The Chinese Journal of School Health is a series of academic journals sponsored by the Chinese Preventive Medicine Association and overseen by the National Health Commission of China. Its main objective is to reflect on academic research and practices related to school health and pediatric health in China. The journal aims to serve the needs of researchers, educators, practitioners, and managers in the field of school health and pediatric health.

Photo credit: Official website homepage of "Chinese School Health" magazine.

In April 2023, this journal published an article written by Ms. Yin Qiqi, an expert from the Smoking Prevention and Control Office of the Macau Health Bureau, titled "The Current Status and Influencing Factors of Electronic Cigarette Use Among Middle School Students in Macau.

Source Image: Front page of the April 2023 Volume 44 Issue 4 of "China School Health", featuring an article titled "Current status and influencing factors of electronic cigarette experimentation among Macau teenagers in grades 7-10.

The summary of the paper is as follows:

Research background: Tobacco use is a public health issue that has received global attention. Since lifelong smoking usually begins during adolescence, teenagers are often identified as a key population for tobacco control. This study analyzes data collected from the "2021 Macao Youth Tobacco Use Survey" conducted from March to May 2021 to understand the prevalence of electronic cigarette use among middle school students in Macao and to conduct a factor analysis of influencing factors, in order to provide a basis for developing intervention strategies to prevent adolescent use of electronic cigarettes.

The research team includes Ms. Yin Qiqi, a 1988-born Macau resident who is currently a medical doctor and master's student, employed at the Tobacco Control Office of the Macau Health Bureau. She specializes in health education and research on tobacco harm prevention and control, actively exploring and promoting behavior intervention strategies to assist smoking cessation. Her research team is dedicated to improving the efficiency and effectiveness of smoking cessation services, making contributions to building a healthier society.

Photo source: Official website homepage of the Smoking Prevention and Control Office of the Macau Health Bureau.

Experimental Method: This experiment utilized the "Global Youth Tobacco Survey Questionnaire (Macau Version)," which is based on the standardized core questionnaire provided by the World Health Organization's Global Youth Tobacco Survey. The questionnaire included personal background information, data on tobacco/e-cigarette use, exposure to second-hand smoke, tobacco harm education, tobacco advertising and promotion, as well as knowledge and attitudes towards tobacco harm/e-cigarettes. A total of 25 secondary schools in Macau with students in grades 7-10 were randomly selected, totaling 98 classes and 2,712 students. After weighting the samples, they represent 19,480 Macau students in grades 7-10. Ultimately, 2,683 valid questionnaires were collected, resulting in an effective response rate of 98.9%. Participants were informed and consented to the survey, which was anonymous and carried out without the presence of their teachers.

Results from the study show that the rate of electronic cigarette usage among adolescents in Macau is significantly higher compared to other areas in mainland China, with an 11.3% reported usage rate among middle school students in grades 7-10 (95%CI=10.2%-12.6%). Male students (12.1%) reported a higher rate of usage compared to female students (10.5%), with statistical significance (χ2=11.01,P<0.01). These findings highlight the prevalence of electronic cigarette experimentation among youth in Macau.

Here are the most significant factors that have a positive correlation with the research results (with odds ratios of 1.48, 3.01, 1.79, 1.34, 1.67, 1.27, 1.33, 1.34, 1.58, 3.53 and all P values < 0.01):

Teenagers aged 14-16 or 17 years and older who receive a higher weekly allowance believe that e-cigarettes are less harmful than traditional cigarettes. Those who have been taught about the dangers of e-cigarettes in the classroom in the past 12 months also agree that they have a greater appeal to young people. Additionally, those who have been exposed to second-hand smoke at home in the past 7 days or seen tobacco advertisements online in the past 30 days are more likely to try e-cigarettes. Furthermore, having a close friend who smokes cigarettes or uses e-cigarettes also influences their behaviour. Notably, teenagers with at least one smoking parent are more likely to be exposed to these factors.

Conclusion: The use of electronic cigarettes by young people in Macau is widespread, with multiple and complex contributing factors. The whole society should strengthen multi-party cooperation and promote comprehensive measures targeting the prevention of youth using electronic cigarettes.

Firstly, due to the lack of understanding and curiosity of teenagers towards the virtual world of the internet, as well as their inherent psychological vulnerabilities during the growth stage, tobacco companies exploit these weaknesses to promote their tobacco products. Therefore, the government must fulfill its responsibility to protect teenagers and prohibit any harmful actions taken by tobacco companies.

Secondly, there exists a significant amount of misconceptions among teenagers regarding the use of electronic cigarettes, such as the belief that using them can help one relax or appear more attractive. Therefore, there is a need to strengthen the analysis and study of adolescent psychology and behavior, as well as evaluate various educational methods in order to find more targeted and effective means of education.

Thirdly, parents' attitudes towards tobacco use can subtly influence their children. Therefore, parents should set a good example, strengthen their care and communication with their children, and work together to create a "smoke-free home". At the same time, they should reasonably control their children's pocket money, promote a healthy consumption concept, and refuse to allow the consumption of harmful products such as electronic cigarettes.

In conclusion, peers have a significant influence on the attitudes of teenagers towards smoking or using e-cigarettes, even more so than their parents. Peer role models for healthy behavior are negatively correlated with teenage experimentation with smoking. Therefore, efforts to educate teenagers on the harms of smoking should be strengthened to create a positive "no smoking" peer environment. Through mutual monitoring and support among peers, we can work together to break the negative habit of e-cigarette use.

References:

Current Status and Influential Factors of Teenagers' Experimentation with E-cigarettes in Macau from Grades 7 to 12

Macao (China)