Influences affecting adolescent smoking behavior in China Jerry L. Grenard, Qian Guo, Guneet Kaur Jasuja, Jennifer B. Unger, Chih-Ping Chou, Peggy E. Gallaher, Ping Sun, Paula Palmer, C. Anderson Johnson [Received 2 February 2005; accepted 10 August 2005] 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 (N511,583) 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. Introduction China consumes more tobacco products than any other country in the world. Among 1.1 billion smokers worldwide, 0.32 billion are in China (H. Zhang & Cai, 2003). A Chinese population-based national survey administered in 1996 in 30 provinces of China reported that 34.1% of Chinese, aged 15–59 years, smoked at least one cigarette per day; this rate had increased by 3.4 percentage points since 1984 when the first national survey was administered (Yang et al., 1999). Further, the survey reported that 63% of men and 3.8% of women were current smokers (Yang et al., 1999). This increasing rate was similar to that experienced in the United States 40 years ago (H. Zhang & Cai, 2003). Smoking prevalence among adolescents also is increasing. Currently, 9 million adolescents, aged 15– 19 years, are smokers; this total includes 18% of all boys and 0.28% of all girls in the country (H. Zhang & Cai, 2003). Every day, about 80,000 adolescents become new smokers. If current trends continue, it is estimated that 100 million men presently less than 30 years of age will die from smoking-related diseases (H. Zhang & Cai, 2003). Empirical studies of adolescent smoking in China According to B. P. Zhu et al. (1992), much of the current knowledge about teenage smoking in China has come from western countries. Smoking among children in China has not received as much attention as smoking prevalence among adults. As in the western countries, empirical studies conducted on the main determinants of adolescent smoking in China have identified the influences to be multifactorial. In a number of studies, boys had a higher risk of ISSN 1462-2203 print/ISSN 1469-994X online # 2006 Society for Research on Nicotine and Tobacco DOI: 10.1080/14622200600576610 Jerry L. Grenard, M.A., Qian Guo, M.P.H., Guneet Kaur Jasuja, M.A., Jennifer B. Unger, Ph.D., Chih-Ping Chou, Ph.D., Peggy E. Gallaher, Ph.D., Ping Sun, Ph.D., Paula Palmer, Ph.D., C. Anderson Johnson, Ph.D., Institute for Health Promotion and Disease Prevention Research, University of Southern California, Alhambra, CA. Correspondence: Jerry L. Grenard, University of Southern California, Institute of Prevention Research, 1000 South Fremont Avenue, Unit # 8, Alhambra, CA 91803, USA. Tel: +1 (626) 457-4039; Fax: +1 (626) 457-4012; E-mail: grenard@usc.edu Nicotine & Tobacco Research Volume 8, Number 2 (April 2006) 245–255