Health Behaviors and Protective factors of School Students Aged Years Old in Four Cities of China

Transcription

1 Studnts Halth Bhaviors in China Tian t al. Halth Bhaviors and Protctiv factors of School Studnts Agd Yars Old in Four Citis of China Bnchun Tian, MD 1 ; Wi Zhang, BC 1 ; Ling Qian, PhD 1 ; Shuhong Lv, MPH 1 ; Xiangyang Tian, MPH 2 ; Guanglian Xiong, MD 3 ; Wihong Yan, BC 4 ; Xinwi Zhang, BC 5 ; Laura K Kann, PhD 6 ; Lann Rily; PhD 7 Authors 1 ar affiilitatd with th Institut for Halth Education of China CDC. Author 2 is affilitatd with th CDC of Bijing City. Author 3 is affiliatd with th Public Halth School of Huazhong Univrsity for Scintifictchniqu. Author 4 is affiliatd with th CDC of Xinjiang Provinc. Author 5 is affiliatd with th CDC of Zhjiang Provinc. Author 6 is affiliatd with th US CDC. Author 7 is affiliatd with th WHO. Contact author: Tian Bnchun, Institut for Halth Education of China CDC, Bijing, ; Phon: ; doctor_tian@126.com Submittd Fbruary 7, 2006; Rvisd and Accptd April 3, 2007 Abstract This papr prsnts baslin data on halth bhaviors and protctiv factors among junior middl school studnts agd 1315 yars old in China for th purpos of dvloping prioritis, stablishing programs and policis for school halth and youth halth and also stablishing trnds in th prvalnc of ths bhaviors. Th 2003 CHINA GSHS mployd a twostag clustr sampl dsign to produc a rprsntativ sampl of junior middl school studnts in Grads 1 4 in Bijing, Hangzhou, Wuhan and Urumchi. A World Halth Organization (WHO) dvlopd survy was usd to collct th data among 7,393 studnts. Rsults showd that 14.6% of studnts drank at last on alcohol drink on on or mor of th past 30 days, 7.1% wr at risk of bcoming ovrwight, 25.9% did not hav habit of washing hands bfor ating, 17.8% sriously considrd attmpting suicid during th past 12 months, and only 12.2% of studnts wr physically activ 7 days during a typical wk for a total of at last 60 minuts pr day. Additionally, 6% of studnts missd classs or school without prmission on on or mor of th past 30 days, 48.1% of studnts had bn taught about HIV or AIDS during th school yar, 6.2% of studnts smokd cigartts during th past 30 days, 18.4% of studnts wr involvd in a physical fight and 20.6% wr sriously injurd during th past 12 months. Finally, 93% of studnts wr taught how to prvnt Suddn Acut Rspiratory Syndrom (SARS) during th past school yar. Rsults also indicatd thr wr many diffrnt problms on halth bhaviors and protctiv factors of school studnts among four citis. This was th first Global Schoolbasd Studnt Halth Survy (GSHS) conductd in China and it is xpctd th rsults will b hlpful in providing data for program dvlopmnt and making policis concrning school halth and halth ducation. Additionally, th data will b hlpful for intrnational comparisons btwn countris. Ky words: Halthy bhaviors; Protctiv factors; Halth ducation; Junior middl school studnts Intrnational Elctronic Journal of Halth Education, 2007; 10:3559 1

2 Studnts Halth Bhaviors in China Tian t al. Introduction In 2001, th World Halth Organization (WHO) in collaboration with UNAIDS, UNESCO, and UNICEF, and with tchnical assistanc from th US Cntrs for Disas Control and Prvntion (CDC), initiatd th dvlopmnt of th Global Studnt Halth Survy (GSHS). Sinc 2003, Ministris of Halth and Education around th world hav bn using th GSHS to priodically monitor th prvalnc of ky halth risk bhaviors and protctiv factors among studnts to hlp dvloping prioritis, stablishing programs, and advocating for rsourcs for school halth and youth halth programs and policis. 1 To dat, 35 countris hav compltd th first GSHS. 2 Th China GSHS is a schoolbasd survy conductd primarily among studnts agd 1315 yars. It masurs bhaviors and protctiv factors rlatd to th lading causs of mortality and morbidity among youth and adults in China. Th bhaviors assssd in th survy includd alcohol and othr drug us, ditary bhaviors, hygin rlatd bhaviors, mntal halth rlatd bhaviors, physical activity. In addition, protctiv factors, HIVrlatd knowldg, tobacco us, violnc and unintntional injury and qustions rlatd to SARS wr also includd. Alcohol and Othr Drug Us Worldwid, alcohol us causs 3% of daths (1.8 million) annually, which is qual to 4% of th global disas burdn. 3 Vry littl data rlatd to alcohol and drug us is availabl in China, particularly among young adults and adolscnts. Data from this survy will b vry hlpful for futur planning and policy making. Ditary Bhaviors During adolscnc, ovrwight is associatd with hyprlipidmia, hyprtnsion, abnormal glucos tolranc, and advrs psychological and social consquncs. Ovrwight acquird during childhood or adolscnc may prsist into adulthood and incras risk latr in lif for coronary hart disas, diabts, gallbladdr disas, som typs of cancr, and ostoarthritis of th wightbaring joints. Nutritional dficincis as a rsult of food inscurity (protinnrgy malnutrition, iron, Vitamin A, and iodin dficincy) affct school participation and larning. 4 It is important that ditary bhaviors b includd in th survy. Hygin Dntal caris and othr oral disas can affct a numbr of halth ffcts including ability to at, apparanc, communication, ovrall halth status, and ability to larn. In addition, diarrha disass kill 2 to 3 million childrn in dvloping countris vry yar. Handwashing with soap alon could cut daths in half. Rmoving xcrta and claning hands with soap aftr contact with fcal matrials prvnts transmission of th bactria and protozoa that caus diarrha disass. Thrfor, it is important that data on hygin rlatd bhaviors ar assssd in th survy. Mntal Halth Anxity disordrs, dprssion and mood disordrs, and bhavioral and cognitiv disordrs ar among th most common mntal halth problms among adolscnts in th world. Evry country and cultur has childrn and adolscnts struggling with mntal halth problms. Most of ths young popl suffr ndlssly, unabl to accss appropriat rsourcs for rcognition, support, and tratmnt. Ignord, ths young popl ar at high risk for abus and nglct, suicid, alcohol and othr drug us, school failur, violnt and criminal activitis, mntal illnss in adulthood, and halthjopardizing impulsiv bhaviors. Th assssmnt of mntal halth rlatd bhaviors can b hlpful in planning and policy making for adolscnts in China. Physical Activity Participating in adquat physical activity throughout th lif span and maintaining normal wight ar th most ffctiv ways of prvnting many chronic disass, including cardiovascular disas and diabts. 5 Participating in adquat physical activity also hlps build and maintain halthy bons and muscls, control wight, build lan muscl, rduc fat, rduc flings of dprssion and anxity, and promot psychological wllbing. 6 Lik othr halth bhaviors, physical activity is includd to hlp providing data for halth profssionals and policy makr in China. Protctiv Factors For most adolscnts, school is th most important stting outsid of th family. School attndanc is rlatd to th prvalnc of svral halth risk bhaviors including violnc and sxual risk 7, 8, 9 bhaviors. It is hlpful to includ this typ of bhavior and othr protctiv bhaviors in th survy. HIVRlatd Knowldg Sinc th pidmic bgan, mor than 60 million popl hav bn infctd with HIV. Mor than half of thos nwly infctd with HIV today ar btwn Intrnational Elctronic Journal of Halth Education, 2007; 10:3559 2

