Tobacco advertisements: One of the strongest risk factors for smoking in Hong Kong students

Study objective: To describe the prevalence of smoking in junior secondary school students in Hong Kong and to analyse the relationship between a range of risk factors and ever-smoking experience, including tobacco advertisements. Methods: Cross-sectional survey using an anonymous standardised self-administered questionnaire. Setting: 61 randomly selected secondary schools in Hong Kong. Participants: 6,304 form 1 to 3 Chinese students from 172 classes (51% girls and 49% boys; 90% were aged 12 to 15 years). Results: The smoking status (95% confidence interval) was: (1) never smoker, 71.1% (70.0%-72.2%), (2) tried only, 15.5% (14.6%-16.4%), (3) used to smoke but not now, 4.2% (3.7%-4.7%), (4) smoked < 1 cigarette per week, 2.9% (2.5%-3.4%), (5) smoked 1-6 per week, 1.7% (1.4%-2.0%), and (6) smoked > 6 per week, 4.5% (4.0%-5.0%). In a backward stepwise logistic regression model, ever-smoking (including categories 2 to 6 above) was independently associated with thirteen factors, including gender (boys), increasing age, place of birth (outside Hong Kong, mainly China), poor knowledge of the hazards of smoking, positive attitudes to smoking, smoking in family members, participation in tobacco promotional activities, and perception of cigarette advertisements as attractive. Among the strongest associations observed was the youth's perception of cigarette advertisements as attractive, with the adjusted odds ratio (95% confidence interval) of 2.68 (2.33-3.07). Conclusions: Smoking among young people is an important public health problem. Although the causes are multifactoral, in Hong Kong environmental tobacco advertising is an important risk factor that can be removed by banning all forms of tobacco promotion to young people.