Prevalence in trying smoking behavior among adolescent in rural western China and its relationship with Psychosocial factors: Evidence from Global Youth Tobacco Survey

Abstract Background: Smoking behavior is a continuous and gradual behavior, and most of the addiction of adult smokers comes from their childhood and adolescence.Once they start trying smoking, if no timely intervention measures are taken, the vast majority of smokers will become lifelong smokers.Adolescent is the most effective group in implementing tobacco control and smoking bans.The study aims to effectively evaluate the characteristics of trying smoking behavior of adolescents in rural western China and identify the key psychosocial factors to provide a scientific basis for preventing and reducing the occurrence of smoking behaviors of adolescents. Methods: A total of 2671 students from rural middle schools in western China were surveyed using the Adolescent Health Questionnaire including Global Youth Tobacco Survey (GYTS). Structural Equation Model (SEM) was used to analyze the direct or indirect relationship between adolescent's try smoking behavior and psychosocial influencing factors. Results: (1)Tobacco use: 28.3% of adolescents have tried tobacco products, boys are higher than girls,senior is higher than junior,and the tobacco use rate increases with the increase in monthly living expenses (P<0.05). Among the adolescents who tried to smoke, 99% of adolescents first tried to use tobacco products at the elementary and middle school.59% of adolescents reported that the reason for smoking for the first time was curiosity. 58.0% of adolescents have seen teachers smoking in school, and even 26.2% of adolescents see teachers smoking in school almost every day.(2) Social support had a complete mediating effect on try smoking behavior through mental health problems and life satisfaction (β=-0.022, 95%CI: -0.028 to -0.016).Mental health had a positive and direct effect on try smoking behavior (β=0.112,P<0.05).Life satisfaction had a negative direct impact on try smoking behavior (β=-0.125,P<0.05).Mental health problemshad a partial mediating effect on try smoking behavior through life satisfaction(β=0.016, 95%CI: 0.008 to 0.025),and the mediating effect accounted for 20.7% of the total effect. Conclusions: Findings of this study highlight that adolescents smoking behavior is a complex psychosocial behavior. Reducing mental health problemsand promoting life satisfaction should be considered as the key target for interventions aiming to the prevalence of adolescents’ smoking behavior.