Student tobacco use, secondhand smoke exposure, and policy beliefs before and after implementation of a tobacco-free campus policy: Analysis of five U.S. college and university campuses.

The adoption of comprehensive tobacco policies by colleges and universities may help reduce student tobacco use. To this end, The American Cancer Society's Tobacco-Free Generation Campus Initiative (TFGCI) awarded grants to 106 higher learning institutions to adopt 100% tobacco-free campus policies. This study measured changes in student tobacco use, reported exposure to secondhand smoke, and support for types of tobacco policies among five TFGCI grantee institutions who implemented 100% tobacco-free policies. Students at five U.S. TFGCI grantee institutions completed two independent cross-sectional online surveys regarding tobacco use, exposure to secondhand smoke, and policy attitudes, once before (n = 2499) and once after (n = 1667) their campuses adopted a tobacco-free policy. Students were less likely to report current cigarette smoking (aOR: 0.73, 95% C.I.: 0.63, 0.85) and exposure to secondhand smoke on campus (aOR: 0.42, 95% C.I.: 0.23, 0.76) following the policy change. In contrast, students were more likely to report past 30-day use of electronic nicotine delivery systems (ENDS) (aOR: 2.16, C.I.: 1.77, 2.63) following the policy change, despite the policy's inclusion of all tobacco and nicotine products. Tobacco-free campus policies can be associated with decreases in tobacco product use and environmental smoke exposure. The extent of their effectiveness may vary by product and the inclusion of tailored messaging, cessation support, and enforcement approaches. To discourage use of these products among students, colleges and universities should adopt 100% tobacco-free policies, monitor product use trends, offer cessation support and messaging customized for specific groups and products, and utilize a comprehensive enforcement strategy.

A Qualitative Study of Vape Shop Operators' Perceptions of Risks and Benefits of E-Cigarette Use and Attitude Toward Their Potential Regulation by the US Food and Drug Administration, Florida, Georgia, South Carolina, or North Carolina, 2015.

INTRODUCTION: Approximately 8,500 vape shops in the United States sell a variety of electronic nicotine delivery systems (ENDS). This study examined vape shop operators' perceptions of benefits and risk of ENDS use, what they perceive to be the reasons for ENDS use, their source of product information, what information they shared with customers, and the impact of existing and future regulation of ENDS on its use and on their business. METHODS: We conducted qualitative interviews with 20 vape shop operators located in Florida, Georgia, South Carolina, and North Carolina in spring 2015. A semi-structured interview guide was used, and interviews were audio-recorded and transcribed verbatim. The transcripts were analyzed using NVIVO software. RESULT: Vape shop owners perceived ENDS to be less harmful and more economical than conventional cigarettes and indicated that most of their customers used ENDS as a smoking cessation tool. Most owners were former smokers and used ENDS to quit. Shop owners relied on their personal experiences and the Internet for information, and shared information with customers at point of sale by using the shop's website and social media. Most expressed concern that complying with potential regulations, including banning flavors or tax increases, would jeopardize their business. Some felt that ENDS should not be regulated as tobacco products and felt that big tobacco was behind these proposed regulations. Most owners supported age restrictions and quality controls for e-liquid. CONCLUSION: Vape shop owners are in a unique position to serve as frontline consumer educators. Interventions should focus on providing them with current information on benefits and risks of ENDS and information on national, state, and local regulations and compliance requirements.

The Effects of Antismoking Messages From Family, School, and Mass Media on Smoking Behavior and Smoking Intention Among Chinese Adolescents.

The prevalence of adolescent smoking has been increasing rapidly in China. Expanding adolescent exposure to antismoking messages may be an effective approach to prevent tobacco use among this population. Using a cross-sectional sample of 8,444 high school students in four Chinese cities, this study assessed the relation between self-reported exposure to antismoking messages from families, schools, and mass media and the rate of past 30-day smoking and smoking intention among junior and senior high school students. Results from logistic regression suggested that antismoking messages delivered via school and media inhibited both tobacco use and the intention to smoke. The effects of familial warnings about harmful effects of smoking, in contrast, were at best insignificant.

Severe and differential underestimation of self-reported smoking prevalence in Chinese adolescents.