3 Studnts Halth Bhaviors in China Tian t al. 15 and 24 yars old. Each day, narly 6,000 bcom infctd. 10 HIV/ AIDS hav bcom an important halth thrat for adolscnts in China. Thrfor, it is important th survy also includs HIVrlatd knowldg. Tobacco Us About on in thr or 1.1 billion popl worldwid smok. Among ths, about 80% liv in low and middlincom communitis. 11 By 2020, th tobacco pidmic is xpctd to kill mor popl than any singl disas. Most popl who us tobacco initiat us prior to ag 18. Exposur to tobacco smok in th nvironmnt can aggravat allrgis and incras th svrity of symptoms in childrn and adolscnts with asthma and hart disas; it is also associatd with lung cancr. 12 This itm is includd in th survy to provid data for govrnmnt to plan and implmnt tobacco prvntion program. Violnc and Unintntional Injury Injuris ar a major caus of dath and disability among young childrn. 13, 14 Each yar, 750,000 childrn di from injuris. Anothr 400 million childrn ar hurt sriously. In 2000, stimatd 190,000 youth homicids (9.2 pr 100,000 populations) occurrd globally. For vry youth homicid, approximatly 20 to 40 victims of nonfatal youth violnc rciv hospital tratmnt. Many injuris lad to prmannt disability and brain damag. Th data on violnc and unintntional injury is ndd for planning school halth and halth promotion programs as wll. Qustions Rlatd to SARS (Suddn Acut Rspiratory Syndrom) Adolscnts ar vulnrabl to th attack of th suddn acut rspiratory syndrom (SARS). To hlp prvnt th rcurrnc of th SARS in China, w ar intrstd in assssing th knowldg rlatd to SARS among adolscnts. This information will b vry hlpful for planning ducation and prvntion campaign in China. Th purpos of th GSHS was to provid data on halth bhaviors and protctiv factors among studnts to hlp dvlop prioritis, stablish programs, and advocat for rsourcs for school halth and youth halth programs and policis in China. Additionally, rsults of th China GSHS could also allow intrnational agncis and othr countris to mak comparisons rgarding th prvalnc of halth bhaviors and protctiv factors and to stablish trnds in th prvalnc of ths bhaviors for valuation of school halth and youth halth promotion programs. This rport prsnts rsults from th first GSHS conductd in four citis of China Bijing, Hangzhou, Wuhan and Urumchi by th Institut for Halth Education, China CDC during Sptmbr Novmbr in Ths four citis wr slctd basd on th gographical considration, conomical dvlopmnt status, thnicitis and population siz. Bijing rprsnts a dvlopd larg city locatd in th nothrn China with 15 million populations. Wuhan rprsnts a modratly dvlopd midsiz city in th cntral China. Urumchi rprsnts a dvloping city in th northwstrn China with many minority thnic groups. Hangzhou is a dvlopd midsiz city locatd in th southast China. Mthods Sampling Th 2003 CHINA GSHS mployd a twostag clustr sampl dsign to produc a rprsntativ sampl of junior middl school studnts in grads 1 4. Th firststag sampling fram consistd of all junior middl schools. Schools wr slctd with probability proportional to school nrollmnt siz in four slctd citis Bijing, Hangzhou, Wuhan and Urumchi. Schools with mor 1315 yar old studnts ar mor likly to b slctd to participat than schools with fwr 1315 yar olds. Twnty fiv schools in ach city wr slctd to participat in th China GSHS. Th scond stag of sampling consistd of randomly slctd intact classrooms (using a random chart) from ach school to participat. All classrooms in ach slctd school wr includd in th sampling fram. All studnts in th sampld classrooms wr ligibl to participat in th GSHS. For th 2003 China GSHS availabl qustionnairs wr compltd in 100 schools in four sits, among thm thr ar 7,393 studnts agd 1315 yar old, and this rport dscribs rsults from 1315 yar olds only. Oldr and youngr studnts wr xcludd from analysis. Th school rspons rat was 100%, th studnt rspons rat was 98%, and th ovrall rspons rat was 98%. Th data st was cland and ditd for inconsistncis. Missing data wr not statistically imputd. GSHS data ar rprsntativ of all studnts attnding grads 1 4 of junior middl school in four citis. S Tabl 1 for th dmographic information including distribution of ag, gndr, grads, and hight and wight. Survy Administration Intrnational Elctronic Journal of Halth Education, 2007; 10:3559 3

4 Studnts Halth Bhaviors in China Tian t al. Survy administration occurrd from Sp 1 st 2003 to Nov 23 rd Survy procdurs wr dsignd to protct studnt privacy by allowing for anonymous and voluntary participation. Studnts compltd th slfadministrd qustionnair during on classroom priod and rcordd thir rsponss dirctly on a computrscanabl answr sht. GSHS Qustionnair Th CHINA GSHS qustionnair containd 83 qustions addrssing th following tn moduls: Alcohol and othr drug us, Ditary bhaviors, Hygin, Mntal halth, Physical activity, Protctiv factors, Sxual bhaviors, Tobacco us, Violnc and unintntional injury, and Qustions about SARS. Th dvlopmnt of GSHS was basd on th YRBS qustionnair dvlopd by CDC in US. Th validity and rliability of th instrumnt is prsntd basd on th YRBS qustionnair. CDC has conductd two tstrtst rliability studis of th national YRBS qustionnair that is th prcdnt of GSHS qustionnair, on in 1992 and on in In th first study, th 1991 vrsion of th qustionnair was administrd to a convninc sampl of 1,679 studnts in grads 712. Th qustionnair was administrd on two occasions, 14 days apart. Approximatly thr fourths of th itms wr ratd as having a substantial or highr rliability (kappa = 61%100%), and no statistically significant diffrncs wr obsrvd btwn th prvalnc stimats for th first and scond tims that th qustionnair was administrd. Th rsponss of 7th grad studnts wr lss consistnt than thos of studnts in highr grads, indicating that th qustionnair is bst suitd for studnts in grads >8. In th scond study, th 1999 vrsion of th qustionnair was administrd to a convninc sampl of 4,619 high school studnts. Th qustionnair was administrd on two occasions, approximatly 2 wks apart. Approximatly on of fiv itms (22%) had significantly diffrnt prvalnc stimats for th first and scond tims that th qustionnair was administrd. Tn itms (14%) had both kappa <61% and significantly diffrnt tim1 and tim2 prvalnc stimats, indicating that th rliability of ths itms is qustionabl. Crtain itms (.g., an itm rlatd to injury during physical activity) hav bn rvisd or dltd from latr vrsions of th qustionnair. In 2000, CDC also conductd a study to assss th validity of th two YRBS qustions rgarding slfrportd hight and wight. In that study, 2,965 high school studnts compltd th 1999 vrsion of th YRBS qustionnair on two occasions approximatly 2 wks apart. Aftr complting th qustionnair, th studnts wr wighd and had thir hight masurd. Slfrportd hight, wight, and BMI calculatd from ths valus wr substantially rliabl, but on avrag, studnts in th study ovr rportd thir hight by 2.7 inchs and undrrportd thir wight by 3.5 pounds, which indicats that YRBSS probably undrstimats th prvalnc of ovrwight in adolscnt populations. Statistics Analysis All answr shts wr snt to US CDC, scannd into computr and built rlvant data fils. Data is analyzd by Epiinfo Softwar that taks into considration of th complx sampl dsign to comput prvalnc stimats and 95% confidnc intrvals. Th significanc of th diffrncs was dtrmind if 95% confidnc intrvals of prvalnc rat did not ovrlap btwn two cits or two variabls. Rsults Alcohol and Othr Drug Us Th ovrall prvalnc of currnt alcohol us among all studnts (i.., drank at last on drink containing alcohol on on or mor of th past 30 days) was 14.6%. Fiv prcnt of th studnts indicatd thy obtaind th alcohol thy drank by buying it in a stor, shop, or from a strt vndor during th past 30 days. (S Tabl 2) Ovrall, 10.8% of studnts got drunk on or mor tims during thir liftim. Also, about 5.4% of studnts vr had a hangovr, flt sick, got into troubl, missd school, or got into fights on or mor tims as a rsult of drinking alcohol during thir lif. Th liftim drug us among studnts in th survy was 1.6%. Ditary Bhaviors As indicatd in Tabl 3, 7.1% studnts wr at risk for bcoming ovrwight (at or abov th 85th prcntil, but blow th 95th prcntil for body mass indx by ag and sx) and 3.0% wr ovrwight (i.., at or abov th 95th prcntil for body mass indx by ag and sx). Ovrall, 2.3% of studnts wnt hungry most of th tim or always bcaus thr was not nough food in thir hom during th past 30 days. On th othr hand, 63.9% of studnts usually at fruit on or mor tims pr day during th past 30 days. In addition, Intrnational Elctronic Journal of Halth Education, 2007; 10:3559 4

