Smoking behavior among adolescents in the city, suburbs, and rural areas of Shanghai

Purpose. The study was designed to investigate differences in predisposing factors, enabling factors, reinforcing factors, and smoking behavior among middle school students living in the city suburbs, and rural areas of Shanghai. Design. A one-time cross-sectional survey design was applied in this study. Setting. The study was conducted in 11 schools in three areas. Subjects. A total number of 1116 students from these three areas participated in this study. The response rates were 92, 88, and 84% for city, suburbs, and rural areas, respectively. Measure. A PRECEDE instrument including predisposing, enabling, and reinforcing factors was employed to collect data. A Multivariate Analysis of Variance (MANOVA) and Multiple Regression Analysis were used to analyze the data. Results. Smoking was reported by 39.8% of boys and 5.14% of girls. Students in the city of Shanghai had the best (against smoking) predisposing factors, but students in rural areas had the best (against smoking) enabling and reinforcing factors and consumed the fewest cigarettes. Conclusion. Results indicated that smoking behavior in students was affected strongly by enabling factors and reinforcing factors that were related to socioeconomic, cultural, and environmental influences in China.