OBJECTIVETo understand the tendency of smoking in middle school students during the last 5 years and to identify the relationship between subjective life qualities and different smoking behaviors in order to determine the possible effects on tobacco use.

METHODSSix middle schools were chosen in the city and rural areas of Hefei in 1998 and 2003, respectively. Smoking behaviors such as ever smoking, smoking before 13 years old, current smoking, regular smoking and addictive smoking were surveyed. Emotional symptoms, satisfaction on school life and on general life were chosen to estimate subjective life qualities. Relationship between subjective life qualities and smoking behaviors was analyzed.

RESULTSPrevalence rates of smoking before 13 years old, current smoking, regular smoking and addictive smoking in 2003 (8.8%, 12.0%, 5.6% and 1.7%, respectively) were higher in 1998 (3.1%, 3.0%, 1.7% and 0.6%, respectively). The prevalence rates of depression and anxiety were high among students with ever smoking, current smoking, regular smoking, addictive smoking, smoking before 13 years old and no attempt to quit cigarette smoking. Lower school life satisfaction and general estimation of life were found among these students. Higher satisfaction on school life (OR = 0.657) and on ordinary life (OR = 0.766) were protecting factors of current smoking but comorbid depression and anxiety were risk factors (OR = 2.181). Higher school life satisfaction (OR = 0.388) seemed to be protecting factor of addictive smoking while depression was risk factor of addictive smoking (OR = 2.753) and regular smoking (OR = 1.676).

CONCLUSIONSmoking behaviors were common in middle school students and affected by several emotional and cognitive factors of subjective life qualities. Longitudinal designs are required to clarify the causal relationship between these factors and smoking behaviors in adolescents.