5 Studnts Halth Bhaviors in China Tian t al. 25.1% of studnts usually at fruits and vgtabls fiv or mor tims pr day during th past 30 days. On th prcption of body wight, 32.3% of studnts dscribd thir wight as slightly ovrwight or vry ovrwight. Mal studnts (61.2%) wr lss likly than fmal studnts (66.6%) to dscrib thir wight as slightly ovrwight or vry ovrwight. Ovrall, 78.9% of studnts at brakfast most of tim or always during th past 30 days. On th othr hand, 17.4% of studnts indicatd thy usually drink carbonatd soft drinks, such as Cok, Ppsi, or Sprit two or mor tims pr day during th past 30 days, and mal studnts (20.1%) wr mor likly than fmal studnts (14.6%) to consum carbonatd soft drinks. HyginRlatd Bhaviors Tabl 4 prsnts data rlatd to hyginic bhaviors. Ovrall, 2.4% of studnts did not clan or brush thir tth during th past 30 days. Also, 25.9% of studnts did not hav a habit of washing hands bfor ating or aftr using toilt or latrins. Furthrmor, 11.4% of studnts nvr or rarly usd soap whn washing thir hands during th past 30 days. Mntal Halth Issus On th mntal halth rlatd issus, Tabl 5 indicatd that an avrag of 7.4% of studnts flt lonly most of th tim or always during th past 12 months and 7.4% of studnts had no clos frinds. An avrag of 4.3% of studnts survyd indicatd that thy flt so worrid about somthing that prvntd thm from slping at night most of th tim or always during th past 12 months. Ovrall, 20.7% of studnts flt so sad or hoplss almost vry day for two wks or mor in a row that thy stoppd doing thir usual activitis during th past 12 months. Rsults also indicatd that 17.8% of studnts sriously considrd attmpting suicid during th past 12 months. Ovrall, 8.4% of studnts mad a plan about how thy would attmpt suicid during th past 12 months. Physical Activity As shown in Tabl 6, only 12.2% of studnts in ths 4 citis wr physically activ 7 days during a typical or usual wk for a total of at last 60 minuts pr day. Ovrall, 22.0% of studnts spnt thr or mor hours pr day doing sitting activitis during a typical or usual day and 20.9% of studnts did not walk or bicycl to and from school during th past 7 days. Also, on an avrag, 55.4% of studnts usually took lss than 30 minuts to gt to and from school ach day during th past 7 days. Protctiv Bhaviors Tabl 7 prsnts data rlatd to protctiv bhavior. Ovrall, 6.0% of studnts missd classs or school without prmission on on or mor of th past 30 days and mal studnts (7.2%) wr significantly mor likly than fmal studnts (4.9%) to miss classs or school without prmission. On an avrag, 47.8% of studnts rportd that most of th studnts in thir school wr kind and hlpful most of th tim or always during th past 30 days. Mal studnts (41.6%) wr lss likly than fmal studnts (53.8%) to rport that most of th studnts in thir school wr kind and hlpful most of th tim or always during th past 30 days. About 35.7% of studnts rportd that thir parnts or guardians chckd to s if thir homwork was don most of th tim or always during th past 30 days. Also, 35.0% of studnts rportd thir parnts or guardians undrstood thir problms and worris most of th tim or always during th past 30 days and 44.0% of studnts rportd thir parnts or guardians rally know what thy wr doing with thir fr tim most of th tim or always during th past 30 days. HIVRlatd Knowldg As indicatd in Tabl 8, 96.5% of studnts in th 4 citis had vr hard of HIV or th disas calld AIDS and 48.1% of studnts had bn taught in any of thir classs about HIV or AIDS during th school yar. On an avrag, 37.4% of studnts had bn taught in any of thir classs how to avoid HIV or AIDS during this school yar. On th othr hand, 46.6% of studnts vr talkd about HIV or AIDS with thir parnts or guardians. Tobacco Us Prvalnc of tobacco us among studnts in th four citis is prsntd in Tabl 9. Ovrall, 6.2% of studnts smokd cigartts on on or mor days during th past 30 days. Among studnts who smokd cigartts during th past 30 days, 27.2% trid thir first cigartt at ag 9 or youngr. Ovrall, 1.5% of studnts usd any othr form of tobacco on on or mor days during th past 30 days. Among studnts who smokd cigartts during th past 12 months, 65.5% trid to stop smoking cigartts. Ovrall, 63.1% of studnts rportd that popl smokd in thir prsnc on on or mor days during th past svn days. Ovrall, 62.6% of Intrnational Elctronic Journal of Halth Education, 2007; 10:3559 5

