| [Background]The harmful effect due to tobacco use is one of the most serious public health issues in the world. China is not only the largest tobacco producer and consumer, but also the the country with the largest number of smokers, and it has the largest number of death cases caused by the tobacco related diseases at the same time. More than1,000,000Chinese died of smoking-related diseases each year. Because the diseases and deaths caused by smoking lag evidently, it could be predicted that the dealths would on the rise in the future. Tobacco use has become the "first killer" to the health of the Chinese population. Relevent studies have shown that most smokers start smoking since their adolescent, and the earlier they start smoking, the more likely they will become the regular smokers, the more cigarettes they will consume when they grow up, the more harmful effect their bodies would suffer, and the less likely they could quit. If the young people start smoking later, the future smoking prevalence and morbidity as well as the mortality due to smoking-related diseases will greatly drop down. Smoking also has close relationship to adolescent behavior problem. Adolescent smokers often have some behavior issues in studying, moral, mental and other aspects. Therefore the teenagers are the key population for the tobacco control and it is an important task for centuries to educate them to be far away from tobacco. Tobacco control is also a priority measure to take care of the young people well in health and to prevent the rapid growth of smoking population.Smoking not only harms the smokers themselves, but some studies have shown that long-term passive smokers suffer more serious harm than active smokers. Young people are in a period of growth and development, their bodies have not yet been mature, their resistance to harmful factors is weaker than the adults and they are more vulnerable to the toxicity hazard Therefore passive smoking is more harmful to them. A few of studies indicated that passive smoking could lead to the defects of cognitive abilities and increase the possibility to suffer behavioral problems in children. If the children between16to18years old often suffer from passive smoking, their performance in studying will be greatly affected, failure rates in exam will increase30%than other children.In2010, GATS showed that there were301,000,000current smokers and740,000,000second-hand smokers including180,000,000teenagers in China.43.9%of teenagers suffer from secondhand smoke in their families and55.8%in public places.88.20%of the students reported that there were smokers in the people who had close relationship with them. A survey carried out in2005showed that the proportion of the population who had ever smoked a whole cigarette before the age of13increased15%than that in1998. A survey on healthy/risk behavior of young people carried ou in Shandong Province in2008indicated that the proportion of the people who had smoked a whole cigarette before the age of13the was49.79%, and52.47%of the students reported that they suffered passive smoking in the past7days.Primary school period is crucial for people to develop their philosophy, values and behavioral habits, and it is also the best time for behavioral interventions. Because primary school students learn new things fast and develop healthy behaviors easily. Children can maintain better compliance and cooperation. At the same time, children receive less pressure from studying, so sysmetic operational measures can be taken easily during this period. Effective tobacco control education and behavioral intervention is not only important to tobacco control in young people but also important to the whole society. From this point, we planned this survey in order to learn the pupils’exposure status to tobacco as well as its influence factors and to assess the influence of passive smoking on studying performance, and to understand the pupil’s awareness about tobacco as well as the channel to get the related knowledge, so as to provide scientific evidence for the further tobacco control measures, we conducted a questionnaire survey which contained several categorical kinds of questions such as tobacco exposure, influence factors, tobacco related knowledge and its message sources, etc.[Objectives]To learn the active and passive smoking exposure status and related influence factors among pupils in Shandong Province, to explore the passive smoking influence on studying performance, to understand pupils’tobacco related knowledge and its sources, and to provide scientific evidence and baseline data for the further tobacco control health education and interventions.[Methods]A multi-stage stratified-cluster random sampling method was used in the study.6050students and their parents from13schools in3different cities of Shandong were selected as the study population. A self-administered anonymous questionnaire was designed by the researchers and the survey was conducted by the trained investigators in each class collectively. The parent questionnaires were brought home by the students and filled by the parents then submitted to the investigators. We established a database by Epidata, then analyzed demographic characteristics, tobacco exposure status and influence factors, tobacco related knowledge by SPSS16.0statistical software.[Results]1. The rate of attempting smoking of the pupils in Shandong Province was6.0%, and the current smoking rate was1.2%. The average age of first smoking was7.8±2.1years. The top three reasons for attempting smoking were "curiousness","request of the companion" and "being in a bad or good mood". The main sources to get the cigarettes were from home and purchasing by themselves.2. The passive smoking rate of the pupils (in all places) in Shandong province was50.5%. It was higher in urban than in rural areas, and higher in Liaocheng City than in Laiwu City and Weihai City in Shandong province. The most common places where the pupils passively smoke were restaurants/hotels, shopping mall, family and public transport vehicles, respectively.3. The household passive smoking rate of the pupils in Shandong Province was49.7%. It was also higher in rural areas than in urban areas, higher in only one-child families than in multiple-child families. The household passive smoking rate was in connection with the family structure. It was highest in separate generation families, and then in re-organized families, multiple-generation families. The major smokers in the families were fathers and grandfathers,43.42%of the fathers and73.96%of the grandfathers had smoked for more than10years,66.78%of the fathers and61.56%of the grandfathers smoked1to10cigarettes per day. The main smoking places at home were "anywhere" and "living room". The main risk factors for household passive smoking were multiple-generation families and separate generation families, one-child families, with poor education parents and different city.4. It showed that27.4%of the pupils reported that they had ever seen teachers smoke at school. It was more common in rural areas than in urban areas, in Liaocheng city than in Laiwu City and Wcihai city.5. The study students still know less about the harmful effects of the tobacco. Comparatively they know more about its respiratory system effects and less about its cardivescular and neoplasm effects as well as second-hand smoking. The main channels where pupils acquired the tobacco related knowledge were TV/radio, internet, newspapers and magazines. The channels differ for students from urban and rural areas. Only44.3%of the pupils said that they acquired the message from attending the health education lectures given by the schools.6. The survey showed that passive smoking may be one of the influence factors for the pupils’studying performance. The pupils suffered family passive smoking have higher report rate of poor studying performance than the pupils who did not have family passive smoking. Moreover, the more days they suffered from passive smoking in a week, the less they could score "excellent" and "better than average", the more likely they would score "below average" and "poor"[Conclusions]1. It showed that there was a lowering trend of attemping smoking age in the primary school students in Shandong province and they have poor tobacco-related knowledge. The students from urban and rural areas have different channels to acquire the knowledge. It suggests that tabcco control education for the pupils should be valued. Paticlularly, skills should be taught to them such as how to reject the first cigarette.Tobacco control education should be carried out according to the difference between urban and rural areas.2. The students’smoking behavior was influenced by both themselves and other factors such as their family environment and surrounding evvironments. It suggests that tobaccon control for the pupils should focus on schools and then families and communties should co-operate each other so as to achieve the best results. On one hand the students themselves should be the key population, and on the other hand the change of social environment, the role of parents and teachers in interveining and quitting should not be neglected.3. Smoking in public places is common in Shandong province. A law to ban the smoking should be issued as soon as possible in the province. |
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