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Article(id=1321169925239058554, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169924697993338, articleNumber=null, orderNo=null, doi=10.11847/zgggws1145812, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1724947200000, receivedDateStr=2024-08-30, revisedDate=1735833600000, revisedDateStr=2025-01-03, acceptedDate=1744300800000, acceptedDateStr=2025-04-11, onlineDate=1792921056327, onlineDateStr=2026-10-25, pubDate=1746806400000, pubDateStr=2025-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921056327, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921056327, creator=13701087609, updateTime=1792921056327, 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=520, endPage=525, ext={EN=ArticleExt(id=1321169925478133884, articleId=1321169925239058554, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=The impact of school smoking control interventions on adolescents′ knowledge, attitudes, and behaviors regarding e-cigarettes, columnId=1321169925394247803, journalTitle=Chinese Journal of Public Health, columnName=Special Report – Special Report–Resist the Temptation: Say No to the First Cigarette, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the effectiveness of school-based tobacco control interventions by comparing students′ knowledge, attitudes, and use of e-cigarettes before and after the implementation of interventions, and to provide a basis for further development of school-based tobacco control measures.

Methods

From October 2022 to May 2023, a six-month tobacco control intervention was conducted among all students in a vocational high school in Qingpu district, Shanghai. Anonymous questionnaires were administered before and after the intervention. Propensity score matching was performed using gender, grade, and smoking/vaping status of family members and friends as matching variables. Data were compared using the χ2 test.

Results

A total of 981 and 819 valid questionnaires were collected at baseline and post-intervention, respectively. After propensity score matching, baseline and follow-up data from 770 students were obtained. At the end of the intervention, 79.5% of the students expressed their hope that the school would continue to promote the construction of a smoke-free environment. After the school-based tobacco control intervention, students′ awareness of the harms of e-cigarettes improved. The proportion of students who agreed that "e-cigarettes pose safety hazards" increased significantly from 81.8% to 85.8% (χ2 = 4.604, P = 0.032). Support for e-cigarette control measures increased among adolescents, especially support for banning e-cigarettes in indoor public places, which increased by 4.4% after the intervention. The proportion of students who had ever tried e-cigarettes increased from 4.4% to 5.5%, while the proportions of current e-cigarette users and those intending to use e-cigarettes decreased.

Conclusions

School-based tobacco control interventions are effective in improving students′ knowledge, attitudes, and intentions regarding e-cigarettes, but further efforts are needed to enhance the effectiveness of these interventions.

, authors=Chenyu QIAN1, Ling FANG1, Caifang SHEN2, Pinpin ZHENG1, authorsList=Chenyu QIAN, Ling FANG, Caifang SHEN, Pinpin ZHENG, authorCompany=null, correspAuthors=Pinpin ZHENG, authorNote=null, correspAuthorsNote=
ZHENG Pinpin, E-mail：
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目的

通过比较控烟干预实施前后学生对电子烟的认知、态度及使用情况变化，分析学校控烟干预效果，为进一步开展校内控烟措施提供依据。

方法

于2022年10月—2023年5月，在上海市青浦区某中职学校对全体在校学生开展为期半年的控烟干预。干预前、后各进行1次匿名问卷调查，以性别、年级、家庭成员及朋友是否使用卷烟、电子烟作为匹配变量进行倾向性评分匹配，匹配后数据采用χ2检验进行比较分析。

结果

基线和干预后分别回收到981和819份有效问卷。通过倾向性评分匹配，共获得770名学生的基线和随访数据。在干预结束后，有79.5%的学生在活动效果评价时表示希望学校继续推动无烟环境建设。经学校控烟干预后，学生对电子烟危害的认知程度有所提升，其中学生认同“电子烟存在安全隐患”的比例由81.8%显著上升至85.8%（χ2=4.604，P=0.032）；青少年对于支持电子烟管控的相关陈述均有所上升，尤其是室内公共场所禁止吸电子烟的支持率在干预后上升4.4%；学生尝试使用电子烟的比例从4.4%增至5.5%，当前吸电子烟及有使用意愿的学生比例均有所下降。

结论

学校控烟干预在提升学生对电子烟相关知识的知晓率、认知态度以及降低使用意愿方面效果显著，但仍需进一步加大干预力度。

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钱辰雨（2000—），硕士在读，研究方向：环境医学

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郑频频，E-mail：
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Comparison of basic information of participants before and after matching before and after the intervention