6 Studnts Halth Bhaviors in China Tian t al. studnts had a parnt or guardian who uss any form of tobacco. Violnc and Unintntional Injuris Data in Tabl 10 showd that ovrall 18.4% of studnts wr involvd in a physical fight on or mor tims during th past 12 months. Among studnts who wr bullid during th past 30 days, 17.9% wr bullid most oftn by bing hit, kickd, pushd, shovd around, or lockd indoors. On an avrag, 20.6% of studnts wr sriously injurd on or mor tims during th past 12 months. Among studnts who wr sriously injurd during th past 12 months, 13.1% wr playing or training for a sport whn thir most srious injury happnd to thm, 5.2% had thir most srious injury causd by a fall, 61.2% had thir most srious injury occur as a rsult of hurting thmslvs by accidnt, and 23.8% xprincd a brokn bon or dislocatd joint as thir most srious injury. SARSRlatd Qustions Tabl 11 displays information on SARSrlatd itms. Ovrall, 93.0% of studnts wr taught in any class how to prvnt SARS during th past school yar and 92.2% of studnts washd hands mor oftn during th day bcaus of SARS. On an avrag, 48.4% of studnts wr afraid of gtting SARS during th SARS pidmic and mal studnts (44.6%) wr significantly lss likly than fmal studnts (52.0%) to b afraid of gtting SARS during th SARS pidmic. Discussion This was a first larg scal survy on halth risk bhaviors among junior middl school studnts in China. Th purpos of th survy was to provid assssmnt of risk bhaviors and protctiv factors for school halth planning and policy dcisions in China. Additionally, th information prsntd hr would b hlpful for cross countris comparisons of ths bhaviors. Svral ky findings mrgd from th analysis of data. First, mal studnts had a highr prvalnc rat than fmal in a numbr of risk bhaviors including cigartts and alcohol us, fighting, drinking carbonatd soft drinks, nvr or rarly washd thir hands bfor ating and aftr using toilt, and unintntional injury. Mal studnts drank mor carbonatd soft drinks than fmal studnts could b th rsult of mal studnts participating in mor sports activitis than fmal studnts. On th othr hand, fmal studnts had highr rat of mntal halth issus. Ovr on quartr of fmal studnts sriously considrd attmpting suicid during th past 12months. This rat or trnd was consistnt with othr rports that indicatd fmal studnts ar mor likly to suffr mntal halth problms. A similar survy in Irland also showd that 29% of studnt agd 1314 at school considrd attmpting suicid. 15 Ths data indicat that thr is a nd for dvloping ffctiv programs in th school to tailor diffrnt mal and fmal studnts nds. Scond, 10.7% of mal studnts in th four citis smokd cigartts on on or mor days during th past 30 days, and a larg proportion (62.6%) of parnt or guardian usd any form of tobacco. Parnt smoking is on of th important influnc factors on studnt smoking 16 and th high prcntag of parnt or guardian tobacco us would b a concrn for studnts in China. Th data also indicatd 6.8% of mal studnts had a hangovr, flt sick, got into troubl, missd school, or got into fights on or mor tims as a rsult of drinking alcohol. It appars that many halth problms could b rducd if w can rduc th prvalnc of alcohol misus and abus. Young popl who drink ar mor likly to us tobacco and othr drugs and ngag in risky sxual bhavior, than thos who do not drink. 17 Problms with alcohol can impair adolscnts` psychological dvlopmnt and influnc both th school nvironmnt and lisur tim ngativly. 18 Additionally, a study indicatd that thr is a strong rlationship btwn th ag of initiation of alcohol us and th pattrn of its us and abus in adulthood, so th data on alcohol consumption among adolscnts is vry important for planning prvntion programs. 19 Third, ovr on fifth of studnts did not at brakfast most of tim or always during th past 30 days. Th litratur indicatd that not ating brakfast will affct th ability to larn and study 20, 21. Ladrs in th ducation nd to b informd about this problm. On anothr ditary issu, 32.3% studnts dscribd thir wight as slightly ovrwight or vry ovrwight. Ths rats wr tn tims as thos who wr rally ovrwight (3.1%), spcially among fmal studnts. Fmal studnts appar to b mor concrnd about wight loss. This trnd is consistnt with th situation in othr countris and may b an indication of futur ating disordr problms for adolscnts in China. Intrnational Elctronic Journal of Halth Education, 2007; 10:3559 6

7 Studnts Halth Bhaviors in China Tian t al. Fourth, only 12.2% of studnts wr physically activ svn days for a total of at last 60 minuts pr day during a typical or usual wk and fmal studnts had a highr rat of physical inactivity. In China, gnrally thr ar too much homwork assignd by tachrs for studnts which may lad to lack of tim and nrgy for studnts to attnd sport vnts and participat in xrcis activitis outsid of class. This could b a main concrn for studnts in China. Fifth, ovr on quartr of studnts nvr or rarly washd thir hands bfor ating at school during th past 30 days. This may rflct a lack of halth ducation and watrdrinking facilitis in schools in China. Gastrointstinal infctious disass continud to b a significant halth challng in China and mor school halth programs to addrss handwashing halth habits could b an ffctiv way to rduc this halth challng. Sixth, data indicatd 15.8%22.0% of studnts wr in a physical fight and % of studnts wr sriously injurd on or mor tims during th past 12 months. On th othr hand, 20.2%33.2% wr bullid on on or mor days during th past 30 days. Violnc and bullying ar closly rlatd to a numbr of halth problms and mor programs ar ndd to rduc ths problms. Prvious study indicatd that victims of bullying hav incrasd strss and a rducd ability to concntrat and ar at incrasd risk for substanc abus, aggrssiv bhavior, and suicid attmpts. 22 Svnth, dprssion during adolscnc and young adulthood is rcognizd incrasingly as an important public halth and social problm. An avrag of 17.8% of studnts had sriously considrd attmpting suicid during th past 12 months could b a srious concrn for adolscnts in China and mor rsarch and prvntion programs ar ndd to addrss this problm. On protctiv factor that has bn shown to b ffctiv in rducing this problm is family support and parntal bonding. A study showd that parntal bonding and connction was associatd with lowr lvls of dprssion and suicidal idation, alcohol us, sxual risk bhaviors, and violnc. 23 Worldwid, about 4 million adolscnts attmpt suicid annually, rsulting in at 24, 25, 26 last 100,000 daths. Lastly, thr ar many diffrncs on halth bhavior and protctiv factors among four citis. Ths diffrncs ar summarizd blow. Studnts in Bijing. Th risk for bcoming ovrwight is highr for studnts from Bijing. Th rason is probably du to th ditary styl in north of China contains much mats and fat with high protin and calori. On th othr hand, thr ar som good points among studnts in Bijing including highr rats of ating fruits and vgtabls, bing taught in classs and talking with thir parnts or guardians about HIV or AIDS, lowst rat of insufficint amount of physical activity, last likly to b bullid on on or mor days during th past 30 days, and last likly to b afraid of gtting SARS during th SARS pidmic. Studnts in th city also showd highr rat of protctiv factors including highr rat of thinking that most of th studnts in thir school wr kind and hlpful and highst prcntag of parnts or guardians undrstanding thir childrn s problms and worris. Studnts in Hangzhou. Th ngativ halth bhaviors includ highr rats of drinking carbonatd soft drinks, insufficint amount of physical activity, lowr rat of bing taught in classs and talking with thir parnts or guardians about HIV or AIDS, and highr rat of bing afraid of gtting SARS during th SARS pidmic. On th othr hands, studnts from Hangzhou wr last likly to bcoming ovrwight, last likly to nvr or rarly washd hands aftr using toilt or latrins, and had lowst rat of rcnt cigartts smoking. Studnts in Urumchi. Th problms in th city ar that thr ar highr rat of fling lonly most of th tim or always, fling so sad or hoplss and sriously considrd attmpting suicid; highst rat of bing in a physical fight and sriously injurd on or mor tims. Th positiv factors includ highst rat of bing taught in classs about HIV or AIDS and highr rat of bing taught in any class on how to prvnt SARS. Studnts in Wuhan. Studnts in th cntral city of China showd highr rat of ovrwight, highr rat of bing drunk on or mor tims during thir lif, nvr or rarly washing thir hands bfor ating, having no clos frinds, lowst rat of fling that most of th studnts in thir school wr kind and hlpful, lowr rat of bing taught in classs and talking with thir parnts or guardians about HIV or AIDS. Positiv factors includ lowr rat of cigartts smoking on on or mor days during th past 30 days, lowst rat of bing in a physical fight, and lowr rat of bing afraid of gtting SARS during th SARS pidmic. Limitations Findings of th data nd to b considrd du to svral limitations. First, all survy data ar slfrportd, and th xtnt of undrrporting or ovr Intrnational Elctronic Journal of Halth Education, 2007; 10:3559 7

