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Article(id=1321169970302664979, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169924697993338, articleNumber=null, orderNo=null, doi=10.11847/zgggws1145632, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1722960000000, receivedDateStr=2024-08-07, revisedDate=1739116800000, revisedDateStr=2025-02-10, acceptedDate=1744300800000, acceptedDateStr=2025-04-11, onlineDate=1792921067070, onlineDateStr=2026-10-25, pubDate=1746806400000, pubDateStr=2025-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921067070, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921067070, creator=13701087609, updateTime=1792921067070, updator=13701087609, issue=Issue{id=1321169924697993338, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='5', pageStart='513', pageEnd='640', issueExtLink='null', onlineDate='null', pubDate='1746806400000', pubDateStr='2025-05-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921056198, creator='13701087609', updateTime=1792921056198, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=526, endPage=531, ext={EN=ArticleExt(id=1321169970499797268, articleId=1321169970302664979, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Relationship between secondhand electronic cigarette aerosol exposure and mental health problems in adolescents, columnId=1321169947393376325, journalTitle=Chinese Journal of Public Health, columnName=Special Report – Resist the Temptation: Say No to the First Cigarette, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the relationship between secondhand e-cigarette aerosol exposure and mental health problems in adolescents, and to provide a reference for the formulation of smoke-free environment policies.

Methods

From March to June 2023, a multi-stage stratified cluster sampling method was used to conduct an online questionnaire survey of 2 112 full-time students aged ≤18 years nationwide. A χ2 test was used for univariate analysis of demographic information and mental health problems. Binary logistic regression was used to analyze the relationship between secondhand e-cigarette aerosol exposure and mental health problems in adolescents. Multiple linear regression was used to analyze the relationship between secondhand e-cigarette aerosol exposure and the three dimensions of mental health problems in adolescents: somatic symptoms, anxiety/worry, and family relationships.

Results

In this study the prevalence of mental health problems were 12.03% (254 adolescents) and 620 (29.36%) were exposed to secondhand e-cigarette aerosol. Binary logistic regression analysis showed that adolescents exposed to secondhand e-cigarette aerosol had a 1.500 times higher risk of developing mental health problems than those not exposed (OR = 1.500, 95%CI: 1.127 - 1.998). Multiple linear regression results showed that adolescents exposed to secondhand e-cigarette aerosol in the past 30 days had more severe somatic symptoms (b = 0.758, P < 0.001) and higher anxiety/worry (b = 0.691, P< 0.001).

Conclusions

Secondhand e-cigarette aerosol exposure in adolescents is positively correlated with the occurrence of mental health problems, and is related to the dimensions of somatic symptoms and anxiety/worry.

, authors=Ying LI1, Furong BAI1, Wenwen WANG2, Liangpeng WU2, Zhouling MENG3, Sihui PENG2, authorsList=Ying LI, Furong BAI, Wenwen WANG, Liangpeng WU, Zhouling MENG, Sihui PENG, authorCompany=null, correspAuthors=Sihui PENG, authorNote=null, correspAuthorsNote=
PENG Sihui, E-mail:
, copyrightStatement=Copyright © 2025 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1321169973289009439, articleId=1321169970302664979, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=青少年电子烟二手气溶胶暴露与心理健康问题关系, columnId=1321169925570408573, journalTitle=中国公共卫生, columnName=专题报道——拒绝烟草诱惑，对第一支烟说不, runingTitle=null, highlight=null, articleAbstract=
目的

探究青少年电子烟二手气溶胶暴露与心理健康问题的关系，为无烟环境政策制定提供参考依据。

方法

于2023年3—6月，采用多阶段分层整群抽样方法，在全国范围内对2 112名≤18岁全日制在校生进行在线问卷调查，采用χ2检验进行人口学信息与心理健康问题的单因素分析，二元logistic回归分析电子烟二手气溶胶暴露与青少年心理健康问题的关系，多元线性回归分析电子烟二手气溶胶暴露与青少年心理健康问题的躯体症状、焦虑/担忧、家庭关系不良3个维度的关系。