, figureFileSmall=null, figureFileBig=null, tableContent=
基本信息PSM处理前PSM处理后
基线干预后χ2值P值基线干预后χ2值P值
人数占比/%人数占比/%人数占比/%人数占比/%
性别8.2530.0040.0030.955
　男生64165.358771.754670.954771.0
　女生34034.723228.322429.122329.0
年级17.998<0.0010.0110.995
　一年级38238.926832.726133.926033.8
　二年级35636.337846.234244.434444.7
　三年级24324.817321.116721.716621.6
家庭成员是否使用卷烟0.0140.9040.0030.959
　是53754.744654.541854.341954.4
　否44445.337345.535245.735145.6
家庭成员是否使用电子烟0.1650.6850.0580.904
　是 52 5.3 475.7354.5374.8
　否92994.777294.373595.573395.2
朋友是否使用卷烟4.3390.037<0.0010.999
　是 89 9.1 9912.1709.1709.1
　否89290.972087.970090.970090.9
朋友是否使用电子烟0.3360.5620.0090.925
　是 88 9.0 809.8607.8617.9
　否89391.073990.271092.270992.1
), ArticleFig(id=1321169929513054372, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169925239058554, language=CN, label=表1, caption=

干预前后调查对象及匹配前后基本信息比较

, figureFileSmall=null, figureFileBig=null, tableContent=
基本信息PSM处理前PSM处理后
基线干预后χ2值P值基线干预后χ2值P值
人数占比/%人数占比/%人数占比/%人数占比/%
性别8.2530.0040.0030.955
　男生64165.358771.754670.954771.0
　女生34034.723228.322429.122329.0
年级17.998<0.0010.0110.995
　一年级38238.926832.726133.926033.8
　二年级35636.337846.234244.434444.7
　三年级24324.817321.116721.716621.6
家庭成员是否使用卷烟0.0140.9040.0030.959
　是53754.744654.541854.341954.4
　否44445.337345.535245.735145.6
家庭成员是否使用电子烟0.1650.6850.0580.904
　是 52 5.3 475.7354.5374.8
　否92994.777294.373595.573395.2
朋友是否使用卷烟4.3390.037<0.0010.999
　是 89 9.1 9912.1709.1709.1
　否89290.972087.970090.970090.9
朋友是否使用电子烟0.3360.5620.0090.925
　是 88 9.0 809.8607.8617.9
　否89391.073990.271092.270992.1
), ArticleFig(id=1321169929605329061, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169925239058554, language=EN, label=Tab.2, caption=

Evaluation of the effectiveness of school tobacco control interventions by the survey respondents (n = 770)

, figureFileSmall=null, figureFileBig=null, tableContent=
内容不同意一般同意
人数占比/%人数占比/%人数占比/%
我更全面地了解了吸烟和电子烟的危害719.210814.059176.8
我有更大的信心以后做一个无烟者658.410113.160478.4
我觉得学校的无烟环境比以前更好668.611915.558576.0
我觉得学校的吸烟行为比以前更少678.711715.258676.1
我支持学校采取更严格的措施来防止和减少吸烟628.110513.660378.3
我希望学校以后的无烟环境建设能够持续577.410113.161279.5
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调查对象对学校控烟干预活动效果评价（n=770）

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内容不同意一般同意
人数占比/%人数占比/%人数占比/%
我更全面地了解了吸烟和电子烟的危害719.210814.059176.8
我有更大的信心以后做一个无烟者658.410113.160478.4
我觉得学校的无烟环境比以前更好668.611915.558576.0
我觉得学校的吸烟行为比以前更少678.711715.258676.1
我支持学校采取更严格的措施来防止和减少吸烟628.110513.660378.3
我希望学校以后的无烟环境建设能够持续577.410113.161279.5
), ArticleFig(id=1321169929789878439, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169925239058554, language=EN, label=Tab.3, caption=

Awareness of e-cigarette harms (n =770)

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内容基线干预后χ2值P值
人数占比/%人数占比/%
吸电子烟会成瘾61980.464784.03.4810.062
吸电子烟对身体有害66686.568889.42.9600.085
电子烟会产生二手烟问题60778.863081.82.1740.140
电子烟对青少年智力发育有不良影响62180.664483.62.3420.126
电子烟本身存在安全隐患63081.866185.84.6040.032
), ArticleFig(id=1321169933329871016, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169925239058554, language=CN, label=表3, caption=

电子烟危害认知情况（n=770）

, figureFileSmall=null, figureFileBig=null, tableContent=
内容基线干预后χ2值P值
人数占比/%人数占比/%
吸电子烟会成瘾61980.464784.03.4810.062
吸电子烟对身体有害66686.568889.42.9600.085
电子烟会产生二手烟问题60778.863081.82.1740.140
电子烟对青少年智力发育有不良影响62180.664483.62.3420.126
电子烟本身存在安全隐患63081.866185.84.6040.032
), ArticleFig(id=1321169933430534313, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169925239058554, language=EN, label=Tab.4, caption=

Attitudes of adolescents towards e-cigarettes (n =770)

, figureFileSmall=null, figureFileBig=null, tableContent=
内容基线干预后χ2值P值
人数占比/%人数占比/%
我不想在吸电子烟的人身边停留38549.941453.82.1880.139
赞成室内公共场所禁止吸电子烟43856.947261.33.1050.078
赞成禁止向未成年人售卖电子烟53869.956072.71.5360.215
赞成在电子烟的产品包装上印刷电子烟对健康危害的警示54270.456973.92.3550.125
赞成青少年应该远离烟草及相关制品56273.057875.10.8650.352
), ArticleFig(id=1321169933694775466, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169925239058554, language=CN, label=表4, caption=

青少年对电子烟的态度（n=770）

, figureFileSmall=null, figureFileBig=null, tableContent=
内容基线干预后χ2值P值
人数占比/%人数占比/%
我不想在吸电子烟的人身边停留38549.941453.82.1880.139
赞成室内公共场所禁止吸电子烟43856.947261.33.1050.078
赞成禁止向未成年人售卖电子烟53869.956072.71.5360.215
赞成在电子烟的产品包装上印刷电子烟对健康危害的警示54270.456973.92.3550.125
赞成青少年应该远离烟草及相关制品56273.057875.10.8650.352
), ArticleFig(id=1321169933799633067, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169925239058554, language=EN, label=Tab.5, caption=

E-cigarette use and future intention to use among survey participants (n = 770)

, figureFileSmall=null, figureFileBig=null, tableContent=
内容基线干预后χ2值P值
人数%人数%
尝试过电子烟0.8860.347
　是344.4425.5
　否73695.672894.5
现在吸电子烟1.3320.248
　是121.670.9
　否75898.476399.1
电子烟使用意愿0.7380.390
　有648.3557.1
　无70691.771592.9
), ArticleFig(id=1321169933875130540, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169925239058554, language=CN, label=表5, caption=

调查对象电子烟使用情况及未来使用意愿（n=770）

, figureFileSmall=null, figureFileBig=null, tableContent=
内容基线干预后χ2值P值
人数%人数%
尝试过电子烟0.8860.347
　是344.4425.5
　否73695.672894.5
现在吸电子烟1.3320.248
　是121.670.9
　否75898.476399.1
电子烟使用意愿0.7380.390
　有648.3557.1
　无70691.771592.9
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学校控烟干预对青少年电子烟认知、态度及行为影响
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钱辰雨 1 , 方玲 1 , 沈彩芳 2 , 郑频频 1, *, *
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): 520-525
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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) : 520 -525
学校控烟干预对青少年电子烟认知、态度及行为影响
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钱辰雨1, 方玲1, 沈彩芳2, 郑频频1, *, *
作者信息
  • 1复旦大学公共卫生学院预防医学与健康教育教研室，上海 200030
  • 2上海市青浦区爱国卫生和健康促进指导中心，上海 201700
通讯作者:
郑频频，E-mail：
作者简介:

钱辰雨（2000—），硕士在读，研究方向：环境医学

The impact of school smoking control interventions on adolescents′ knowledge, attitudes, and behaviors regarding e-cigarettes
Chenyu QIAN1, Ling FANG1, Caifang SHEN2, Pinpin ZHENG1
Affiliations
  • 1Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, Shanghai 200030, China
  • 2Patriotic Health and Health Promotion Guidance Center, Qingpu District, Shanghai 201700, China
    • Corresponding Author:
    ZHENG Pinpin, E-mail：
出版时间: 2025-05-10 doi: 10.11847/zgggws1145812
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摘要
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目的

通过比较控烟干预实施前后学生对电子烟的认知、态度及使用情况变化，分析学校控烟干预效果，为进一步开展校内控烟措施提供依据。

方法

于2022年10月—2023年5月，在上海市青浦区某中职学校对全体在校学生开展为期半年的控烟干预。干预前、后各进行1次匿名问卷调查，以性别、年级、家庭成员及朋友是否使用卷烟、电子烟作为匹配变量进行倾向性评分匹配，匹配后数据采用χ2检验进行比较分析。

结果

基线和干预后分别回收到981和819份有效问卷。通过倾向性评分匹配，共获得770名学生的基线和随访数据。在干预结束后，有79.5%的学生在活动效果评价时表示希望学校继续推动无烟环境建设。经学校控烟干预后，学生对电子烟危害的认知程度有所提升，其中学生认同“电子烟存在安全隐患”的比例由81.8%显著上升至85.8%（χ2=4.604，P=0.032）；青少年对于支持电子烟管控的相关陈述均有所上升，尤其是室内公共场所禁止吸电子烟的支持率在干预后上升4.4%；学生尝试使用电子烟的比例从4.4%增至5.5%，当前吸电子烟及有使用意愿的学生比例均有所下降。

结论

学校控烟干预在提升学生对电子烟相关知识的知晓率、认知态度以及降低使用意愿方面效果显著，但仍需进一步加大干预力度。

青少年  /  电子烟  /  无烟学校建设  /  控烟干预  /  上海市
Objective

To analyze the effectiveness of school-based tobacco control interventions by comparing students′ knowledge, attitudes, and use of e-cigarettes before and after the implementation of interventions, and to provide a basis for further development of school-based tobacco control measures.

Methods

From October 2022 to May 2023, a six-month tobacco control intervention was conducted among all students in a vocational high school in Qingpu district, Shanghai. Anonymous questionnaires were administered before and after the intervention. Propensity score matching was performed using gender, grade, and smoking/vaping status of family members and friends as matching variables. Data were compared using the χ2 test.

Results

A total of 981 and 819 valid questionnaires were collected at baseline and post-intervention, respectively. After propensity score matching, baseline and follow-up data from 770 students were obtained. At the end of the intervention, 79.5% of the students expressed their hope that the school would continue to promote the construction of a smoke-free environment. After the school-based tobacco control intervention, students′ awareness of the harms of e-cigarettes improved. The proportion of students who agreed that "e-cigarettes pose safety hazards" increased significantly from 81.8% to 85.8% (χ2 = 4.604, P = 0.032). Support for e-cigarette control measures increased among adolescents, especially support for banning e-cigarettes in indoor public places, which increased by 4.4% after the intervention. The proportion of students who had ever tried e-cigarettes increased from 4.4% to 5.5%, while the proportions of current e-cigarette users and those intending to use e-cigarettes decreased.

Conclusions

School-based tobacco control interventions are effective in improving students′ knowledge, attitudes, and intentions regarding e-cigarettes, but further efforts are needed to enhance the effectiveness of these interventions.

adolescents  /  e-cigarettes  /  smoke-free schools  /  tobacco control interventions  /  Shanghai city
钱辰雨, 方玲, 沈彩芳, 郑频频. 学校控烟干预对青少年电子烟认知、态度及行为影响. 中国公共卫生, 2025 , 41 (5) : 520 -525 . DOI: 10.11847/zgggws1145812
Chenyu QIAN, Ling FANG, Caifang SHEN, Pinpin ZHENG. The impact of school smoking control interventions on adolescents′ knowledge, attitudes, and behaviors regarding e-cigarettes[J]. Chinese Journal of Public Health, 2025 , 41 (5) : 520 -525 . DOI: 10.11847/zgggws1145812
正文
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电子烟的使用已成为重要的公共卫生问题，因其迎合青少年好奇、模仿、猎奇等心理特点，使用电子烟最多的人群为15～24岁的青少年[1–2]。2019年中国中学生烟草调查数据显示，过去5年我国青少年电子烟的知晓率和使用率明显升高[3]。2021年中国中学生听说过电子烟、使用过电子烟、现在使用电子烟的比例分别为86.6%、16.1%和3.6%，与2019年相比分别上升了9.2%、3.5%和0.8%，而职高生使用电子烟的比例及其上升幅度均明显高于普高生和初中生[4]。青少年处于身体发育阶段，电子烟的使用不仅损害青少年的生理和心理健康，影响神经系统的发育，增加其他成瘾性行为发生的风险，还存在“门户效应”，即电子烟成为青少年吸食传统卷烟的桥梁，甚至出现电子烟和传统卷烟的双重使用[5–6]。学校作为青少年学习和生活的主要场所，加强学校无烟环境建设和控烟教育，增加有关电子烟及其危害的知识，提高青少年对同伴电子烟使用的抵抗力，可降低青少年电子烟的使用风险[1]。本研究于2022年10月—2023年5月在上海市青浦区某中等职业学校对全校学生开展控烟干预，通过比较学校控烟干预实施前后学生对电子烟的认知、态度及使用变化情况，分析学校控烟干预效果，为进一步开展校内控烟措施提供依据。
1　对象与方法
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1.1　对象
综合考虑学校地理位置以及学校无烟环境建设水平，选取上海市青浦区某中等职业学校的15～20岁全体在校学生作为调查对象。纳入标准：（1）上海市青浦区某中职学校在校学生；（2）在规定时间内完成问卷调查；（3）能够参与本研究的学生；（4）问卷的质量符合控制标准者。基线调查共有1 016名学生参与，实际有效人数981人，有效应答率为96.6%；干预后调查学生827人，实际有效819人，有效应答率为99%。本研究经复旦大学伦理委员会审批通过（IRB#2021-04-0898），并获得学生家长的知情同意。
1.2　方法
研究人员在研究开展前明确告知所有班级的班主任调查细则，由班主任向学生解释问卷填写的具体步骤，学生在限定时间内自行完成网络问卷调查。调查分2次进行，干预前于2022年10月在上海市青浦区某中等职业学校的全体在校学生中进行匿名第1次问卷调查。在基线调查完成后，上海市青浦区某中等职业学校以《关于进一步加强无烟学校建设工作的通知》[7]中的无烟学校建设指南为指导，结合《关于进一步加强青少年控烟工作的通知》[8]、《关于进一步保护未成年人免受电子烟侵害的通告》[9]开展一系列学校控烟干预活动。首先建立健全学校控烟规章制度，开展全方位控烟检查；营造无烟环境，根据《上海市公共场所控制吸烟条例》在校内外设置明显的禁烟警示和最新版禁烟标识[10]，其中包括电子烟；另外，在多形式开展的控烟宣传教育中对学生进行电子烟特色干预，发放科普材料《电子烟并不安全》等给学生讲述电子烟的危害、各班级开展远离电子烟主题班会、组织学生设计禁烟（含电子烟）小报比赛以及邀请专家进行电子烟相关专题讲座等。在系列控烟干预措施实施半年后，于2023年5月对全体学生进行第2次问卷调查。
1.3　问卷调查
基于全球青少年烟草调查问卷（Global Youth Tobacco Survey, GYTS）[11]和国内外相关文献[12–14]自行设计问卷。基线问卷主要包括：调查对象基本特征（性别、年级、周围朋友、父母等人群卷烟及电子烟使用情况等6道题）；对电子烟危害的认知及态度（10道题）；电子烟暴露情况（电子烟尝试使用情况和现在使用情况，未来电子烟使用意愿，学校电子烟的二手烟暴露情况等10题），共计26题。干预后问卷内容与基线问卷基本保持一致，仅添加4道学生对学校控烟干预的过程和效果评价相关问题，共计30题。
1.4　指标定义
尝试过电子烟[15]：曾经吸过电子烟，即使只吸一两口；现在吸电子烟[15]：过去30 d内使用过电子烟；电子烟使用意愿：“在未来12个月，你认为自己有可能使用电子烟吗”回答“肯定不会”者为无电子烟使用意愿；电子烟危害认知判定：“在以下关于电子烟危害的观点中选择合适的一项”，回答“正确”者为电子烟的危害认知情况好。
1.5　质量控制
调查人员为具备专业知识的控烟领域研究人员。为了确保问卷填写的真实性和保护学生的隐私，2次调查均通过问卷，并以匿名形式在线进行的。为了能够将匿名的基线和随访问卷做到前后匹配，减少混杂因素对研究结果的干扰，扩展应用倾向性评分匹配（propensity score matching, PSM）模块对干预前后的调查对象基本信息进行倾向性评分匹配[16]。既往研究表明，青少年电子烟的使用与性别[17]、年级[17]、家庭成员使用卷烟[18]或者电子烟[19]、同伴使用卷烟[16]或者电子烟[20]具有不同程度的相关性，因此将性别、年级、家庭成员是否使用卷烟、家庭成员是否使用电子烟、朋友是否使用卷烟、朋友是否使用电子烟作为匹配变量纳入 PSM，卡钳值设定为 0.001，以保证匹配结果的优良性。为保证调查质量，对所收集的问卷进行严格的质量控制，如出现以下情况则按无效问卷处理：（1）问卷的选项之间存在明显的逻辑错误；（2）问卷的所有选项均为同一选项，或整个问卷的选项具有明显的规律性。
1.6　统计分析
使用SPSS 26.0 软件进行分析。对匹配后新样本的人口学特征、认知、态度、使用行为等进行描述性分析，率（构成比）的比较采用χ2检验。所有统计分析均采用双侧检验，检验水准 α=0.05。
2　结　果
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2.1　干预前后调查对象基本信息比较（表1）
基线共回收有效问卷981份，其中男生641人（65.3%），女生340人（34.6%）。干预后共回收有效问卷819份，其中男生587人（71.6%），女生232人（28.3%）。为了提高组间可比性，以1:1匹配的方式对干预前、后进行倾向性评分匹配后，精确匹配767对，模糊匹配 3 对，共有770对调查对象匹配成功。倾向性评分匹配前，干预前后的调查对象在性别、年级、朋友是否使用卷烟上的差异均有统计学意义（均P<0.05），前后不可比；倾向性评分匹配后，干预前后调查对象基本信息差异均无统计学意义（P>0.05），前后可比。表明通过倾向性评分匹配，2组各变量的均衡性得到提高。
2.2　学生对学校控烟干预活动评价（表2）
学生对学校控烟干预活动开展情况反馈良好，有79.5%的同学希望学校的无烟环境建设能够持续开展。78.4%对于继续做一个无烟者产生了更大的信心，78.3%支持学校能够采取更严格的措施防止和减少吸烟行为。此外，76.8%表示对吸烟和电子烟的危害有了更全面的了解。
2.3　电子烟危害认知情况（表3）
干预前学生对电子烟危害的相关认知情况较好，其中86.5%认同 “吸电子烟会对身体有害”，但对于“电子烟会产生二手烟”的危害认知仅占78.8%。经学校控烟干预后，对于电子烟危害相关知识具有正确认知的学生数量均有所上升，认同“电子烟本身存在安全隐患”的学生比例明显上升，差异有统计学意义（χ2=4.604，P=0.032）；对电子烟相关的其他危害知识认同率略有上升，但总体变化不明显，差异无统计学意义（P>0.05）。
2.4　青少年对电子烟的态度（表4）
经学校控烟干预后，青少年对于支持电子烟管控的相关陈述均有所上升，认同 “我不想在吸电子烟的人身边停留”的青少年比例从49.9%上升至53.8%，同时对室内公共场所禁止吸电子烟的支持率在干预后上升4.4%。此外，赞同在电子烟的产品包装上印刷电子烟对健康危害警示的上升比例较高，但差异均无统计学意义（P>0.05）。
2.5　电子烟使用情况及未来使用意愿（表5）
经学校控烟干预后，学生尝试使用电子烟的比例由4.4%增至5.5%，增加了1.1%，但现在吸电子烟以及将来有电子烟使用意愿的学生比例均下降，以上差异均无统计学意义（P>0.05）。表明无烟学校建设对电子烟使用者戒掉电子烟有促进作用，但也可能潜在促使非电子烟使用者使用电子烟。
3　讨　论
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尽管一些研究表明，学校控烟干预对保护青少年远离烟草制品具有积极意义，但具体到电子烟等新型制品的影响则缺乏充分的证据支持[21–22]。本研究旨在分析学校控烟干预对青少年电子烟认知、态度以及行为的影响。结果显示，经学校控烟干预后学生对电子烟相关的危害知识知晓率和对电子烟立法的支持比例都有所上升，并且现在吸电子烟以及有电子烟使用意愿的学生比例均下降。此结果可为今后在关于新型烟草制品的控烟干预制定更有效的公共卫生政策和教育干预措施提供科学依据。
