Increased Risk of Cigarette Smoking Among Immigrant Children and Girls in Hong Kong: An Emerging Public Health Issue
Despite global progress in tobacco control, data are needed for subgroups with increased risk of tobacco use for more effective smoking prevention. Survey data from a random sample of 6,486 youth in grades 7, 8 and 9 were derived from the project Chinese Student Health Survey. Prevalence and hazards of smoking onset were compared by gender and immigrant status. Mediation analysis was used to assess factors that may mediate the impact of immigrant status on smoking. Immigrant students had a much higher risk of hazards of smoking initiation than non-immigrant students. Parental monitoring and parental smoking significantly mediated the effect of immigrant status on early smoking onset. In addition, gender differences in the prevalence of smoking and hazards of smoking onset in our study were smaller than those reported by others targeting non-Hong Kong Chinese youth. Findings of this study imply that immigrant children and girls in Hong Kong are at increased risk to tobacco use. Special attention should be paid to these subgroups for prevention intervention. Prevention intervention for immigrant children should address parental smoking and parental monitoring. Reduced gender difference in smoking among Hong Kong youth suggests an emerging trend for more Chinese girls on the Mainland to smoke along with the rapid socioeconomic development.
KeywordsImmigrants Gender differences Adolescent smoking Hong Kong
This analysis is one of the research outputs from the project of the Action Health, which is a part of the project Chinese Student Health Survey. Data collection for this study was supported by the Centraline Charity Fund Limited.
Conflict of interest
All authors have no conflict of interests associated with the funding agency.
- 3.Shafey, O., Dolwick, S., & Guindon, G. E. (2003). Tobacco control country profiles (2nd ed.). Atlanta, GA: American Cancer Society.Google Scholar
- 4.World Health Organization. (2009). WHO report on the global tobacco epidemic, 2009: Implementing smoke-free environments. Geneva: WHO Press, World Health Organization. Available from http://www.who.int/tobacco/mpower/2009/gtcr_download/en/index.html. Accessed December 22, 2010.
- 7.Chen, X. G., Unger, J. B., Palmer, P., Weiner, M. D., Johnson, C. A., Wong, M. M., et al. (2002). Prior cigarette smoking initiation predicting current alcohol use: Evidence for a gateway drug effect among California adolescents from eleven ethnic groups. Addictive Behaviors, 27, 799–817.PubMedCrossRefGoogle Scholar
- 8.Schneider, S., Mohnen, S. M., & Pust, S. (2008). The average age of smoking onset in Germany—Trends and correlates. Paper presented at the International Journal of Public Health.Google Scholar
- 9.Warren, C. W., Jones, N. R., Peruga, A., Chauvin, J., Baptiste, J.-P., de Silva, V. C., et al. (2008). Global youth tobacco surveillance, 2000–2007. Morbidity and Mortality Weekly Report, 57, 1–32.Google Scholar
- 13.Booker, C. L., Unger, J. B., Azen, S. P., Baezconde-Garbanati, L., Lickel, B., & Johnson, C. A. (2008). A longitudinal analysis of stressful life events, smoking behaviors, and gender differences in a multicultural sample of adolescents. Substance Use and Misuse, 43, 1509–1531.CrossRefGoogle Scholar
- 15.Chen, X. G., Stanton, B., Fang, X. Y., Li, X. M., Lin, D. H., Zhang, J. T., et al. (2006). Perceived smoking norms, socioenvironmental factors, personal attitudes and adolescent smoking in China: A mediation analysis with longitudinal data. Journal of Adolescent Health, 38, 359–368.PubMedCrossRefGoogle Scholar
- 24.Census and Statistics Department of Hong Kong. (2007). 2006 population by-census thematic report: Persons from the Mainland having resided in Hong Kong for less than 7 years. Hong Kong: Census and Statistics Department, Hong Kong Government.Google Scholar
- 25.Ma, Z. D., Lin, G., & Zhang, F. (2010). Examining cross-border marriage in Hong Kong: 1998–2005. In W. S. Yang & M. C. W. Lu (Eds.), Asian cross-border marriage migration: Demographic patterns and social issues. Amsterdam: Amsterdam University Press.Google Scholar
- 26.Yau, S. (2006). Family relationships: Cross-border marriage between Hong Kong and Mainland China residents. Journal of Youth Studies, 9, 57–64.Google Scholar
- 27.Lohéac, Y., & Page, L. (2006). Princeton or prison? A joint analysis of school achievement and crime rate for children or immigrants. Paper presented at the XX annual conference of the European Society for population economics held on June 22–24, 2006, Verona, Italy.Google Scholar
- 28.Molcho, M., Kelly, C., Gavin, A., & Nic Gabhainn, S. (2008). Inequalities in health among school-aged children in Ireland. Dublin: Department of Health and Children.Google Scholar
- 29.Census and Statistics Department of Hong Kong. (2006). Needs of persons from the Mainland having resided in Hong Kong for less than 7 years in thematic household survey report no. 28, Census and Statistics Department, Hong Kong Government, Hong Kong.Google Scholar
- 30.Siu, H. F. (2009). ‘Hong Kongers’ and ‘new immigrants’, Hong Kong Journal. Available at http://www.hkjournal.org/archive/2009_summer/4.htm. Accessed on January 4, 2011.
- 34.Singleton, R., & Straits, B. C. (2010). Sampling. In R. Singleton & B. C. Straits (Eds.), Approaches to social research (5th ed.). Oxford: Oxford University Press.Google Scholar
- 36.Centers for Disease Control and Prevention & World Health Organization. Global school-based student health survey (GSHS). Atlanta and Geneva: Centers for Disease Control and Prevention, and World Health Organization. Available from http://www.cdc.gov/gshs/questionnaire/index.htm. Accessed January 3, 2011.
- 37.Cox, D. R., & Oaks, D. (1984). Analysis of survival data. London: Chapman and Hall.Google Scholar
- 38.Kalbfleisch, J. D., & Prentice, R. L. (1980). The statistical analysis of failure time data. New York: Wiley.Google Scholar
- 40.Samet, J. M., & Yoon, S. Y. (2010). Gender, women, and the tobacco epidemic. Geneva: WHO Press, World Health Organization.Google Scholar
- 43.Hong Kong Department of Health, Center for Health Protection. (2010). Smoking: A women’s health perspective. Non-Communicable Diseases Watch, 3, 1–4.Google Scholar