicine Board in New York (CMB 00-29). The authors gratefully acknowledge the contribution of Huangpu Education Bureau and 6 secondary schools. We also appreciate Professor Zhijin Wang, Dr Yuming Chen, and Dr Yuantao Hao for their assistance in developing the questionnaires.
Table 1. Items of Knowledge About Smoking and Health for Chinese
Secondary School Students

Knowledge Content               Answer

Diseases caused by smoking
  Chronic bronchitis            Yes
  Cold                          No
  Emphysema                     Yes
  Tuberculosis                  No
  Lung cancer                   Yes
  Coronary heart disease        Yes
  Hypertension                  Yes
  Stroke                        Yes
  Bladder cancer                Yes
  Diabetes                      Yes
Harmful components of tobacco
  Nicotine                      Yes
  Tar                           Yes
  Carbon monoxide (CO)          Yes
  Hydrocyanic acid (HCN)        Yes
General smoking-related
    knowledge
  Is passive smoking            Yes
    harmful to health?
  Which day is "World           May 31
    No Smoking Day?"
  Who will get worse            Adolescents
    consequence if they
    smoke, adolescents
    or adults?
  Are there bans for            Yes
    tobacco advertisements
    on mass media in
    advertisement law?
  Is a pregnant woman's         Yes
    smoking bad for
    her baby?
  What is the change            Decrease
    tendency of smoking
    prevalence in western
    countries since 1970s?

                                  Attitudes Toward
Knowledge Content                 Smoking and Health            +/- *

Diseases caused by smoking      Effects of tobacco
  Chronic bronchitis              Smoking is very               +
                                    harmful to health
  Cold                            Smoking can relieve           -
                                    fatigue and improve
                                    study efficiency
  Emphysema                       We should try to increase     -
                                    job positions by
                                    developing tobacco
                                    industry
  Tuberculosis                    The feeling of smoking
                                    after meals is just
                                    like being a happy
                                    spirit
  Lung cancer                   Smoking image
  Coronary heart disease          A man without smoking         -
                                    is not a real man
  Hypertension                    It is a fashion for young     -
                                    females to smoke
  Stroke                          A brave youth should try      -
                                    the feeling of smoking
  Bladder cancer                Smoking is a symbol             -
                                    of maturation and
                                    independence
  Diabetes                      Cigarette's role in
                                    social contact
Harmful components of tobacco     It is impolite to refuse      -
                                    the cigarettes passed
                                    by others
  Nicotine                        It is easy to get close       -
                                    relationship by pas-
                                    sing cigarettes each
                                    other
  Tar                             Parents should not smoke      +
                                    in front of children

  Carbon monoxide (CO)            It is uncivil to smoke        +
                                    in public places
  Hydrocyanic acid (HCN)        Tobacco control measures
General smoking-related           Smoking should be             +
    knowledge                       forbidden in public
                                    places
  Is passive smoking              All the tobacco adver-        +
    harmful to health?              tisements should
                                    be forbidden
  Which day is "World             Cigarette sales to minors     +
    No Smoking Day?"                should be banned
  Who will get worse              No one should be              +
    consequence if they             allowed to smoke in
    smoke, adolescents              school area
    or adults?
  Are there bans for
    tobacco advertisements
    on mass media in
    advertisement law?
  Is a pregnant woman's
    smoking bad for
    her baby?
  What is the change
    tendency of smoking
    prevalence in western
    countries since 1970s?

* "+" positive attitude; "-;" negative attitude.

Table 2. Differences in Demographic Characteristics Among Students in
Public, Factory, and Private Schools in Guangzhou, China (Reported
by Students)

                       Gender (%)         Age [+ or -] SD)

School Type         Males    Females       Seventh Grade

Factory (n = 476)   50.4       49.6      12.7 [+ or -] 0.5
Public (n = 2691)   50.7       49.3      12.8 [+ or -] 0.6
Private (n = 790)   58.4       41.6      13.2 [+ or -] 0.9
[chi square]              15.09                71.49 *
P                         <.001                <.001

                               Age (X [+ or -] SD)

School Type           Eighth Grade          Ninth Grade

Factory (n = 476)   13.7 [+ or -] 0.5    14.8 [+ or -] 0.6
Public (n = 2691)   13.8 [+ or -] 0.6    14.9 [+ or -] 0.6
Private (n = 790)   14.2 [+ or -] 0.7    15.2 [+ or -] 0.8
[chi square]              84.63 *              18.15 *
P                         <.001                <.001

                                    Birthplaces (%)

                                                           Out of
School Type         Huangpu District   Other Districts   Guangzhou

Factory (n = 476)         78.6               9.5            11.8
Public (n = 2691)         90.4               3.3             6.3
Private (n = 790)         27.5              18.0            54.6
[chi square]                                1354
P                                          <.001

* Kruskal-Wallis test was used here because of the heterogeneous
age variances.

