Parental migration and smoking behavior of left-behind children: evidence from a survey in rural Anhui, China

Background: Parental migration is most an important factor affecting children's behaviors. Few studies have addressed the association between parental migration and children's smoking behavior in China. This study aims to estimate the current smoking prevalence among children, evaluate the association of parental migration and the smoking behavior of children and identify factors associated with smoking behavior among left-behind children (LBC). Methods: A cross-sectional study was conducted in 6 cities in Anhui province during July and August, 2012. All participants were interviewed face-to-face using a standardized questionnaire. Only children 10 to 14 years old that live in rural villages for at least 6 months during the previous year were included in the study. Results: A total of 1343 children met the sampling criteria and participated in the study. Of these, 56 % are LBC and 44 % live with both parents. The average rate of smoking is 3.4 %. The rate of smoking is statistically higher for LBC with both parents out (rate = 6.1 %; OR = 5.59, P < 0.001) than for children living with both parents (1.4 %). Similarly, the rate of LBC with father home only (rate = 5.0 %; OR = 5.60, P = 0.005) is also statistically higher than for children living with both parents when controlling other variables. Factors affecting the smoking behavior of LBC, include gender (i.e., boys), (perceived) school performance and primary caregiver. Conclusions: Parental migration is associated with a significant increase in smoking behavior among children. Intervention studies that target LBC would help to develop strategies to reduce smoking among rural children. Gender-specific strategies and anti-smoking education also appears to be needed to reduce tobacco use among rural LBC.