Interaction of smoking and being bullied on suicidal behaviors: a school-based cross-sectional survey in China

BACKGROUND@#Suicidal behaviors are seriously social issues among adolescents in the world. Exposed to smoking and being bullied are risk factors of suicidal behaviors. The present study was aimed to examine the interaction of smoking and being bullied on suicidal behaviors among Chinese adolescents.@*METHODS@#A total of 18,900 students were involved in the questionnaire study, in four cities of China from November 2017 to January 2018. Suicidal behaviors, smoking, and being bullied were measured by self-reported validated instruments. Chi-square tests and logistic regression were used to analyze the associations of suicidal ideation (SI)/suicidal plan (SP)/suicidal attempt (SA), smoking, and being bullied.@*RESULTS@#The prevalence of smoking, being bullied, SI/SP/SA, were 3.1%, 20.6%, 26.4%, 13.2%, and 5.2% respectively. Interaction analysis indicated that being bullied was associated with a greater increase in the likelihood of suicidal behaviors for adolescents with smoking than for those without smoking.@*CONCLUSIONS@#These finding suggest that smoking exacerbates the association between being bullied and suicidal behaviors. Future research should explore how and why smoking appears to more bully-victims than for those without smoking and how to mitigate it.

Interaction of health literacy and second-hand smoke exposure on psychopathological symptoms of middle school students / 中华预防医学杂志

Objective@#To explore the interaction of health literacy and second-hand smoke exposure on psychopathological symptoms of middle school students.@*Methods@#From November 2015 to January 2016, 22 628 middle school students from Shenyang of Liaoning Province, Bengbu of Anhui Province, Xinxiang of Henan Province, Ulanqab of Inner Mongolia Autonomous Region, Chongqing Municipality, and Yangjiang of Guangdong Province were enrolled by using the multi-stage cluster convenience sampling method. A questionnaire was used to collect the data including demographic information, health literacy, second-hand smoke exposure, and psychopathological symptoms. A multivariate logistic regression model was used to analyze the interaction of health literacy and second-hand smoke exposure on psychopathological symptoms of middle school students.@*Results@#The age of students was (15.36±1.79) years old, of which 10 990 were boys, accounting for 48.6% of total students. The detection rate of psychopathological symptoms was 29.1% (6 581/22 628). The detection rate of psychopathological symptoms in those who were exposed to second-hand smoke was 38.1% (2 401/6 304), which was higher than that in the non-second-hand smoke exposure group [25.6% (4 180/16 324)] (P<0.001). The OR (95%CI) of the interaction between medium and low levels of overall health literacy, low level of interpersonal dimension of health literacy and second-hand smoke exposure was 1.19 (1.15-1.24), 2.00 (1.92-2.10) and 1.59 (1.52-1.66), respectively.@*Conclusion@#There was a positive interaction between middle and low levels of overall health literacy, low level of interpersonal dimension of health literacy and second-hand smoke exposure on psychopathological symptoms of middle school students.

Association of health literacy and smoking behaviors among middle school students in six cities of China / 中华预防医学杂志

Objective@#To explore the association between the health literacy (HL) and smoking behaviors in middle school students.@*Methods@#From November 2015 to January 2016, middle school students in Shenyang City of Liaoning Province, Bengbu City of Anhui Province, Xinxiang City of Henan Province, Ulanqab City of Inner Mongolia Autonomous Region, Chongqing City and Yangjiang City of Guangdong Province were enrolled by using a multistage stratified cluster sampling method. A total of 23 137 questionnaires were issued and 22 628 questionnaires were valid. A questionnaire survey was conducted to collect demographic information, HL and smoking behaviors. The low, middle, and high-level group were classified according to the tertile of HL score. A multiple logistic regression model was conducted to explore the association between the HL and smoking behaviors.@*Results@#The age of subjects was (15.4±1.8) years old, and HL score was (104.1±18.7) points. The proportion of former smoking, recent smoking and passive smoking was 9.2% (2 071), 2.8% (635) and 27.9% (6 304), respectively. The proportion of former smokers who tried to quit smoking was 50.1% (1 037/2 071). Compared to the high-level HL, the low-level HL increased the risk of former smoking [OR (95%CI): 1.85 (1.61−2.13)], recent smoking [OR (95%CI): 1.68 (1.33−2.14)] and passive smoking [OR (95%CI): 1.34 (1.23−1.46)], and decreased the likelihood of smoking cessation [OR (95%CI): 0.70 (0.53−0.92)], after adjusting for the gender, school type, registered residence, household structure, accommodation type, educational level of patients, and self-reported family economic status.@*Conclusion@#The HL of middle school students was related to their smoking behaviors.