Table 3. Differences in Family Characteristics Among the Students
in Public, Factory, and Private Schools in Guangzhou, China
(Reported by Parents)
                          Factory      Public        Private
                          School       School        School
Family Characteristics     n %          n %           n %

Parental marital status
  Married                367   96.3   1638   96.0   603   98.2
  Divorced                 5    1.3     29    1.7     5    0.8
  Widowed                  7    1.8     31    1.8     3    0.5
  Separated                2    0.5      9    0.5     3    0.5
Educational level
  Illiteracy               3    0.8     10    0.6    11    1.7
  Primary school          21    5.4    249   14.2   115   17.6
  Secondary school       136   34.7    825   47.0   302   46.3
  High school            155   39.5    543   30.9   190   29.1
  College                 77   19.6    129    7.3    34    5.2
Monthly family income (/person) in dollars
  Low (0-125)             88   25.5    590   43.9   196   38.0
  Middle (126-300)       173   50.1    533   39.7   218   42.2
  High ([greater than     84   24.3    221   16.4   102   19.8
    or equal to] 301)

Family Characteristics    [chi square]     P

Parental marital status
  Married
  Divorced
  Widowed                        8.3      .217
  Separated
Educational level
  Illiteracy
  Primary school
  Secondary school             122.4     <.001
  High school
  College
Monthly family income (/person) in dollars
  Low (0-125)
  Middle (126-300)              41.0     <.001
  High ([greater than
    or equal to] 301)

Table 4. Differences in Smoking-Related Family and School Environment
Among the Students in Factory, Public, and Private Schools in
Guangzhou, China

                               Factory       Public      Private
                                School       School      School
                              (Ns = 476,   (Ns = 2691,   (Ns = 790,
                               Np = 395)   Np = 1810)    Np = 665)

                               n     %      n      %      n     %
Family environment
  Father's smoking            287   60.3   1686   62.7   466   59.0
    (reported by students)
  Mother's smoking              4    0.8     26    1.0    11    1.4
    (reported by students)
  Sibling's smoking            26    5.5    250    9.3    83   10.5
    (reported by students)
  Educate children not to     335   84.8   1541   85.1   583   87.7
    smoke (reported by
    parents)
  Teach children smoking-     311   78.7   1359   75.1   483   72.6
    related knowledge
    (reported by parents)
School environment (all
    reported by students)
  Peers' smoking               47    9.9    406   15.1   140   17.7
  Supervising teacher's        49   10.3    178    6.6   101   12.8
    smoking
  Someone smoking in          325   68.3   2255   83.8   652   82.5
    school area
  Signs of no smoking         284   59.7   1825   67.8   426   53.9
    in school
  Feel the antitobacco        306   64.3   1453   54.0   384   48.6
    atmosphere

                              [chi square]     P
Family environment
  Father's smoking                3.89        .14
    (reported by students)
  Mother's smoking                1.28        .53
    (reported by students)
  Sibling's smoking               9.64        .008
    (reported by students)
  Educate children not to         2.82        .24
    smoke (reported by
    parents)
  Teach children smoking-         4.94        .085
    related knowledge
    (reported by parents)
School environment (all
    reported by students)
  Peers' smoking                 14.4         .001
  Supervising teacher's          33.4        <.001
    smoking
  Someone smoking in             65.6        <.001
    school area
  Signs of no smoking            55.8        <.001
    in school
  Feel the antitobacco           29.5        <.001
    atmosphere

Ns, number of students; Np, number of parents.

Table 5. Differences in Students' Smoking-Related Knowledge and
Attitudes Among Chinese Factory, Public, and Private Schools in
Guangzhou, China

                              Score of Smoking-
                              Related Knowledge

                          Boys                Girls

School Type           (X [+ or -] SD)      (X [+ or -] SD)
Factory (n = 476)   10.3 [+ or -] 2.8    10.5 [+ or -] 2.5
Public (n=2691)      9.8 [+ or -] 2.9    10.0 [+ or -] 2.6
Private (n = 790)    9.7 [+ or -] 2.8     9.6 [+ or -] 2.7
F/[chi square]             4.50                 9.92
P                          .011                <.001

                             Score of Attitudes
                                Toward Smoking

                          Boys                Girls

School Type           (X [+ or -] SD)      (X [+ or -] SD)
Factory (n = 476)   67.4 [+ or -] 11.5   69.5 [+ or -] 9.2
Public (n=2691)     66.5 [+ or -] 10.4   70.4 [+ or -] 7.8
Private (n = 790)   65.2 [+ or -] 9.5    69.7 [+ or -] 7.5
F/[chi square]             17.0 *              3.91 *
P                         <.001                .141

* Kruskal-Wallis test was used here because of the heterogeneous
attitude score variances.

Table 6. Differences in Prevalence of Smoking Among Public, Factory,
and Private School Students in Guangzhou, China (%)

                        Male

                        Lifetime   Weekly     Daily
School Type    Number   Smokers    Smokers   Smokers

Factory          237     16.5       5.5       3.8
Public          1330     26.5       8.3       6.4
Private          454     49.6       9.9       6.4
[chi square]            110         3.98      2.46
P                        <.001       .136      .292

                        Female

                        Lifetime   Weekly
School Type    Number   Smokers    Smokers
Factory          233      9.9       2.6
Public          1294      7.2       0.8
Private          323     15.2       1.2
[chi square]             20.6       6.09
P                         <.001      .048

                        Total *

                        Lifetime   Weekly     Daily
School Type    Number   Smokers    Smokers   Smokers
Factory          476      13.2       4.0      2.7
Public          2691      17.4       4.9      3.5
Private          790      35.4       6.2      3.9
[chi square]             139.63      3.42     1.26
P                          <.001       .18     .53

* 86 students did not report their gender.
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Article Details
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Title Annotation:Research Article
Author:Wen, Xiaozhong; Chen, Weiqing; Qian, Zhengmih; Muscat, Joshua E.; Lu, Ciyong; Ling, Wenhua
Publication:Journal of School Health
Article Type:Report
Geographic Code:9CHIN
Date:Jan 1, 2008
Words:6158
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