Severe and Differential Underestimation of Self-reported Smoking Prevalence in Chinese Adolescents

Background: Evaluating the progress of tobacco control across the world heavily relies on smoking prevalence estimates. Those estimates are often based on surveys of self-reported cigarette smoking status. The accuracy varies among populations with different social and cultural backgrounds.

Purpose: The objective of this study was to estimate the prevalence of smoking and assess the accuracy of self-report smoking status in Chinese adolescents.

Method: This population-based cross-sectional survey included 10,934 adolescents aged 12 to 18 years from 17 schools in Shanghai, China. Data on adolescents’ smoking status were collected from adolescents’ self-reporting and from parents’ questionnaires, separately. Based on the data of two sources, the total number of smokers among the study participants was estimated using a capture–recapture method.

Results: Among 5,452 girls and 5,482 boys, the prevalence estimates of self-reported smoking were 13.6 % (748) and 5.2 % (284) for boys and girls, respectively. Parents only identified smaller proportions of smoking adolescents: 2.9 % (160) boys and 0.6 % (30) girls. Using the capture–recapture method, we estimated the prevalence of smoking as 18.3 % (95 % CI 16.4, 20.3) for boys and 14.2 % (95 % CI 7.6, 20.8) for girls.

Conclusion: Reliance on self-reporting to identify smokers among Chinese adolescents significantly underestimates the number of smokers, particularly among Chinese girls. Self-reported smokers only represent less than half of actual smokers in girls. Our findings are important for monitoring smoking trends and evaluating tobacco control interventions among Chinese adolescents.