Correlation of health literacy and mobile phone use dependence with psychopathological symptoms in middle school students / 中华预防医学杂志

Objective@#To explore the correlation of health literacy and mobile phone use dependence with psychopathological symptoms in middle school students.@*Methods@#22 628 middle school students in Shenyang, Bengbu, Xinxiang, Ulanqab, Chongqing and Yangjiang were enrolled by multistage cluster sampling method from November 2015 to January 2016. Chinese Adolescent Interactive Health Literacy Questionnaire (CAIHLQ), Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU) and Multidimensional Sub-health Questionnaire of Adolescents (MSQA) were applied to acquire basic characteristics, health literacy, mobile phone use dependence and psychopathological symptoms of subjects. Subjects were classified into three groups, low level (<P25), medium level (P25-P75) and high level (>P75), according to the percentile of the questionnaire score. Multivariate logistic regression model was used to analyze the correlation of health literacy, mobile phone with psychopathological symptoms.@*Results@#The students were (15.4±1.8) years old with 10 990 boys (48.6%). The score of health literacy of students were (104.1±18.7) points. The rate of mobile phone use dependence was 25.4% (5 752/22 628) and the rate of psychopathological symptoms was 29.1% (6 581/22 628). Compared with high health literacy level, medium and low health literacy levels were related to psychopathological symptoms, with OR (95%CI) about 2.30 (2.10-2.52) and 5.40 (4.89-5.97), respectively. Compared with mobile phone use independence, mobile phone use dependence was related to psychopathological symptoms, with OR (95%CI) about 3.60(3.37-3.85). The highest rate of psychopathological symptoms occurred in students with mobile phone use dependence and low health literacy level [68.0% (1 345/1 977)], with OR (95%CI) about 19.59 (17.07-22.48).@*Conclusion@#Health literacy and mobile phone use dependence are related factors of psychopathological symptoms in middle school students.

Interactive effects between health literacy and mobile phone dependence as well as its relation with unintentional injuries in middle school students / 中华流行病学杂志

Objective To investigate the interaction between health literacy,mobile phone dependence and unintentional injuries in middle school students,and to provide guidance for prevention on unintentional injuries in adolescents.Methods From November 2015 to January 2016,a questionnaire survey was conducted among 22 628 middle school students in Shenyang of Liaoning province,Bengbu of Anhui province,Xinxiang of Henan province,Ulanqab of Inner Mongolia Autonomous Region,Chongqing and Yangjiang of Guangdong province.Chinese Adolescent Interactive Health Literacy Questionnaire (CAIHLQ),Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU),and Unintentional Injuries Assessment Scale and demographic variables were used to measure the health literacy,mobile phone dependence and unintentional injuries among the Chinese middle school students.Results The detection rates of mobile phone dependence and unintentional injuries were 25.4％ and 46.7％,respectively.The rates of unintentional injuries of middle school students with mobile phone dependence and with low,medium and high health literacy were 53.6％,44.4％ and 48.8％,48.1％,41.7％.Factors as mobile phone dependence,low and middle health literacy were positively related to unintentional injuries (OR=1.452,1.196,1.364).However,the multiplicative interaction between mobile phone dependence and health literacy on unintentional injuries was noticed significant (OR=1.217,95％CI:1.041-1.422).Conclusions Our results showed that the prevalence of unintentional injuries was relatively high in middle school students.Health literacy and mobile phone dependence seemed related to unintentional injuries.Interaction between health literacy and mobile phone dependence on unintentional injuries appeared significant.

Interactive effects between health literacy and mobile phone dependence as well as its relation with unintentional injuries in middle school students / 中华流行病学杂志

Objective To investigate the interaction between health literacy,mobile phone dependence and unintentional injuries in middle school students,and to provide guidance for prevention on unintentional injuries in adolescents.Methods From November 2015 to January 2016,a questionnaire survey was conducted among 22 628 middle school students in Shenyang of Liaoning province,Bengbu of Anhui province,Xinxiang of Henan province,Ulanqab of Inner Mongolia Autonomous Region,Chongqing and Yangjiang of Guangdong province.Chinese Adolescent Interactive Health Literacy Questionnaire (CAIHLQ),Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU),and Unintentional Injuries Assessment Scale and demographic variables were used to measure the health literacy,mobile phone dependence and unintentional injuries among the Chinese middle school students.Results The detection rates of mobile phone dependence and unintentional injuries were 25.4％ and 46.7％,respectively.The rates of unintentional injuries of middle school students with mobile phone dependence and with low,medium and high health literacy were 53.6％,44.4％ and 48.8％,48.1％,41.7％.Factors as mobile phone dependence,low and middle health literacy were positively related to unintentional injuries (OR=1.452,1.196,1.364).However,the multiplicative interaction between mobile phone dependence and health literacy on unintentional injuries was noticed significant (OR=1.217,95％CI:1.041-1.422).Conclusions Our results showed that the prevalence of unintentional injuries was relatively high in middle school students.Health literacy and mobile phone dependence seemed related to unintentional injuries.Interaction between health literacy and mobile phone dependence on unintentional injuries appeared significant.