结果

本研究中青少年有心理健康问题者254人（12.03%），有电子烟二手气溶胶暴露者620人（29.36%）。二元logistic回归分析结果显示，电子烟二手气溶胶暴露者心理健康问题发生的风险是非暴露者的1.500倍（OR=1.500，95%CI=1.127～1.998）。多元线性回归结果显示，过去30 d内有电子烟二手气溶胶暴露的青少年有更严重的躯体症状（b=0.758，P= <0.001）和更高的焦虑/担忧（b=0.691，P= <0.001）。

结论

青少年电子烟二手气溶胶暴露与心理健康问题发生呈正相关，且与躯体症状维度、焦虑/担忧维度有关。

, authors=李瑛1, 白芙蓉1, 王雯雯2, 吴良鹏2, 孟州令3, 彭嗣惠2, *, *, authorsList=李瑛, 白芙蓉, 王雯雯, 吴良鹏, 孟州令, 彭嗣惠, authorCompany=null, correspAuthors=彭嗣惠, authorNote=

李瑛（1991—），讲师，硕士，研究方向：健康行为与生命质量

, correspAuthorsNote=
彭嗣惠，E-mail：
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(2021-11-10)[2024-02-04]. https://www.gov.cn/gongbao/content/2021/content_5661977.htm., articleTitle=null, refAbstract=null), Reference(id=1321169982529061246, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169970302664979, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=42, rfOrder=41, authorNames=null, journalName=null, refType=null, unstructuredReference=贾晓娴, 谢臣晨, 龚正阳, 等. 电子烟的健康风险研究进展[J]. 环境与职业医学, 2021, 38(4): 438-445., articleTitle=null, refAbstract=null), Reference(id=1321169982600364415, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169970302664979, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=43, rfOrder=42, authorNames=null, journalName=null, refType=null, unstructuredReference=Gentzke A S, Wang T W, Marynak K L, et al. Exposure to Secondhand Smoke and Secondhand E-Cigarette Aerosol Among Middle and High School Students[J]. 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Comparison of demographic characteristics and detection rates of mental health problems in the surveyed population

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变量调查人数人数比例/%有心理健康问题人数心理健康问题检出率/%χ2值P值
性别20.021<0.001
　男性1 50771.3515110.02
　女性60528.6510317.02
年龄/岁1.4710.225
　13～1523911.32239.62
　16～181 87388.6823412.49
年级9.7310.008
　一年级1 28961.0313310.32
　二年级56726.858014.11
　三年级及以上25612.124116.02
专业分类1.5450.672
　文科/管理/经济1 36064.3917212.65
　理科/工科66431.4471.05
　医学/药学/公共卫生643.03710.94
　其他241.1428.33
家庭居住地8.2540.041
　农村1 22958.1913410.90
　乡镇1768.331810.23
　县城1798.482011.17
　城市52825.008215.53
民族1.0070.316
　汉族1 71481.1621212.37
　其他民族39818.844210.55
父亲文化程度18.6910.001
　小学及以下50623.96489.49
　初中93844.4110411.09
　高中或中专41119.466114.84
　大专1527.201711.18
　大学本科及以上1054.972422.86
母亲文化程度15.0950.005
　小学及以下71233.71699.69
　初中84339.919511.27
　高中或中专35116.625716.24
　大专1145.401513.16
　大学本科及以上924.361819.57
父亲职业5.4720.361
　工人/农民/商人1 43868.0916211.27
　行政干部/公司职员1959.233115.90
　科技或教育工作301.42310.00
　退休210.99419.05
　无业1929.092714.06
　其他23611.182711.44
母亲职业20.3820.001
　工人/农民/商人1 30161.601289.84
　行政干部/公司职员1487.001912.84
　科技或教育工作653.081015.38
　退休200.95525.00
　无业36017.056317.50
　其他21810.322913.30
月消费金额/元5.2360.264
　<50046021.786113.26
　500～99970933.578111.42
　1 000～1 49963530.076710.55
　1 500～1 9991647.772112.80
　≥2 0001446.812416.67
每天≥30 min体育锻炼24.577<0.001
　是1 49170.601459.73
　否62129.4010817.39
平时睡眠时长/h37.526<0.001
　<61255.923225.60
　6～40319.086516.13
　7～99747.2110910.93
　≥858727.79488.18
自我报告健康状况103.582<0.001
　很好72534.33527.17
　较好76536.22719.28
　一般54425.769918.20
　较差582.752339.66
　很差200.95945.00
吸烟2.1650.141
　是44921.264510.02
　否1 66378.7420912.57
卷烟二手烟暴露2.6480.104
　是90642.9012113.36
　否1 20657.1013311.03
电子烟二手气溶胶暴露13.961<0.001
　是62029.3610016.13
　否1 49270.6415410.32
心理健康问题
　有25412.03
　无1 85887.97
), ArticleFig(id=1321169977261015376, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169970302664979, language=CN, label=表1, caption=

调查对象人口学特征分布及心理健康问题检出率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
变量调查人数人数比例/%有心理健康问题人数心理健康问题检出率/%χ2值P值
性别20.021<0.001
　男性1 50771.3515110.02
　女性60528.6510317.02
年龄/岁1.4710.225
　13～1523911.32239.62
　16～181 87388.6823412.49
年级9.7310.008
　一年级1 28961.0313310.32
　二年级56726.858014.11
　三年级及以上25612.124116.02
专业分类1.5450.672
　文科/管理/经济1 36064.3917212.65
　理科/工科66431.4471.05
　医学/药学/公共卫生643.03710.94
　其他241.1428.33
家庭居住地8.2540.041
　农村1 22958.1913410.90
　乡镇1768.331810.23
　县城1798.482011.17
　城市52825.008215.53
民族1.0070.316
　汉族1 71481.1621212.37
　其他民族39818.844210.55
父亲文化程度18.6910.001
　小学及以下50623.96489.49
　初中93844.4110411.09
　高中或中专41119.466114.84
　大专1527.201711.18
　大学本科及以上1054.972422.86
母亲文化程度15.0950.005
　小学及以下71233.71699.69
　初中84339.919511.27
　高中或中专35116.625716.24
　大专1145.401513.16
　大学本科及以上924.361819.57
父亲职业5.4720.361
　工人/农民/商人1 43868.0916211.27
　行政干部/公司职员1959.233115.90
　科技或教育工作301.42310.00
　退休210.99419.05
　无业1929.092714.06
　其他23611.182711.44
母亲职业20.3820.001
　工人/农民/商人1 30161.601289.84
　行政干部/公司职员1487.001912.84
　科技或教育工作653.081015.38
　退休200.95525.00
　无业36017.056317.50
　其他21810.322913.30
月消费金额/元5.2360.264
　<50046021.786113.26
　500～99970933.578111.42
　1 000～1 49963530.076710.55
　1 500～1 9991647.772112.80
　≥2 0001446.812416.67
每天≥30 min体育锻炼24.577<0.001
　是1 49170.601459.73
　否62129.4010817.39
平时睡眠时长/h37.526<0.001
　<61255.923225.60
　6～40319.086516.13
　7～99747.2110910.93
　≥858727.79488.18
自我报告健康状况103.582<0.001
　很好72534.33527.17
　较好76536.22719.28
　一般54425.769918.20
　较差582.752339.66
　很差200.95945.00
吸烟2.1650.141
　是44921.264510.02
　否1 66378.7420912.57
卷烟二手烟暴露2.6480.104
　是90642.9012113.36
　否1 20657.1013311.03
电子烟二手气溶胶暴露13.961<0.001
　是62029.3610016.13
　否1 49270.6415410.32
心理健康问题
　有25412.03
　无1 85887.97
), ArticleFig(id=1321169977357484369, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169970302664979, language=EN, label=Tab.2, caption=

Multifactorial logistic regression analysis of secondhand e-cigarette aerosol exposure and mental health problems in the study population

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自变量参照组β $ S_{\overline{x}} $Wald χ2值OR值95%CIP值
女性男性0.5230.14712.5851.6861.263～2.251<0.001
父亲文化程度0.1880.0687.5741.2071.056～1.3810.006
平均睡眠时长–0.2730.08211.1470.7610.649～0.8940.001
自我报告健康状况0.5290.07846.1831.6981.457～1.978<0.001
电子烟二手气溶胶暴露否0.4060.1467.7011.5001.127～1.9980.006
), ArticleFig(id=1321169977458147666, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169970302664979, language=CN, label=表2, caption=

调查对象电子烟二手气溶胶暴露与心理健康问题的多因素logistic回归分析

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自变量参照组β $ S_{\overline{x}} $Wald χ2值OR值95%CIP值
女性男性0.5230.14712.5851.6861.263～2.251<0.001
父亲文化程度0.1880.0687.5741.2071.056～1.3810.006
平均睡眠时长–0.2730.08211.1470.7610.649～0.8940.001
自我报告健康状况0.5290.07846.1831.6981.457～1.978<0.001
电子烟二手气溶胶暴露否0.4060.1467.7011.5001.127～1.9980.006
), ArticleFig(id=1321169977558810963, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169970302664979, language=EN, label=Tab.3, caption=

Multiple linear regression analysis of secondhand e-cigarette aerosol exposure and mental health status in different dimensions among the participants

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变量参照组模型一：躯体症状维度模型二：焦虑/担忧维度模型三：家庭关系不良维度
b $ {S_{\overline x }} $P值b $ {S_{\overline x }} $P值b $ {S_{\overline x }} $P值
女性男性0.7550.129<0.0010.4800.1400.001–0.3140.0970.001
年级一年级–0.0140.0810.862–0.0230.0880.7970.2150.061<0.001
每天缺乏≥30 min体育锻炼不缺乏0.2090.1270.1000.4150.1380.0030.1650.0950.083
平均睡眠时长<6 h–0.3940.068<0.001–0.3050.074<0.001–0.0790.0510.122
自我报告健康状况很好0.7760.065<0.0010.8370.070<0.0010.0440.0480.366
电子烟二手气溶胶暴露无0.7580.123<0.0010.6910.134<0.001–0.0740.0920.423
城市农村–0.2770.1620.088–0.3830.1760.0300.0850.1210.483
常量5.1870.411<0.0015.0030.446<0.0014.8930.307<0.001
), ArticleFig(id=1321169977651085652, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169970302664979, language=CN, label=表3, caption=

调查对象电子烟二手气溶胶暴露与不同维度心理健康状况多元线性回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量参照组模型一：躯体症状维度模型二：焦虑/担忧维度模型三：家庭关系不良维度
b $ {S_{\overline x }} $P值b $ {S_{\overline x }} $P值b $ {S_{\overline x }} $P值
女性男性0.7550.129<0.0010.4800.1400.001–0.3140.0970.001
年级一年级–0.0140.0810.862–0.0230.0880.7970.2150.061<0.001
每天缺乏≥30 min体育锻炼不缺乏0.2090.1270.1000.4150.1380.0030.1650.0950.083
平均睡眠时长<6 h–0.3940.068<0.001–0.3050.074<0.001–0.0790.0510.122
自我报告健康状况很好0.7760.065<0.0010.8370.070<0.0010.0440.0480.366
电子烟二手气溶胶暴露无0.7580.123<0.0010.6910.134<0.001–0.0740.0920.423
城市农村–0.2770.1620.088–0.3830.1760.0300.0850.1210.483
常量5.1870.411<0.0015.0030.446<0.0014.8930.307<0.001
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青少年电子烟二手气溶胶暴露与心理健康问题关系
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李瑛 1 , 白芙蓉 1 , 王雯雯 2 , 吴良鹏 2 , 孟州令 3 , 彭嗣惠 2, *, *
中国公共卫生 | 专题报道——拒绝烟草诱惑，对第一支烟说不 2025,41(5): 526-531
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中国公共卫生 |专题报道——拒绝烟草诱惑，对第一支烟说不 2025 , 41 (5) : 526 -531
青少年电子烟二手气溶胶暴露与心理健康问题关系
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李瑛1, 白芙蓉1, 王雯雯2, 吴良鹏2, 孟州令3, 彭嗣惠2, *, *
作者信息
  • 1西安医学院公共卫生学院，西安 710021
  • 2暨南大学基础医学与公共卫生学院，广州 510632
  • 3昆明卫生职业学院教务处，昆明 650607
通讯作者:
彭嗣惠，E-mail：
作者简介:

李瑛（1991—），讲师，硕士，研究方向：健康行为与生命质量

Relationship between secondhand electronic cigarette aerosol exposure and mental health problems in adolescents
Ying LI1, Furong BAI1, Wenwen WANG2, Liangpeng WU2, Zhouling MENG3, Sihui PENG2
Affiliations
  • 1School of Public Health, Xi’an Medical University, Xi'an 710021, China
  • 2Jinan University, Guangzhou 510632, China
  • 3Kunming Health Vocational College, Kunming 650607, China
    • Corresponding Author:
    PENG Sihui, E-mail:
出版时间: 2025-05-10 doi: 10.11847/zgggws1145632
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摘要
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目的

探究青少年电子烟二手气溶胶暴露与心理健康问题的关系，为无烟环境政策制定提供参考依据。

方法

于2023年3—6月，采用多阶段分层整群抽样方法，在全国范围内对2 112名≤18岁全日制在校生进行在线问卷调查，采用χ2检验进行人口学信息与心理健康问题的单因素分析，二元logistic回归分析电子烟二手气溶胶暴露与青少年心理健康问题的关系，多元线性回归分析电子烟二手气溶胶暴露与青少年心理健康问题的躯体症状、焦虑/担忧、家庭关系不良3个维度的关系。

结果

本研究中青少年有心理健康问题者254人（12.03%），有电子烟二手气溶胶暴露者620人（29.36%）。二元logistic回归分析结果显示，电子烟二手气溶胶暴露者心理健康问题发生的风险是非暴露者的1.500倍（OR=1.500，95%CI=1.127～1.998）。多元线性回归结果显示，过去30 d内有电子烟二手气溶胶暴露的青少年有更严重的躯体症状（b=0.758，P= <0.001）和更高的焦虑/担忧（b=0.691，P= <0.001）。

结论

青少年电子烟二手气溶胶暴露与心理健康问题发生呈正相关，且与躯体症状维度、焦虑/担忧维度有关。

电子烟  /  二手气溶胶  /  青少年  /  心理健康问题
Objective

To investigate the relationship between secondhand e-cigarette aerosol exposure and mental health problems in adolescents, and to provide a reference for the formulation of smoke-free environment policies.

Methods

From March to June 2023, a multi-stage stratified cluster sampling method was used to conduct an online questionnaire survey of 2 112 full-time students aged ≤18 years nationwide. A χ2 test was used for univariate analysis of demographic information and mental health problems. Binary logistic regression was used to analyze the relationship between secondhand e-cigarette aerosol exposure and mental health problems in adolescents. Multiple linear regression was used to analyze the relationship between secondhand e-cigarette aerosol exposure and the three dimensions of mental health problems in adolescents: somatic symptoms, anxiety/worry, and family relationships.

Results

In this study the prevalence of mental health problems were 12.03% (254 adolescents) and 620 (29.36%) were exposed to secondhand e-cigarette aerosol. Binary logistic regression analysis showed that adolescents exposed to secondhand e-cigarette aerosol had a 1.500 times higher risk of developing mental health problems than those not exposed (OR = 1.500, 95%CI: 1.127 - 1.998). Multiple linear regression results showed that adolescents exposed to secondhand e-cigarette aerosol in the past 30 days had more severe somatic symptoms (b = 0.758, P < 0.001) and higher anxiety/worry (b = 0.691, P< 0.001).

Conclusions

Secondhand e-cigarette aerosol exposure in adolescents is positively correlated with the occurrence of mental health problems, and is related to the dimensions of somatic symptoms and anxiety/worry.

e-cigarettes  /  secondhand aerosol  /  adolescents  /  mental health problems
李瑛, 白芙蓉, 王雯雯, 吴良鹏, 孟州令, 彭嗣惠. 青少年电子烟二手气溶胶暴露与心理健康问题关系. 中国公共卫生, 2025 , 41 (5) : 526 -531 . DOI: 10.11847/zgggws1145632
Ying LI, Furong BAI, Wenwen WANG, Liangpeng WU, Zhouling MENG, Sihui PENG. Relationship between secondhand electronic cigarette aerosol exposure and mental health problems in adolescents[J]. Chinese Journal of Public Health, 2025 , 41 (5) : 526 -531 . DOI: 10.11847/zgggws1145632
正文
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电子烟的原理是电池动力装置将烟液加热转化为可吸入的微小颗粒气溶胶，供吸食者使用。然而，随着吸食者的抽吸，部分气溶胶暴露于环境中，形成二手气溶胶（secondhand aerosol，SHA）[1–2]，造成环境污染[3–5]。SHA中含有尼古丁、丙二醇、羰基化合物、烟草特有N–亚硝胺（TSNAs）、重金属等[6–7]。青少年暴露于SHA会引起肺功能急性下降、喉咙痛、呼吸道和眼部症状等躯体健康不良后果[8–9]，但对心理健康不良影响研究较少[10]。心理健康问题是一种影响一个人的思维、感觉或情绪的状态，可能会影响个体与他人交往和日常生活的能力[11]。青少年是发生心理健康问题的高危人群[12]，而我国目前多聚焦成人卷烟二手烟（secondhand smoking, SHS）暴露和青少年电子烟使用与心理健康问题的研究[11,13]，青少年电子烟SHA暴露与心理健康问题相关研究证据较少。基于此，本研究于2023年3—6月，对4个城市11所高职院校的2 112名13～18岁全日制不吸电子烟在校生进行调查，分析我国青少年电子烟SHA暴露与心理健康问题的关系，为无烟环境政策制定提供参考依据。
1　对象与方法
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1.1　对象
于2023年3—6月，采用多阶段分层整群抽样方法对全日制在校高职院校学生进行横断面调查。第1阶段，按照地理位置分布和经济发展水平从全国选取广州、上海、兰州和昆明4所城市；第2阶段，在每个城市依据合作意愿确定2～3所高职院校参与调查，该阶段共确定11所院校；第3阶段，每所院校按大类专业比例抽取2～3个班级；第4阶段，对抽样班级中所有学生进行调查。研究对象纳入标准：（1）年龄≤18岁；（2）全日制在读；（3）正常读写中文；（4）拥有可上网的智能手机。排除标准：（1）过去1个月提出休学；（2）有严重身体和心理疾病导致难以完成调查者；（3）自我报告正在使用电子烟，包括经常使用和偶尔使用。本研究共调查2 175人，有效人数2 112人，有效率为97.10%。所有参与者均知情同意、匿名调查。本研究已获暨南大学基础医学与公共卫生学院伦理委员会审批（JNUKY-2022-047）。
1.2　方法
根据研究目的参考全球青少年烟草调查（Global Youth Tobacco Survey，GYTS）设计调查问卷[14]，以线下发布、线上填写的数据采集方式进行调查。问卷内容包括：（1）人口学特征（性别、年龄、年级、专业、家庭居住地、父母文化程度及职业、自我报告健康状况等），父母职业中“无业”是指无正式职业，包括待业、失业和全职家务的情况，自由职业归类为“其他”。（2）健康相关行为（体育锻炼、睡眠时长、吸烟及SHS暴露等）。其中，体育锻炼通过询问“每天有≥30 min的体育锻炼”，回答为“是”或“否”；吸烟是指吸卷烟，通过询问“目前你是否吸卷烟”进行判断，应答项为：1=每天都要吸、2=只在某些天吸、3=不吸，应答1和2者定义为吸烟；通过询问“在过去30 d内，你接触卷烟二手烟的情况是”和“在过去30 d内，有人在你面前吸电子烟吗”来界定SHS和SHA暴露，应答项为：1=几乎每天、2=平均每周有4～6 d、3=平均每周有1～3 d、4=从来没有。回答4定义为没有SHS/SHA暴露，编码为0，否则为1。（3）心理健康状况采用杨廷忠等人在一般健康问卷（General Health Questionnaire, GHQ）基础上修订的中文版一般健康问卷（Chinese General Health Questionnaire, CHQ），共12个条目，广泛用于流行病学调查和社区人群心理健康问题的筛查，具有较好的信效度[15]。各条目询问调查者最近1～2周的健康情况，各有4个应答项：1=一点也不、2=与平时差不多、3=比平时严重些、4=比平时严重得多，其中，回答1、2项记0分，3、4项记1分，第7和10条目为反向计分，总分为0～12分，分数越高代表心理困扰程度越高，>3分定义为有心理健康问题[16]。本研究中的Cronbach′s α 系数为0.816。需特殊说明的是本研究中的心理健康问题是社区人群倾向性的表达，与临床心理学中的精神障碍不同。该问卷可分为躯体症状、焦虑/担忧、家庭关系不良3个维度，各应答项分别记1～4分（第7和10条目反向计分），得分越低代表该维度健康状况越好[16]。
1.3　统计分析
数据使用Excel 2021软件录入到数据库，采用SPSS 26.0软件进行统计分析。计数资料以频数和构成比（%）表示，组间比较采用χ2检验。采用logistic回归分析电子烟SHA暴露与心理健康问题关系；采用多元线性回归分析躯体症状、焦虑/担忧、家庭关系不良3个维度与自变量的关系。方程采用逐步后退法，双侧检验，检验水准$ \alpha $=0.05。
2　结　果
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2.1　调查对象人口学特征及心理健康问题检出率（表1）
最终纳入2 112名13～18岁不吸电子烟的青少年，男生1 507人（71.35%），女生605人（28.65%）；家庭居住地为农村1 229人（58.19%）；1 714人（81.16%）为汉族；每天体育锻炼>30 min有1 491人（70.60%）；每天平均睡眠时长≥7 h有1 584人（75.00%）；有449人（21.26%）吸卷烟；有906人（42.90%）存在SHS暴露；有620人（29.36%）存在SHA暴露；有423人（20.03%）同时存在SHS和SHA暴露。有心理健康问题者254人，占12.03%。不同人口学信息与心理健康问题检出率的单因素χ2检验结果显示，不同性别、年级、家庭居住地、父亲文化程度、母亲文化程度、母亲职业、每天≥30 min体育锻炼、每天平均睡眠时长、自我报告健康状况、SHA暴露等比较差异均有统计学意义（均P<0.05）。
2.2　电子烟二手气溶胶暴露与心理健康问题的关系（表2）
按照CHQ得分的判断标准，以心理健康问题为因变量Y（无=0，有=1），以电子烟SHA暴露为自变量，将单因素分析中P<0.05的9个因素（性别、年级、家庭居住地、父亲文化程度、母亲文化程度、母亲职业、每天≥30 min体育锻炼、每天平均睡眠时长、自我报告健康状况）、SHS暴露作为控制变量纳入分析。logistic回归分析结果显示，电子烟SHA暴露者心理健康问题发生风险是非暴露者的1.500倍（95%CI=1.144～2.038）。
2.3　电子烟二手气溶胶暴露与CHQ各维度的关系（表3）
调查对象躯体症状维度、焦虑/担忧维度、家庭关系不良维度的平均得分分别为7.89、8.03、4.63分。以CHQ 3个维度的分数分别为因变量，以是否有SHA暴露为自变量，以单因素分析中有意义的9个因素（性别、年级、家庭居住地、父亲文化程度、母亲文化程度、母亲职业、每天≥30 min体育锻炼、每天平均睡眠时长、自我报告健康状况）、SHS暴露为协变量纳入多元线性回归分析，得到3个模型。模型一（躯体症状维度）结果显示，电子烟SHA暴露会使躯体症状增加（b=0.758，P<0.05）；模型二（焦虑/担忧维度）结果显示，电子烟SHA暴露会增加焦虑/担忧（b=0.691，P<0.05）；模型三（家庭关系不良维度）结果显示，电子烟SHA暴露与家庭关系之间无统计学意义（b= –0.074，P=0.423>0.05）。
3　讨　论
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有关电子烟SHA暴露研究自2015年以来呈上升趋势，成为近年来的公共卫生热点问题[17]。美国全国青少年烟草调查数据显示，虽然二手烟暴露有所下降，但SHA暴露显著增加[18]。2020年，美国青少年电子烟SHA暴露率为44.5%[19]。本研究中有29.36%的青少年报告在过去30 d内曾暴露于电子烟SHA，与2023年中国疾病预防控制中心发布的中国青少年烟草调查报告中，我国中学生在过去30 d内暴露于二手烟（卷烟、电子烟）的比例（35.4%）[20]相当。SHA暴露增加与烟草营销宣传、电子烟认知和态度，以及环境控烟政策有关。近年来，电子烟以成分更清洁、更易戒除，是传统香烟的健康替代品等宣传特征[21]，制造了电子烟无害的假象，削弱了青少年对电子烟及其SHA健康危害后果的群体意识[22]。已有研究发现，青少年持有“电子烟可以帮助戒烟”“电子烟不会产生二手烟”或“电子烟二手气溶胶对健康无害”等错误观念[23–25]，一项面向1 056名成都青少年的研究显示，有23.10%的青少年不知道电子烟会产生SHA[26]，这些错误的认知将导致非吸食者青少年对同伴和公众在家庭、学校和公共场所吸食电子烟及其造成SHA暴露的行为持有更加包容的态度，进而增加了青少年电子烟使用倾向[27–28]，以及他们对电子烟和烟草的易感性[29–30]。尽管我国从保护未成年人的立场上采取了一系列收紧电子烟的生产、销售和监管的措施[31]，但青少年仍然可以通过各种社交媒体接触电子烟广告[32]。未来公共卫生行动要重视个体教育和政策强化相结合，一方面加强对青少年电子烟SHA暴露的健康教育，树立正确认知和态度；另一方面积极推进室内外公共场所禁止电子烟，规范电子烟宣传途径和销售渠道，尤其是针对短视频等新媒体平台空间增强监管[33]，以此减少环境中SHA暴露风险，保护青少年的身心健康发展。
本研究结果表明，电子烟SHA暴露是青少年心理健康问题发生的危险因素，进一步分析发现，SHA暴露的青少年报告了更严重的躯体症状和更高的焦虑/担忧。SHA常与SHS出现双重暴露[34]，本研究中有20.03%的青少年同时暴露于SHA和SHS。国外研究指出，SHS与抑郁症状、躯体症状之间存在单调递增的剂量–反应关系[35]，非吸烟者接触SHS出现心理困扰的可能性要高出近50%[36]。SHA暴露对心理健康问题的影响机制可能与SHS具有相似性，包括相同的有害成分（如尼古丁暴露对情绪的失调效应）[37–39]和压力应对机制[11]。不可否认，电子烟SHA暴露与心理健康问题的关系还需更严谨的控制试验设计来检验。
保护公众免受烟草危害是世界卫生组织提出的重要政策措施。2020年，《中华人民共和国未成年人保护法》[40]首次将“电子烟”写入国家层面的立法范畴中，2021年我国修订了《中华人民共和国烟草专卖法实施条例》[41]，要求电子烟参照卷烟的有关规定执行。尽管如此，目前仅有深圳市、上海市、杭州市和香港特别行政区等部分行政区域的地方性法规中明确将电子烟纳入公共场所禁烟范围[42]。缺乏国家层面对公共场所使用电子烟的监管，可能会使现有的无烟政策执行受到阻力，助长烟草使用行为的正常化[43]。只有全面有力执行包括电子烟在内的无烟政策，才能降低社会对电子烟及其SHA暴露的接受度，才能保护青少年免受其被动危害，这也是《“健康中国”2030规划纲要》中实现室内公共场所全面禁烟目标的必经之路。
本研究仍存在许多不足。首先本研究为横断面调查，无法推断电子烟SHA与心理健康问题间的因果联系，未来应考虑开展长周期的时间队列设计研究。其次，本研究中电子烟SHA暴露未区分具体场所，下一步研究应考虑不同场所SHA暴露的差异。最后，本研究中的变量测量为主观应答，可能存在记忆偏差，将来研究需进一步采用客观抽样法或诊断法以评估研究变量。

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2025年第41卷第5期
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doi: 10.11847/zgggws1145632
  • 接收时间：2024-08-07
  • 首发时间：2026-10-25
  • 出版时间：2025-05-10
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  • 收稿日期：2024-08-07
  • 修回日期：2025-02-10
  • 录用日期：2025-04-11
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    1西安医学院公共卫生学院，西安 710021
    2暨南大学基础医学与公共卫生学院，广州 510632
    3昆明卫生职业学院教务处，昆明 650607

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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