Family and personal protective factors moderate the effects of adversity and negative disposition on smoking among Chinese adolescents

BACKGROUND. Tobacco use among Chinese adolescents is increasing at approximately 80,000 new smokers per day. Assessing the causes for initiating tobacco use in China will be important in developing effective interventions and policies to stem rising prevalence rates. METHODS. This study tested constructs from Resilience Theory in a sample of 602 adolescents, from a population-based registry in Qingdao, China. Surveys assessed lifetime smoking, prior adversity (negative family-, school-, peer-, and violence-related events), disposition (i.e., depression, anxiety, hostility, physical aggression), and protective factors (i.e., family cohesion, family adaptability, parental monitoring, positive affect). Multiple logistic regression and moderation analyses were conducted to test correlates of lifetime smoking. RESULTS. Results revealed that negative school and family-related events were significantly associated with increased smoking in females. Overall, some family factors were found to be protective against smoking, depending on the level of prior adversity or negative disposition reported. For example, adolescents with a low level of family cohesion but a high level of negative family-related events had a much greater odds for smoking than those who reported a low level of negative family-related events. However, for adolescents with a high level of family cohesion, the odds of smoking were low regardless of the level of family-related adversity. DISCUSSION. Findings suggest that resilience constructs may be more relevant to the cultural and social structure for female rather than male adolescents in China. Thus, tobacco control policies should be designed to reach males and females based on their differential motivations for tobacco use.