Objective: To analyze the association between eye use behavior and self reported myopia in middle and high school students, and provide the scientific basis for the prevention and control of myopia. Methods: A total of 14 872 middle and high school students was selected from four provinces and cities from December 2015 to March 2016, including Jiangxi(Nanchang,Yintan,Dexing), Liaoning(Shenyang), Guangdong(Shenzhen), Henan(Zhengzhou) provinces. A self administrated questionnaire was used to collect the basic information, self reported myopia and eye use behaviors among middle and high school students. The Chi square tests were applied to compare the differences in self reported myopia among middle and high school students with different characteristics. Multivariate binary Logistic regression models were used to analyze the association between eye use behavior and self reported myopia in middle and high school students. Results: The self reported myopia rate of middle and high school students was 68.5%, with 59.7% and 78.6% for junior high school students and senior high school students, respectively. After adjusting for the potential confounders, the Logistic regression models showed that middle and high school students who read and write with their heads down ( OR =1.94, 2.32),middle and high school students who lie down or lie on stomach when using their eyes ( OR =1.27, 1.28) had a higher risk of self reported myopia ( P <0.01). There was a negative correlation between eye use distance (reading and writing distance, distance from eyes to TV, mobile phone, or tablet) and self reported myopia ( OR =0.73, 0.70, 0.81; 0.61, 0.66 , 0.76) in middle and high school students ( P <0.01). In addition, the risk of self reported myopia was lower in middle school students with longer eye to computer distance ( OR=0.77, P <0.01). Conclusion There is a significant association between eye use postures, eye use distance and self reported myopia in middle and high school students. Health education for the risk and behavior factors of myopia should be actively promoted to ensure the visual health of children and adolescents.