8 Studnts Halth Bhaviors in China Tian t al. rporting of bhaviors cannot b dtrmind, although masurs dscribd in this rport dmonstrat that th data ar of accptabl quality. Scond, th schoolbasd survy data apply only to youth who attndd school and, thrfor, ar not rprsntativ of all prsons in this ag group. Third, th survy only addrsss bhaviors that contribut to th lading causs of morbidity and mortality among adolscnts in China. Howvr, dspit this limitd scop, school and community intrvntions should focus not only on bhaviors but also on th dtrminants of thos bhaviors. Also, th translation of th GSHS may hav affctd how th qustions or rsponss wr intrprtd. Futur Implications and Rsarch As with any public halth survillanc systm, GSHS is constantly volving to mt th nds of th WHO and othr usrs of th data. As dscribd prviously in this rport, th qustionnair is rvisd bfor ach binnial cycl, and nw survy populations priodically hav bn addd to th systm sinc its incption. In th futur, additional substat sampling and analysis might b possibl, similar to th Slctd Mtropolitan/Micropolitan Ara Risk Trnds that ar part of th Bhavioral Risk Factor Survillanc Systm. Intrnational Elctronic Journal of Halth Education, 2007; 10:3559 8

9 Studnts Halth Bhaviors in China. Tian t al. Rfrncs 1 WHO. Global schoolbasd studnt halth survy (GSHS) Availabl onlin at 2 WHO. Global schoolbasd studnt halth survy (GSHS) implmntation Availabl onlin at 3 Poikolainn K, TuulioHnriksson A, AaltoStala T, Marttunn M, Lonnqvist J. Prdictors of alcohol intak and havy drinking in arly adulthood: a 5yar followup of 1519 yarold Finnish adolscnts, Alcohol and Alcoholism. 2001, 36(1): VincWhitman C, Aldingr C, Lvingr B, Birdthistl I. School Halth and Nutrition. UNESCO: Intrnational Consultativ Form on Education for All, WHO. Dit, Physical Activity and Halth: Rport by th Scrtariat. Fiftyfifth World Halth Assmbly, Provisional agnda itm 13.11, Physical Activity and Halth: A Rport of th Surgon Gnral. Atlanta: Cntrs for Disas Control and Prvntion, National Cntr for Chronic Disas Prvntion and Halth Promotion, Dardn K, Hal C, Woolly T. Th antcdnts of tn fathrhood: A rtrospctiv cascontrol study of Grat Britian youth. Amrican Journal of Public Halth. 1995, 85(4): Wstall J. Poor ducation linkd with tn prgnancis. British Mdical Journal. 1997, 314 (7080): Halcon L, Buhring T, Blum R. A Portrait of Adolscnt Halth in th Caribban. Minnapolis, Minnsota: WHO Collaborating Cntr on Adolscnt Halth, Division of Gnral Pdiatrics and Adolscnt Halth, Univrsity of Minnsota, and Pan African Halth Organization, Population Program Adolscnt Halth and Dvlopmnt, UNICEF, UNAIDS, WHO. Young Popl and HIV/AIDS Opportunity in Crisis. Nw York, NY: UNICEF, WHO. What in th World Works? Intrnational Consultation on Tobacco and Youth. Singapor, Sptmbr 2830, WHO, UNESCO, Education Intrnational. WHO Information Sris on School Halth Tobacco Us Prvntion: An Important Entry Point for th Dvlopmnt of HalthPromoting Schools. Gnva, Switzrland: WHO, WHO. World Rport on Violnc and Halth. Gnva, Switzrland: WHO, UNICEF. Injury Prvntion Availabl onlin at 15 Osulliuan M, Fitgrald M. Suicidal idation and acts of slfharm among Dublin school childrn [J]. J Adolsc. 1998, 21: Rogrs PD, Thomas MH. Alcohol and Adolsnt. Pdiatric Clinics of North Amrica, 1995, 42: Hibll B, Andrsson B, Ahlstrom S, Balakirva O, Bjarnason T, Kokkvi A, Morgan M. Th 1999 ESPAD Rport: Alcohol and Othr Drug Us Among Studnts in 30 Europan Countris. Stockholm, Swdn: Council of Europ, Halth and Halth Bhaviour Among Young Popl. Curri C, Hurrlmann K, Sttrtobult W, Smith R, Todd J, ds. Copnhagn, Dnmark: WHO Rgional Offic for Europ, Poikolainn K, TuulioHnriksson A, AaltoStala T, Marttunn M, Lonnqvist J. Prdictors of alcohol intak and havy drinking in arly adulthood: a 5yar followup of 1519 yarold Finnish adolscnts, Alcohol and Alcoholism. 2001, 36(1): Siga Riz,Popkin BM, Trri Carson. Trnds in brakfast consumption for childrn in th Unitd Stats from 1965 to Am J Clin Nutr, 1998, 67 (suppl): Wirths W. School catring tsts in light of nutritional physiology. Nutr Abstr Rv, 1976, 46: AntiBullying Cntr. School Bullying: Ky Facts. Trinity Collg, Dublin: AntiBullying Cntr, Availab onlin at 23 Barbr BK. Rgulation, connction, and psychological autonomy: Evidnc from th Cross National Adolscnc Projct (CNAP). Papr prsntd at th WHOsponsord mting Rgulation as a Concpt and Construct for Adolscnt Halth and Intrnational Elctronic Journal of Halth Education, 2007; 10:3559 9

10 Studnts Halth Bhaviors in China Tian t al Dvlopmnt. WHO Hadquartrs, Gnva, Switzrland, April 1618, WHO. Mntal Halth Fact Sht Availabl onlin at t.pdf 25 Annan KA. W th Childrn: Mting th Promiss of th World Summit for Childrn. Nw York, NY: UNICEF, WHO. Th World Halth Rport 2001 Mntal Halth: Nw Undrstanding, Nw Hop. Gnva, Switzrland: WHO, Intrnational Elctronic Journal of Halth Education, 2007; 10:

11 Studnts Halth Bhaviors in China Tian t al. Tabl 1. Dmographics Bijing Hangzhou Urumqi Wuhan n Ag% Gndr% Mal Fmal Grad% Avrag hight (m) 1.62± ± ± ±0.08 Avrag wight (kg) 52.36± ± ± ±15.30 Intrnational Elctronic Journal of Halth Education, 2007; 10:

12 Studnts Halth Bhaviors in China Tian t al. Tabl 2. Alcohol us and othr drug us, % (CI)*, by city, CHINA, Qustion Bijing Hangzhou Urumchi Wuhan Ovrall Mal Fmal Mal Fmal Mal Fmal Mal Fmal Mal Fmal Drank at last on drink containing alcohol on on or mor of th past 30 days 13.0 ( ) 17.7 ( ) 8.6 ( ) 18.1 ( ) 20.9 ( ) 15.0 ( ) 13.7 ( ) 16.3 ( ) 11.0 ( ) 14.8 ( ) 19.7 ( ) 9.7 ( ) 14.6 ( ) 18.5 ( ) 11.0 ( ) Usually got th alcohol thy drank by buying it in a stor, shop, or from a strt vndor during th past 30 days 5.1 ( ) 8.2 ( ) 2.2 ( ) 4.7 ( ) 5.7 ( ) 3.5 ( ) 4.7 ( ) 6.3 ( ) 3.0 ( ) 6.0 ( ) 7.9 ( ) 4.0 ( ) 5.0 ( ) 7.1 ( ) 3.1 ( ) Drank so much alcohol thy wr rally drunk on or mor tims during thir lif 8.4 ( ) 11.9 ( ) 4.8 ( ) 8.8 ( ) 12.3 ( ) 5.2 ( ) 12.7 ( ) 16.0 ( ) 9.0 ( ) 13.5 ( ) 18.5 ( ) 8.0 ( ) 10.8 ( ) 14.7 ( ) 7.0 ( ) Had a hangovr, flt sick, got into troubl, missd school, or got into fights on or mor tims as a rsult of drinking alcohol during thir lif 4.8 ( ) 6.7 ( ) 2.9 ( ) 4.2 ( ) 4.6 ( ) 3.8 ( ) 6.2 ( ) 7.7 ( ) 4.6 ( ) 6.3 ( ) 8.1 ( ) 4.1 ( ) 5.4 ( ) 6.8 ( ) 4.0 ( ) Intrnational Elctronic Journal of Halth Education, 2007; 10:

13 Studnts Halth Bhaviors in China Tian t al. Tabl 2. (cotd). Usd drugs such as ic, marijuana, mthamphtamin, or hroin on or mor tims during thir lif 0.9 ( ) 1.2 ( ) 0.7 ( ) 2.5 ( ) 3.5 ( ) 1.5 ( ) 1.3 ( ) 1.5 ( ) 1.1 ( ) 2.3 ( ) 3.8 ( ) 0.7 ( ) 1.6 ( ) 2.3 ( ) 1.0 ( ) *95% confidnc intrval. Intrnational Elctronic Journal of Halth Education, 2007; 10:

14 Studnts Halth Bhaviors in China Tian t al. Tabl 3. BMI and ditary bhaviors, % (CI)*, by city, CHINA, Qustion Bijing Hangzhou Urumchi Wuhan Ovrall At risk for bcoming ovrwight ( ) Mal 13.5 ( ) Fmal 8.0 ( ) 4.0 ( ) Mal 5.5 ( ) Fmal 2.5 ( ) Mal Fmal Mal 6.3 ( ) 9.3 ( ) 3.1 ( ) 7.4 ( ) 9.9 ( ) Fmal 4.6 ( ) 7.1 ( ) Mal 9.7 ( ) Fmal 4.6 ( ) Ovrwight ( ) 6.1 ( ) 2.4 ( ) 1.7 ( ) 2.3 ( ) 1.1 ( ) 0.7 ( ) 1.1 ( ) 0.3 ( ) 8.0 ( ) 8.8 ( ) 7.1 ( ) 3.0 ( ) 4.0 ( ) 2.1 ( ) Wnt hungry most of th tim or always bcaus thr was not nough food in thir hom during th past 30 days 2.4 ( ) 2.9 ( ) 1.9 ( ) 2.6 ( ) 3.3 ( ) 1.9 ( ) 2.3 ( ) 2.6 ( ) 3.0 ( ) 1.9 ( ) 1.9 ( ) 2.0 ( ) 2.3 ( ) 2.7 ( ) 1.9 ( ) Usually at fruit, such as appls, pars, orangs, or bananas, on or mor tims pr day during th past 30 days 72.7 ( ) 69.6 ( ) 75.7 ( ) 65.7 ( ) 64.3 ( ) 67.1 ( ) 61.0 ( ) 58.3 ( ) 63.8 ( ) 54.9 ( ) 52.5 ( ) 57.5 ( ) 63.9 ( ) 61.2 ( ) 66.6 ( ) Usually at vgtabls, such as tomatos, cabbags, radishs, or bans, on or mor tims pr day during th past 30 days 93.2 ( ) 93.2 ( ) 93.1 ( ) 91.5 ( ) 90.4 ( ) 92.6 ( ) 93.4 ( ) 93.1 ( ) 93.7 ( ) 89.1 ( ) 90.2 ( ) 87.9 ( ) 92.1 ( ) 91.9 ( ) 92.3 ( ) Intrnational Elctronic Journal of Halth Education, 2007; 10:

15 Studnts Halth Bhaviors in China Tian t al. Tabl 3. (cotd). At fruits and vgtabls fiv or mor tims pr day during th past 30 days 33.4 ( ) 32.2 ( ) 34.6 ( ) 21.9 ( ) 22.3 ( ) 21.5 ( ) 25.3 ( ) 25.2 ( ) 25.5 ( ) 17.1 ( ) 19.0 ( ) 14.7 ( ) 25.1 ( ) 25.1 ( ) 25.1 ( ) Dscrib thir wight as slightly ovrwight or vry ovrwight 36.7 ( ) 31.4 ( ) 41.9 ( ) 27.4 ( ) 20.8 ( ) 34.5 ( ) 32.6 ( ) 23.3 ( ) 42.8 ( ) 28.6 ( ) 23.5 ( ) 35.0 ( ) 32.3 ( ) 24.8 ( ) 39.6 ( ) At brakfast most of tim or always during th past 30 days 77.3 ( ) 79.0 ( ) 75.7 ( ) 82.1 ( ) 82.2 ( ) 78.5 ( ) 78.4 ( ) 80.2 ( ) 76.3 ( ) 78.9 ( ) 80.2 ( ) 78.0 ( ) 78.9 ( ) 80.4 ( ) 77.6 ( ) Usually drink carbonatd soft drinks, such as Cok, Ppsi, or Sprit two or mor tims pr day during th past 30 days 14.3 ( ) 16.7 ( ) 11.9 ( ) 25.5 ( ) 27.0 ( ) 23.9 ( ) 13.9 ( ) 15.8 ( ) 11.8 ( ) 19.9 ( ) 24.2 ( ) 14.2 ( ) 17.4 ( ) 20.1 ( ) 14.6 ( ) Usually drink carbonatd soft drinks, such as Cok, Ppsi, or Sprit two or mor tims pr day during th past 30 days *95% confidnc intrval ( ) 16.7 ( ) 11.9 ( ) 25.5 ( ) 27.0 ( ) 23.9 ( ) 13.9 ( ) 1 Studnts who wr at or abov th 85 th prcntil, but blow th 95 th prcntil for body mass indx by ag and sx basd on rfrnc data from Col, Bllizzi, Flgal, and Ditz, BMJ, May Studnts who wr at or abov th 95 th prcntil for body mass indx by ag and sx basd on rfrnc data from Col, Bllizzi, Flgal, and Ditz, BMJ, May ( ) 11.8 ( ) 19.9 ( ) 24.2 ( ) 14.2 ( ) 17.4 ( ) 20.1 ( ) 14.6 ( ) Intrnational Elctronic Journal of Halth Education, 2007; 10:

16 Studnts Halth Bhaviors in China Tian t al. Tabl 4. Hyginrlatd bhaviors, % (CI)*, by city, CHINA, Qustion Bijing Hangzhou Urumchi Wuhan Ovrall Mal Fmal Mal Fmal Mal Fmal Mal Fmal Mal Fmal Did not clan or brush thir tth during th past 30 days 2.9 ( ) 4.0 ( ) 1.9 ( ) 2.1 ( ) 3.1 ( ) 1.1 ( ) 2.2 ( ) 2.8 ( ) 1.5 ( ) 2.8 ( ) 2.1 ( ) 3.5 ( ) 2.4 ( ) 3.0 ( ) 1.9 ( ) Nvr or rarly washd thir hands bfor ating during th past 30 days 3.0 ( ) 3.6 ( ) 2.3 ( ) 6.4 ( ) 7.6 ( ) 5.0 ( ) 4.1 ( ) 4.3 ( ) 3.8 ( ) 9.1 ( ) 9.4 ( ) 8.6 ( ) 5.2 ( ) 5.8 ( ) 4.6 ( ) Nvr or rarly washd thir hands bfor ating at school during th past 30 days 16.8 ( ) 20.2 ( ) 13.3 ( ) 20.9 ( ) 22.3 ( ) 19.4 ( ) 30.8 ( ) 30.6 ( ) 31.0 ( ) 35.1 ( ) 36.0 ( ) 34.4 ( ) 25.9 ( ) 27.4 ( ) 24.5 ( ) Nvr or rarly washd thir hands aftr using toilt or latrins at school during th past 30 days 9.9 ( ) 11.1 ( ) 8.7 ( ) 2.5 ( ) 2.7 ( ) 2.1 ( ) 9.1 ( ) 9.0 ( ) 9.2 ( ) 6.9 ( ) 7.8 ( ) 5.9 ( ) 7.5 ( ) 8.0 ( ) 7.0 ( ) *95% confidnc intrval. Intrnational Elctronic Journal of Halth Education, 2007; 10:

17 Studnts Halth Bhaviors in China Tian t al. Tabl 5. Mntal halth issus, % (CI)*, by city, CHINA, Qustion Bijing Hangzhou Urumchi Wuhan Ovrall Mal Fmal Mal Fmal Mal Fmal Mal Fmal Mal Fmal Most of th tim or always flt lonly during th past 12 months 6.9 ( ) 6.6 ( ) 7.3 ( ) 5.0 ( ) 4.2 ( ) 5.8 ( ) 8.8 ( ) 7.7 ( ) 9.9 ( ) 8.0 ( ) 7.1 ( ) 9.2 ( ) 7.4 ( ) 6.5 ( ) 8.2 ( ) Most of th tim or always flt so worrid about somthing that thy could not slp at night during th past 12 months 4.9 ( ) 5.1 ( ) 4.7 ( ) 3.4 ( ) 3.2 ( ) 3.6 ( ) 4.6 ( ) 4.6 ( ) 4.6 ( ) 4.1 ( ) 3.9 ( ) 4.4 ( ) 4.3 ( ) 4.3 ( ) 4.4 ( ) Flt so sad or hoplss almost vry day for two wks or mor in a row that thy stoppd doing thir usual activitis during th past 12 months 18.4 ( ) 19.8 ( ) 17.0 ( ) 19.1 ( ) 18.4 ( ) 19.7 ( ) 24.3 ( ) 24.0 ( ) 24.6 ( ) 20.0 ( ) 18.9 ( ) 20.6 ( ) 20.7 ( ) 20.5 ( ) 20.8 ( ) Sriously considrd attmpting suicid during th past 12months 14.3 ( ) 12.5 ( ) 16.2 ( ) 14.5 ( ) 13.0 ( ) 16.3 ( ) 21.3 ( ) 17.6 ( ) 25.1 ( ) 19.0 ( ) 15.6 ( ) 22.5 ( ) 17.8 ( ) 14.9 ( ) 20.5 ( ) Mad a plan about how thy would attmpt suicid during th past 12 months 7.1 ( ) 6.0 ( ) 8.2 ( ) 7.1 ( ) 6.3 ( ) 8.0 ( ) 9.5 ( ) 7.3 ( ) 11.8 ( ) 9.6 ( ) 7.4 ( ) 12.1 ( ) 8.4 ( ) 6.7 ( ) 10.1 ( ) Intrnational Elctronic Journal of Halth Education, 2007; 10:

18 Studnts Halth Bhaviors in China Tian t al. Tabl 5. (cotd). Hav no clos frinds 7.2 ( ) *95% confidnc intrval. 6.7 ( ) 7.6 ( ) 6.3 ( ) 6.4 ( ) 6.2 ( ) 6.6 ( ) 6.7 ( ) 6.5 ( ) 10.3 ( ) 9.8 ( ) 10.8 ( ) 7.4 ( ) 7.2 ( ) 7.5 ( ) Intrnational Elctronic Journal of Halth Education, 2007; 10:

19 Studnts Halth Bhaviors in China Tian t al. Tabl 6. Physical activity, % (CI)*, by city, CHINA, Qustion Bijing Hangzhou Urumchi Wuhan Ovrall Mal Fmal Mal Fmal Mal Fmal Mal Fmal Mal Fmal Physically activ svn days for a total of at last 60 minuts pr day during a typical or usual wk 17.1 ( ) 20.7 ( ) 13.5 ( ) 7.7 ( ) 9.4 ( ) 5.7 ( ) 13.0 ( ) 17.3 ( ) 8.4 ( ) 10.6 ( ) 13.7 ( ) 7.2 ( ) 12.2 ( ) 15.7 ( ) 8.9 ( ) Participatd in an insufficint amount of physical activity 73.0 ( ) 69.2 ( ) 76.7 ( ) 84.9 ( ) 82.7 ( ) 87.3 ( ) 78.6 ( ) 73.4 ( ) 84.1 ( ) 81.9 ( ) 76.9 ( ) 87.7 ( ) 78.6 ( ) 75.1 ( ) 83.5 ( ) Spnt thr or mor hours pr day doing sitting activitis during a typical or usual day 22.0 ( ) 21.3 ( ) 22.6 ( ) 25.0 ( ) 22.4 ( ) 27.8 ( ) 21.6 ( ) 20.8 ( ) 22.5 ( ) 19.1 ( ) 21.8 ( ) 16.0 ( ) 22.0 ( ) 21.6 ( ) 22.5 ( ) Did not walk or bicycl to and from school during th past svn days 15.3 ( ) 16.8 ( ) 13.9 ( ) 13.8 ( ) 13.1 ( ) 14.7 ( ) 32.8 ( ) 33.8 ( ) 31.7 ( ) 16.4 ( ) 17.7 ( ) 14.6 ( ) 20.9 ( ) 21.7 ( ) 20.1 ( ) Usually tak 29 minuts or lss to gt to and from school ach day during th past svn days 54.0 ( ) 56.9 ( ) 51.0 ( ) 62.6 ( ) 65.3 ( ) 59.6 ( ) 52.5 ( ) 55.5 ( ) 49.3 ( ) 55.6 ( ) 57.3 ( ) 53.6 ( ) 55.4 ( ) 58.3 ( ) 52.5 ( ) *95% confidnc intrval. Intrnational Elctronic Journal of Halth Education, 2007; 10:

20 Studnts Halth Bhaviors in China Tian t al. Tabl 7. Protctiv factors, % (CI)*, by city, CHINA, Qustion Bijing Hangzhou Urumchi Wuhan Ovrall Mal Fmal Mal Fmal Mal Fmal Mal Fmal Mal Fmal Missd classs or school without prmission on on or mor of th past 30 days 4.6 ( ) 5.9 ( ) 3.2 ( ) 5.2 ( ) 5.4 ( ) 4.9 ( ) 7.3 ( ) 8.7 ( ) 5.9 ( ) 7.0 ( ) 8.0 ( ) 5.7 ( ) 6.0 ( ) 7.2 ( ) 4.9 ( ) Most of th studnts in thir school wr kind and hlpful most of th tim or always during th past 30 days 57.0 ( ) 49.1 ( ) 64.8 ( ) 43.5 ( ) 38.5 ( ) 48.7 ( ) 48.2 ( ) 42.5 ( ) 54.4 ( ) 36.6 ( ) 32.4 ( ) 41.2 ( ) 47.8 ( ) 41.6 ( ) 53.8 ( ) Parnts or guardians undrstood thir problms and worris most of th tim or always during th past 30 days 41.6 ( ) 40.9 ( ) 47.3 ( ) 30.0 ( ) 26.4 ( ) 37.7 ( ) 34.7 ( ) 36.7 ( ) 32.8 ( ) 32.3 ( ) 31.6 ( ) 32.7 ( ) 35.0 ( ) 34.5 ( ) 35.5 ( ) Parnts or guardians rally knw what thy wr doing with thir fr tim most of th tim or always during th past 30 days 47.4 ( ) 46.6 ( ) 48.3 ( ) 40.8 ( ) 38.2 ( ) 43.6 ( ) 45.1 ( ) 43.8 ( ) 46.4 ( ) 40.8 ( ) 41.1 ( ) 40.6 ( ) 44.0 ( ) 42.7 ( ) 45.2 ( ) *95% confidnc intrval. Intrnational Elctronic Journal of Halth Education, 2007; 10:

21 Studnts Halth Bhaviors in China Tian t al. Tabl 8. HIVRlatd Knowldg, % (CI)*, by city, CHINA,2003. Qustion Bijing Hangzhou Urumchi Wuhan Ovrall Mal Fmal Mal Fmal Mal Fmal Mal Fmal Mal Fmal Evr hard of HIV or th disas calld AIDS 96.3 ( ) 95.6 ( ) 97.0 ( ) 95.8 ( ) 95.3 ( ) 96.2 ( ) 97.6 ( ) 97.3 ( ) 98.0 ( ) 95.3 ( ) 94.7 ( ) 95.9 ( ) 96.5 ( ) 96.0 ( ) 97.0 ( ) Taught in any of thir classs about HIV or AIDS during this school yar 50.4 ( ) 50.5 ( ) 50.4 ( ) 27.2 ( ) 27.1 ( ) 27.3 ( ) 66.9 ( ) 66.8 ( ) 66.8 ( ) 34.6 ( ) 34.8 ( ) 33.9 ( ) 48.1 ( ) 48.0 ( ) 48.2 ( ) Evr talkd about HIV or AIDS with thir parnts or guardians 42.7 ( ) 37.8 ( ) 47.4 ( ) 30.3 ( ) 24.7 ( ) 36.0 ( ) 41.1 ( ) 38.3 ( ) 44.3 ( ) 30.4 ( ) 28.3 ( ) 33.6 ( ) 46.6 ( ) 45.7 ( ) 47.4 ( ) Evr hard of HIV or th disas calld AIDS 96.3 ( ) 95.6 ( ) 97.0 ( ) 95.8 ( ) 95.3 ( ) 96.2 ( ) 97.6 ( ) 97.3 ( ) 98.0 ( ) 95.3 ( ) 94.7 ( ) 95.9 ( ) 96.5 ( ) 96.0 ( ) 97.0 ( ) *95% confidnc intrval Intrnational Elctronic Journal of Halth Education, 2007; 10:

22 Studnts Halth Bhaviors in China Tian t al. Tabl 9. Tobacco us among studnts, % (CI)*, by city, CHINA, Qustion Bijing Hangzhou Urumchi Wuhan Ovrall Mal Fmal Mal Fmal Mal Fmal Mal Fmal Mal Fmal Smokd cigartts on on or mor days during th past 30 days 8.7 ( ) 15.3 ( ) 2.4 ( ) 3.5 ( ) 5.5 ( ) 1.4 ( ) 6.2 ( ) 10.0 ( ) 2.2 ( ) 6.6 ( ) 11.1 ( ) 1.4 ( ) 6.2 ( ) 10.7 ( ) 1.9 ( ) Usd any othr form of tobacco, such as pip or watr pip on on or mor of th past 30 days 1.9 ( ) 3.3 ( ) 0.5 ( ) 1.0 ( ) 1.2 ( ) 0.8 ( ) 1.6 ( ) 2.6 ( ) 0.6 ( ) 1.6 ( ) 2.5 ( ) 0.4 ( ) 1.5 ( ) 2.5 ( ) 0.6 ( ) Among studnts who smokd cigartts during th past 30 days, thos who trid thir first cigartt at ag 9 or youngr 25.9 ( ) 25.4 ( ) 26.4 ( ) 27.9 ( ) 27.2 ( ) 27.5 ( ) 26.1 ( ) Among studnts who smokd cigartts on on or mor days during th past 30 days, thos who trid to stop smoking cigartts during th past 12 months 72.7 ( ) 74.5 ( ) 70.0 ( ) 75.0 ( ) 61.7 ( ) 65.5 ( ) 68.1 ( ) 53.7 ( ) Intrnational Elctronic Journal of Halth Education, 2007; 10: