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.