Objective: The aim of this paper is to understand the prevalence of smoking behavior among middle school students and to analyze the impact of childhood abuse experience on smoking behavior of middle school students. Methods: Stratified cluster sampling method was used to select 14 500 middle school students from Shenzhen, Zhengzhou, Nanchang and Guiyang as participants. A multivariate logistic regression model was established to analyze the effects of childhood abuse on smoking behavior among middle school students. Results: The rate of smoking behavior among middle school students was 3.6%, male students (5.8%) were higher than female students (1.4%), senior high school (5.0%) was higher than junior high school (2.3%), and rural (6.0%) was higher than urban (2.8%). The differences were statistically significant(P<0.01). Those exposed to high-level of various types of childhood abuse had a higher rate of smoking behavior than those with low levels. Multivariate Logistic regression models showed that emotional abuse(OR=1.69, 95%CI=1.38-2.07), physical abuse(OR=2.17, 95%CI=1.78-2.64), sexual abuse(OR=2.56, 95%CI=2.10-3.12), emotional neglect(OR=2.27, 95%CI=1.89-2.74), physical neglect (OR=2.21, 95%CI=1.83-2.67) and childhood abuse experience (OR=2.66, 95%CI=2.21-3.21) increased the risk of smoking among middle school students independently(P<0.01). Conclusion Childhood abuse is closely assoliated with smoking behavior among middle school students. Strengthening the importance and intervention of childhood abuse is beneficial to the prevention and control of smoking behavior among middle school students.