| Summary: | Background: Adolescence is a period of immense behavioral, psychological and social changes and challenges and characterized as a stage of increased imitation and exploration with a range of health-risk behaviors (HRBs). Although there is no uniform definition of HRB worldwide, it is generally considered as behavior that negatively affects health. Prior studies reported that HRBs among adolescents mainly include substances use that consist of the use of alcohol, tobacco, psychoactive drugs; behaviors that contribute to unintentional injuries and violence; sleep behaviors that mainly consist of sleep disturbance and insomnia; mental health including depression, suicidal behaviors and so on. Since the 1980s, with the Open Up policy, living conditions and annual incomes have improved dramatically in both urban and rural households in China, and Chinese adolescents are becoming more and more easily exposed to HRBs. Adolescent HRB has been a major public health problem in China. However, to our knowledge, there are only few small scale studies on HRBs among Chinese adolescents: A previous study in Zhejiang province indicated that approximately 40.0% of Chinese adolescent smokers started smoking before 10 years of age; previous studies in Beijing reported that approximately 70.0% of the study adolescents reporting prior alcohol consumption, about 15.9% of juvenile school students and 1.1% of secondary vocational school students admitted illicit drugs use; 20.8% of Chinese adolescents in Guangdong province reported being involved in bullying behaviors; 16.9% of the Chinese adolescents in Shandong province was troubled with sleep disturbance; 15.8% of adolescents in Guangzhou reported having depressive symptoms; 19.0% of Chinese rural adolescents in Shandong province reported having had suicidal ideation, and 7.0% reported having made a suicidal attempt during the past 6 months. It is necessary to conduct large scale survey studies to determine the sheer number of adolescents with HRBs in mainland China and whether HRBs and their correlates occur in Chinese adolescents in similar way to their manifestation in Western countries. Additionally, although HRBs among Chinese adolescents are prevalent, there is few existing policies for preventing or controlling HRBs in China. For example, although China has signed the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in 2003 and ratified the treaty in 2005, there is no national smoke-free law in China. So far, only 13 cities of China revise or formulate local smoke-free regulations in accordance with FCTC Article 8 Guidelines. Therefore, we conducted a large-scale survey study using a multistage, stratified cluster, random sampling method to obtain a representative sample of high school students and a scoping review summarizing and accessing the existing policies in China to prevent or control adolescent HRBs, in order to estimate the prevalence of current drinking, current smoking, sleep disturbance, depressive symptoms, nonmedical use of prescription drug, illicit drugs use, being bullied, bullying others, both being bullied and bullying others, suicidal ideation, and suicidal attempts among Chinese adolescents; to explore the relationships between sociodemographic, family, school, psychosocial characteristics and each type of HRBs; to examine the internal associations between the HRBs, including the association between sleep disturbance and depressive symptoms, the association between depressive symptoms, bullying and current smoking, and the association between non-medical use of prescription drugs and suicidal behaviors; and to make suggestions for helping develop prevention and intervention programs to reduce adolescent HRBs in China.Methods: A large-scale cross-sectional study was conducted in three provinces of China, and a multistage, stratified cluster, random sampling method was used to a representative sample of junior and senior high school students. Data were collected from a structured questionnaire between 2011 and 2012. Additionally, we conducted a scoping review to summarize the existing policy strategies relating to adolescent HRBs in China. The framework outlines a five-stage approach including identifying the research question; searching for relevant studies; selecting studies; charting data; and collating, summarizing, and reporting the results. Findings: Our survey study findings demonstrated that substance use was prevalent among Chinese adolescents, adolescents’ alcohol use was the highest substance use, and illicit drugs use among Chinese adolescents was lower than other countries; the prevalence rates of bullying behaviors, depressive symptoms, and suicidal behaviors were similar with other previous reports. Moreover, our study found that gender differences were significant in the extent of alcohol use, cigarette use, and drugs use; boys had a higher level of substance use than girls. Students who reported below average family economic status were at a higher risk of HRBs, and poor classmate relations, poor relationships, and below average academic performance were positively associated with most of the HRBs. Furthermore, our scoping review demonstrated that current Chinese national and local efforts focus on expanding smoke-free environments by restricting smoking in schools, hospitals, workplaces, or public places; many of these environments have limited or no restrictions on smoking. Moreover, although more and more public are aware of the problems (e.g. liver and cardiovascular disease, mental disorders, and unintentional injuries) caused by alcohol drinking, there is almost no alcohol control policy in China. Additionally, although the Chinese public are aware of the negative consequences of school bullying behaviors, there is no existing law related to anti-school bullying in China now.Conclusions: In conclusion, Chinese adolescent HRB is a major public health problem nationally, and an adolescent’s family, school, and psychosocial factors have influences on their substance use habits. We suggest that effective prevention and intervention programs should be established and the role of the government, school, family, and individual should be considered. Our study recommends strengthening regulations to limit the sale of substances to adolescents, establishing a surveillance system to monitor and control the adolescent substances use, and providing health services to promote resilience among adolescents involved in mental health problems or bullying behaviors. === Doctorat en Sciences de la santé Publique === info:eu-repo/semantics/nonPublished
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