BACKGROUND: Evaluating the progress of tobacco control across the world heavily relies on smoking prevalence estimates. Those estimates are often based on surveys of self-reported cigarette smoking status. The accuracy varies among populations with different social and cultural backgrounds. PURPOSE: The objective of this study was to estimate the prevalence of smoking and assess the accuracy of self-report smoking status in Chinese adolescents. METHOD: This population-based cross-sectional survey included 10,934 adolescents aged 12 to 18 years from 17 schools in Shanghai, China. Data on adolescents' smoking status were collected from adolescents' self-reporting and from parents' questionnaires, separately. Based on the data of two sources, the total number of smokers among the study participants was estimated using a capture-recapture method. RESULTS: Among 5,452 girls and 5,482 boys, the prevalence estimates of self-reported smoking were 13.6% (748) and 5.2% (284) for boys and girls, respectively. Parents only identified smaller proportions of smoking adolescents: 2.9% (160) boys and 0.6% (30) girls. Using the capture-recapture method, we estimated the prevalence of smoking as 18.3% (95% CI 16.4, 20.3) for boys and 14.2% (95% CI 7.6, 20.8) for girls. CONCLUSION: Reliance on self-reporting to identify smokers among Chinese adolescents significantly underestimates the number of smokers, particularly among Chinese girls. Self-reported smokers only represent less than half of actual smokers in girls. Our findings are important for monitoring smoking trends and evaluating tobacco control interventions among Chinese adolescents.

Challenges for philanthropy and tobacco control in China (1986-2012).

OBJECTIVE: To identify the international philanthropies that have invested in tobacco control in China, describe their role and strategies in changing the social norms of tobacco use, and define the outcomes achieved. METHODS: Information on the international philanthropic donor China projects, including activities and outcomes, was gathered from multiple sources including organisational websites, key informant interviews and emails with project officers, and published research papers and reports. RESULTS: Philanthropic donations to China's tobacco control efforts began in 1986. The donors provided funds to national, city, provincial government organisations, non-government organisations, universities, and healthcare organisations throughout China to establish a tobacco control workforce and effective programmes to reduce the burden of tobacco use. CONCLUSIONS: International engagement has been an important dimension of tobacco control in China. Recognising the large burden of illness and capitalising on proven effective control measures, philanthropic organisations understandably seized the opportunity to achieve major health gains. Much of the international philanthropic investment has been directed at public information, policy change and building the Chinese research knowledge base. Documenting research and evaluation findings will continue to be important to ensure that promising practices and lessons learned are identified and shared with the China tobacco control practitioners. The ultimate question is whether foreign philanthropy is making a difference in tobacco control and changing social norms in China? The answer is plainly and simply that we do not know; the evidence is not yet available.

Lessons learned about post-secondary institution tobacco policy change by Tobacco-Free Generation Campus Initiative Grantees, 2018-2020.

OBJECTIVE: The Tobacco-Free Generation Campus Initiative (TFGCI) granted funding to U.S. post-secondary institutions to assist with creating 100% smoke- and tobacco-free campus policies to prevent young adult tobacco use. This study assessed grantee experiences working on campus tobacco policy change. Participants: Sixty U.S. post-secondary institutions completing TFGCI funded work between 2018 and 2020. Methods: An online survey assessment was completed by each institution at the end of their 18-month grant period to share facilitators and barriers to policy change, lessons learned, and advice for future efforts. Results: Many institutions faced challenges of time and capital constraints and pushback from campus constituents. Collaboration, diverse constituent engagement, and educational efforts throughout the advocacy process were important facilitators of policy change. Conclusions: Adopting and implementing comprehensive tobacco policy on college campuses is challenging. Regardless of institution type, commitment to the long-term goal and diverse stakeholder support guided movement toward 100% smoke- and tobacco-free campus policies.Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2021.1953032 .

Changes in cigarette consumption and intention to quit in response to the COVID-19 pandemic in China.

