Associations between depression risk, bullying and current smoking among Chinese adolescents: Modulated by gender

• The prevalence of current smoking (6.4%) among Chinese adolescents is high and predominately a public health problem among male students.
• Being at high risk for depression, bullying others, being bullied, both bullying others and being bullied were independently risk predictors for current smoking among girls.
• Only being a bully and being a bully-victim independently increased the risk of current smoking for boys.
• School based prevention/intervention programs should focus on high-risk students.

This school-based study aimed to investigate the prevalence of being at risk for depression, bullying behavior, and current smoking among Chinese adolescents in order to explore gender differences in the vulnerability of adolescents with these behaviors to develop a smoking habit. A total of 35,893 high school students sampled from high schools in eighteen cities in China participated in the study from 2011 to 2012. Overall, the prevalence of current smoking was estimated at 6.4%. In total, 1.7% (618) of the participants admitted to bullying others, 5.8% (2071) reported being bullied, 3.5% (1269) were involved in both bullying others and being bullied, and 5.6% (2017) were at high risk for depression. Logistic regression analysis indicated that among girls, with high depression risk, bullying others, being bullied, and both bullying others and being bullied were independently and positively associated with current smoking habits, while the final results among boys showed that bullying others and both bullying others and being bullied were independently associated with an increased risk of current smoking. School-based prevention programs are highly recommended, and we should focus on high-risk students, particularly girls with high risk of depression or involved in school bullying and boys who are involved in school bullying.