Comparison of tobacco use knowledge, attitude and practice among college students in China and the United States.

Prolonged smoking is a leading behavioral cause of premature mortality and disability, resulting in approximately four million deaths annually worldwide [World Health Organization (WHO), 1999]. Although smoking kills more people than AIDS, alcohol, drug abuse, car crashes, murders, suicides and fires combined each year [Centers for Disease Control and Prevention (CDC), 2001], approximately one-third of the global adult population, or 1.1 billion people, have chosen to smoke. This astonishing figure includes many young and school-aged users. According to CDC, in the United States (US) ~80% of adult smokers started smoking before the age of 18 years and nearly 3000 young people in the same age-bracket become regular smokers every day (CDC, 2001). If nothing is done to stop current trends, more than 5 million children living today will die prematurely because of a decision they will make to smoke cigarettes when they are adolescents. According to a WHO report (WHO, 1997), the US and China are the leading consumers of tobacco products. The college students of these two countries live in different socio-economic systems with different cultural values and beliefs, which often influence their attitudes and behaviors regarding tobacco use (Bandura, 1986; Coleman, 1995). Over the last two decades, a large body of research has focused on tobacco use and its health consequences among American