INTRODUCTION: Significant changes occurred in the way people socialize and interact with each other since China reported its first COVID-19 cases. However, little is known about how smoking behaviors may have changed due to the COVID-19 pandemic in China. The aim of this study was to assess changes in smoking behavior and intention to quit during the early stage of the COVID-19 pandemic in China and to investigate the associated factors. METHODS: An online cross-sectional survey was conducted among Chinese adult smokers. Participants were recruited through snowball sampling from 19 March to 2 April 2020. RESULTS: A total of 1388 smokers participated in this study. Of those, 1014 (73.0%) reported not changing their cigarette consumption, 104 (7.5%) reported smoking more and 268 (19.3%) reported smoking less due to the pandemic. Average daily cigarette consumption among all participants decreased from 15.0 (IQR: 10.0-20.0) to 13.0 (IQR: 8.0-20.0) (W=6.919, p<0.001). For intention to quit, 270 (19.5%) respondents reported becoming more willing to quit, and 91 (6.6%) reported becoming less willing to quit. Multivariate analyses showed that tobacco addiction, overall knowledge about the relationship between smoking and COVID-19, level of attention devoted to COVID-19, anxiety, living alone, and number of smokers in the family were significantly correlated with cigarette consumption and intention to quit, and living alone was the strongest factor associated with increased cigarette consumption (AOR=5.29; 95% CI: 1.51-18.56). CONCLUSIONS: The COVID-19 pandemic led to a slight decrease in cigarette consumption and an increase in quitting intention among Chinese smokers. During the early stages of the pandemic, it was important to focus on the anxiety of smokers, dispel smokers' misunderstandings of smoking and COVID-19 and create a supporting environment in the family to help smokers quit.

Reasons why Chinese smokers prefer not to use electronic cigarettes.

INTRODUCTION: China is the world's largest e-cigarette manufacturer. It also has the world's largest smoking population. Although smoking is strongly associated with e-cigarette use, the prevalence of e-cigarette use is low among Chinese smokers compared with smokers in countries such as the US and UK. This study aims to explore the reasons why Chinese smokers prefer not to use e-cigarettes. METHODS: Cross-sectional data from the Tobacco Questions for Surveys (TQS) conducted in four large Chinese cities (Chengdu, Wuhan, Xiamen, and Xi'an) in 2017-2018 were analyzed. A multi-stage cluster sampling approach was applied to select a representative sample of adults for each city. Weighted percentages and 95% confidence intervals (CIs) were estimated for self-reported reasons why smokers in China had never tried e-cigarettes, in total and by demographic characteristics. Multivariate logistic regression models were used to examine the adjusted associations between the top reasons why smokers never tried e-cigarettes and demographic and socioeconomic characteristics. RESULTS: The top three reasons that Chinese adult smokers reported for never having tried e-cigarettes were: 'I do not want to quit smoking' (35.35%), 'I do not think they would help me quit or cut down' (24.31%), and 'I am not addicted to smoking and don't need help to quit' (14.93%). Other prominent reasons included: 'I am concerned they are not safe enough', and 'I do not want to substitute one addiction for another'. Generally, there were no statistically significant associations between reasons why smokers never tried e-cigarettes and demographic and socioeconomic characteristics. CONCLUSIONS: Our results suggest that many Chinese smokers associate e-cigarette use with smoking cessation. Continued monitoring of smokers' views, beliefs, and risk perceptions regarding e-cigarettes is warranted. Health education campaigns communicating the risks of e-cigarettes are also needed.

Secondhand smoke (SHS) exposure before and after the implementation of the Tobacco Free Cities (TFC) initiative in five Chinese cities: a pooled cross-sectional study.

OBJECTIVES: To assess the levels of secondhand smoke (SHS) exposure before and after the implementation of the Tobacco Free Cities (TFC) initiative. DESIGN: City-wide representative, cross-sectional surveys (Tobacco Questions for Surveys, TQS) were conducted in each participating city before and after the implementation of TFC. SETTING: Five large Chinese cities (Chengdu, Chongqing, Wuhan, Xiamen and Xi'an) participated in the TFC initiative. PARTICIPANTS: A total of 10 184 adults participated in the 2015 TQS survey, and 10 233 adults participated in the 2018 TQS survey, respectively. INTERVENTIONS: The TFC initiative, which included targeted media campaigns, educational programmes, implementing city-wide smoke-free policies and providing cessation interventions, was implemented in these five cities between 2015 and 2018. MAIN OUTCOME: Self-reported past 30-day (P30D) SHS exposure in indoor workplaces, restaurants and homes. DATA ANALYSIS: The pre-TFC and post-TFC SHS exposure levels were compared among all residents and among certain population subgroups. Multivariate logistic regressions were used to estimate the adjusted associations between P30D SHS exposure and individual characteristics. RESULTS: Across all five cities, the overall rate of self-reported P30D SHS exposure declined in indoor workplaces (from 49.6% (95% CI: 46.4% to 52.8%) to 41.2% (95% CI: 37.7% to 44.7%)), restaurants (from 72.4% (95% CI: 69.8% to 74.9%) to 61.7% (95% CI: 58.7% to 64.7%)) and homes (from 39.8% (95% CI: 36.9% to 42.7%) to 34.7% (95% CI: 31.5% to 37.8%)) from 2015 to 2018. These declines were statistically significant after controlling for individual characteristics. The P30D SHS exposure was associated with sex, age, education level, occupation and current smoking status. The associations varied by venues. CONCLUSIONS: Our analysis showed that compared with the nationwide SHS exposure levels reported in concurrent national surveys, the declines in P30D SHS exposure in five Chinese cities that implemented the TFC initiative were larger in indoor workplaces and restaurants. Our findings suggest that the TFC initiative was effective in reducing SHS exposure in Chinese cities.

Use of Electronic Nicotine Delivery Systems (ENDS) in China: Evidence from Citywide Representative Surveys from Five Chinese Cities in 2018.

China is the largest cigarette consuming country in the world. The emergence of electronic nicotine delivery systems (ENDS) in China may have important implications for the Chinese tobacco market. Unfortunately, research on ENDS in China, while growing, is still limited. This study was designed to examine the awareness and use of ENDS among adult urban residents in China. Data from five citywide representative surveys conducted in 2017-2018 were used. Percentages of residents who had ever heard of, ever used, or used ENDS in the past 30 days among all residents and smokers were estimated, in total and by demographic characteristics. Multiple logistic regression models were used to estimate the adjusted associations between awareness and use of ENDS and individual-level demographic characteristics and socioeconomic status (SES). Overall, 51.3% had ever heard, 4.8% ever used, and 0.9% used ENDS in the past 30 days. Men, young adults, those with high levels of education, and current smokers were more likely to be aware of and use ENDS. Among smokers, 67.8% had ever heard, 17.1% ever used, and 3.9% used ENDS in the past 30 days, respectively. Young adult smokers and smokers with high levels of education were more likely to be aware of and use ENDS. Our study results on ENDS awareness and use patterns and associated factors in China provide important evidence to inform research and policies related to ENDS manufacture, marketing, and sales in China.

Perceptions About Mindfulness and Text Messaging for Smoking Cessation in Vietnam: Results From a Qualitative Study.

BACKGROUND: With 15.6 million smokers, Vietnam is one of the top 10 largest cigarette-consuming countries in the world. Unfortunately, smoking cessation programs are still scarce in Vietnam. Mindfulness-based and text messaging-based interventions have been increasingly used in smoking cessation studies in developed countries, with promising results. Given the exponential growth of mobile phone usage in Vietnam in recent years, mobile health interventions could be a potential strategy to increase smoking cessation in Vietnam. However, substantial cultural adaptations are needed to optimize the effectiveness of these interventions among Vietnamese smokers. OBJECTIVE: This study aims to involve qualitative research to inform the development of a mindfulness-based text messaging smoking cessation intervention for Vietnamese smokers. METHODS: A total of 10 focus groups were conducted with 71 Vietnamese male smokers aged between 18 and 65 years (5-9 participants per focus group). Overall, 5 focus groups were conducted with smokers who had the intention to quit (ie, preparation stage of change in the transtheoretical model), and 5 focus groups were conducted with smokers who did not have the intention to quit (contemplation or precontemplation stage). The focus groups were audio recorded, transcribed verbatim, and analyzed using NVivo 12 software (QSR International). RESULTS: The major themes included smoking triggers, barriers and facilitators for quitting, the perceptions of text messaging and mindfulness approaches for smoking cessation, and suggestions for the development of a text messaging-based smoking cessation program. Common smoking triggers included stress, difficulties concentrating, and fatigue. Frequently encountering other people who were smoking was a common barrier to quitting. However, participants indicated that concerns about the harmful effects of smoking on themselves and their wives and children, and encouragement from family members could motivate them to quit. The participants preferred diverse message content, including information about the consequences of smoking, encouragement to quit, and tips to cope with cravings. They suggested that text messages be clear and concise and use familiar language. Most smokers perceived that mindfulness training could be useful for smoking cessation. However, some suggested that videos or in-person training may also be needed to supplement teaching mindfulness through text messages. CONCLUSIONS: This study provides important insights to inform the development of a text messaging-based smoking cessation program that incorporates mindfulness for Vietnamese male smokers. The results could also be useful for informing similar programs in other low- and middle-income countries.

Willingness to use and pay for smoking cessation service via text-messaging among Vietnamese adult smokers, 2017.

OBJECTIVES: To examine willingness to use (WTU) and willingness to pay (WTP) for smoking cessation service via text-messaging among adult smokers in Vietnam in 2017; and to identify demographic and socioeconomic factors associated with the WTU and WTP. METHODS: A cross-sectional study of 602 adult smokers who had intention to quit in the next 12 months was conducted in Vietnam in 2017. Participants were provided with the information about a mobile health (mHealth) smoking cessation service via text-messaging and asked about their willingness to use and pay for it. The contigent valuation method was used to estimate the WTP for the service, using single bound question format. Discrete choice model was applied to estimate the average WTP and its associated factors. RESULTS: Seventy-two percent of smokers expressed willingness to use smoking cessation service via text-messaging if it were available. The average willingness to pay among those interested in using the mHealth cessation service was 82,000 VND (US$3.5). Smoking status and quit attempts in the last twelve months were associated with WTU, whereas age of the smokers and monthly income were significant predictors of WTP. CONCLUSION: A high proportion of Vietnamese smokers with intention to quit were interested in using smoking cessation services via text-messaging. The high level of smokers' willingness to use and pay for the text messaging cessation program indicates the mHealth methods could be a potential option for developing and delivering smoking cessation services in Vietnam.

mHealth Intervention is Effective in Creating Smoke-Free Homes for Newborns: A Randomized Controlled Trial Study in China.

Mobile-phone-based smoking cessation intervention has been shown to increase quitting among smokers. However, such intervention has not yet been applied to secondhand smoke (SHS) reduction programs that target smoking parents of newborns. This randomized controlled trial, undertaken in Changchun, China, assessed whether interventions that incorporate traditional and mobile-phone-based education will help create smoke-free homes for infants and increase quitting among fathers. The results showed that the abstinence rates of the fathers at 6 months (adjusted OR: 3.60, 95% CI: 1.41-9.25; p = 0.008) and 12 months (adjusted OR: 2.93, 95% CI: 1.24-6.94; p = 0.014) were both significantly increased in the intervention group compared to the control. Mothers of the newborns in the intervention group also reported reduced exposure to SHS at 12 months (adjusted OR: 0.53, 95% CI: 0.29-0.99; p = 0.046). The findings suggest that adding mHealth interventions to traditional face-to-face health counseling may be an effective way to increase male smoking cessation and reduce mother and newborn SHS exposure in the home.

Using technical assistance to strengthen tobacco control capacity: evaluation findings from the Tobacco Technical Assistance Consortium.

Immediately following the Master Settlement Agreement of 1998 and the corresponding growth of new and existing tobacco control programs, it became clear that tobacco prevention and control organizations required technical assistance to help them carry out their missions. The Tobacco Technical Assistance Consortium (TTAC) was established at the Rollins School of Public Health in 2001 to provide tailored technical assistance services to meet the needs of the expanded workforce and to build tobacco control capacity. To understand whether and how TTAC's technical assistance enhanced capacity, TTAC conducted an evaluation of its services through semi-structured telephone interviews with the primary contacts and one to two additional informants for each of 48 technical assistance services provided over an 18-month period. The majority of respondents reported they had increased knowledge and skills in tobacco control, strengthened leadership skills, developed or strengthened partnerships with other tobacco control organizations, and changed the way they practice tobacco control following the assistance. More modest improvements were noted in the areas of increased organizational support and policy change at the local or state level.

The role of cities in reducing smoking in China.

China is the epicenter of the global tobacco epidemic. China grows more tobacco, produces more cigarettes, makes more profits from tobacco and has more smokers than any other nation in the world. Approximately one million smokers in China die annually from diseases caused by smoking, and this estimate is expected to reach over two million by 2020. China cities have a unique opportunity and role to play in leading the tobacco control charge from the "bottom up". The Emory Global Health Institute-China Tobacco Control Partnership supported 17 cities to establish tobacco control programs aimed at changing social norms for tobacco use. Program assessments showed the Tobacco Free Cities grantees' progress in establishing tobacco control policies and raising public awareness through policies, programs and education activities have varied from modest to substantial. Lessons learned included the need for training and tailored technical support to build staff capacity and the importance of government and organizational support for tobacco control. Tobacco control, particularly in China, is complex, but the potential for significant public health impact is unparalleled. Cities have a critical role to play in changing social norms of tobacco use, and may be the driving force for social norm change related to tobacco use in China.

Tobacco smoking among government employees in six cities in China.

OBJECTIVE: Employer-based tobacco control interventions have been highly successful in developed countries, and, recently, Chinese officials announced a focus on quitting among government employees. However, there are few data offering estimates of smoking prevalence among government workers from developing nations. In this study, we investigate smoking behaviours among government workers in six Chinese cities stratified by educational attainment and occupational grade. DESIGN: Individual-level study of Chinese government employees. DATA SOURCES: Tobacco-Free Cities Initiative of China Tobacco Control Partnership. ANALYSIS: Employed adults aged 18-61 at government worksites in six cities were included (N=6176). Prevalence of current and former smoking across educational (postgraduate, graduate, high school, secondary school or less) and occupational (senior executives, mid-level managers, workers) groups were compared. RESULTS: Overall prevalence of male current smoking was 40.7% (95% CI 39.1% to 42.4%). Age-adjusted smoking prevalence was lowest among those with a postgraduate degree (26.2% (95% CI 21.0% to 31.4%)) compared with those with lower levels of education (college (39.8%; 37.7% to 41.8%); high school (51.0%; 95% CI 45.0% to 57.0%); secondary or less (45.1%; 95% CI 40.3% to 49.8%)). There was no evidence of an association between current smoking and occupational grade. Prevalence of smoking was low in women (1.5%). CONCLUSIONS: Smoking prevalence among male government employees at all levels of education was high and patterned by educational attainment. Government initiatives to address tobacco control among employees should consider targeted interventions for different educational levels.

Predictors of intention to smoke among junior high school students in Shanghai, China: an empirical test of the information-motivation-behavioral skills (IMB) model.

BACKGROUND: Adolescent smoking is a worldwide problem that is particularly severe in low- and middle-income countries. Many endogenous and environmental factors affect the intention to smoke, so a comprehensive model is needed to understand the significance and relationship of predictors. The study aimed to test the associations among information-motivation-behavioral skills (IMB) model constructs as predictors of intention to smoke in junior high school students in Shanghai, China. METHODS: We conducted a cross-sectional study of 16,500 junior high school students in Shanghai, China. Data on tobacco-related information, motivation, behavioral skills, and behaviors were collected from students. Structural equation model (SEM) was used to assess the IMB model. RESULTS: The mean age of participants was 13.8 years old (standard deviation = 1.02; range 11-17). The experimental smoking rate among junior high school students was 6.6% and 8.7% of the participants expected that they would be smokers in 5 years. The IMB model provided acceptable fit to the data (comparative fit index = 0.984, root mean square error of approximation = 0.04). Intention to smoke was predicted by behavioral skills (ß = 0.670, P < 0.001) and motivation (ß = 0.095, P<0.001) among junior high school students. CONCLUSION: The IMB model provides a good understanding of the predictors of intention to smoke and it suggests future interventions among junior high school students should focus on improving motivation and behavioral skills.

Social, psychological, and environmental-structural factors associated with tobacco experimentation among adolescents in Shanghai, China.

OBJECTIVE: To estimate the prevalence and social, psychological and environmental-structural determinants of tobacco experimentation among adolescents in Shanghai, China. METHODS: We conducted a cross-sectional study based on a two-stage cluster sample design by using the Chinese version of the Global Youth Tobacco Survey (GYTS) to investigate smoking behavior among 19,117 students from 41 junior and senior high schools in Shanghai, China. The association between potential factors and tobacco experimentation were assessed using complex samples procedure logistic regression. RESULTS: Of the 19,117 respondents, 10.5% (15.3% boys and 6.2% girls) reported the tobacco experimentation. The main social, psychological, and environmental-structural factors associated with tobacco experimentation were having close friends who smoke (AOR = 8.21; 95% CI: 6.49-10.39); one or both parents smoking (AOR 1.57; CI: 1.39-1.77); a poor school tobacco control environment (AOR 1.53; CI: 1.37-1.83); a high acceptance level of tobacco use (AOR 1.44; CI: 1.28-1.82); and a high level of media tobacco exposure (AOR 1.23; CI: 1.10-1.37). Peer smoking might contribute to smoking experimentation among girls (AOR 8.93; CI: 5.84-13.66) more so than among boys (AOR 7.79; CI: 5.97-9.94) and media tobacco exposure had no association with tobacco experimentation among female students. CONCLUSIONS: Social, psychological, and environmental factors are closely associated with tobacco experimentation among adolescents. Prevention programs aimed at reducing teen tobacco experimentation should be conducted at home and school with support by parents, peers and teachers. Our findings should prove useful for future development of intervention strategies among adolescents in Shanghai, China.