研究发现，接受调查的学生在基线问卷中对于电子烟的危害认知情况较好，基线时学生尝试过电子烟（4.4%）、现在吸电子烟的比例（1.6%）低于2019年职校学生电子烟使用率（4.5%）[23]，在未来12个月内认为自己肯定不会使用电子烟的比例亦低于赵加奎等[24]研究中职业学校学生尝试使用电子烟比例，然而对电子烟的态度却参差不齐。该学校学生对于电子烟的认知、态度和行为从全国来看都较好，其原因可能是得益于上海市 2010 年颁布的《上海市公共场所控制吸烟条例》及较严格的控烟环境[25]。然而2021年调查结果显示职高生使用电子烟的比例及其上升幅度均明显高于普高学生[8]，因此对职高生电子烟认知的干预仍然是学校控烟干预的重点。
研究发现干预后学生对于电子烟危害的认知均有所提高，尤其是对“电子烟本身存在安全隐患”在干预后差异有统计学意义。尽管当前世界范围内对于长期使用电子烟产品导致的健康影响还不完全清楚[26]，但已经有相关证据证明电子烟产品会致癌或增加心脏和肺部疾病的风险[27–29]。青少年对电子烟相关陈述的支持率在干预后都有所上升，尤其是支持 “我赞成室内公共场所禁止吸电子烟” 和“我不想在吸电子烟的人身边停留”的增加比例较高，这表明青少年逐渐形成远离电子烟的无烟社会规范。在干预后青少年们当前的电子烟使用率及未来12个月内的电子烟使用意愿都有一定程度的下降，这些与已有的研究结果一致，美国2019年于肯塔基州一所高中[30]和2021年于阿拉巴马州初、高中[14]使用斯坦福大学通过烟草预防工具包分别开展的一次性电子烟教育课程项目，均表明以学校为基础的电子烟干预课程可以有效促进青少年电子烟认识、危害感知和尝试使用意愿的积极变化。
值得注意的是，电子烟尝试使用的学生比例在干预后增加了1.1%。导致其增加的原因可能是在进行电子烟相关干预时对电子烟这类新型产品的反复介绍增加了青少年的好奇心，以及烟草业在潜移默化的日常生活中对青少年产生了影响，提示在开展学校电子烟控烟干预时应更注重方法，强调电子烟的成瘾性及短期危害，降低尝试吸烟行为。
本次干预活动采取了较为传统的班会、讲座等形式，有一定效果但仍有提升空间。在未来针对学校同类型新型烟草制品的干预中首先需要开展符合青少年心理特点的预防电子烟的新型健康教育形式，应在设计干预方案时更加具体和多样化，以青少年更为喜爱和容易接受的形式呈现对电子烟健康危害的科普宣传和教育。此外，还应加入相应的理论依据来指导设计学校控烟干预策略的方案，加强学生对电子烟等烟草制品危害的理解[31]。其次，虽然学校积极倡导无烟环境和无烟家庭，但并未对家长和教师在电子烟方面开展具体的干预措施，可以考虑在后续开展干预时纳入对学生家长、教师的针对性干预措施，给学生塑造良好的社会规范环境。有研究表明，同时注重家庭和学校对学生控烟干预的支持，对于烟草制品的态度和行为改变都产生了良好的影响 [32]。最后，从政策方面来看，上海市控制吸烟条例已于2022年10月将电子烟正式纳入公共场所禁烟范围，有利于为将来上海市各学校进行青少年电子烟控烟干预提供政策支持，也提示各地政府应加强对电子烟使用的监管和处罚力度。另外，政府应加强对电子烟市场的监管，特别是针对在线销售平台，制定严格的销售年龄限制，从源头上保护未成年人受电子烟产品的侵袭。
本研究存在一定的局限性：对青少年吸烟等行为往往只能采取匿名方式来填写问卷，但同时匿名填写也成为分析干预结果的障碍。本文通过倾向性评分匹配对基线和控烟干预后的调查数据进行统计分析，该方法是一种通过事后随机化在观察性研究中处理混杂偏倚的有力工具[33–34]，可以显著提高因果推断的可信度，也为一些敏感性行为的干预结果分析提供了参考。

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doi: 10.11847/zgggws1145812
  • 接收时间：2024-08-30
  • 首发时间：2026-10-25
  • 出版时间：2025-05-10
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  • 收稿日期：2024-08-30
  • 修回日期：2025-01-03
  • 录用日期：2025-04-11
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    1复旦大学公共卫生学院预防医学与健康教育教研室，上海 200030
    2上海市青浦区爱国卫生和健康促进指导中心，上海 201700

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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