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This study aims to determine if cigarette smoking is associated with engaging in other health-risk behaviors among high school students in Japan. Self-administered anonymous questionnaires were conducted in 1999 using a sample of 1,466 students (male: 50.5%, female: 49.5%) in grades 10 through 12 at seven public senior high schools in urban areas of Okinawa, Japan. Health-risk behaviors studiedal included cigarette smoking, alcohol drinking, thinner use, sexual intercourse, suicidal ideation, nonuse of seat belts, physical inactivity, and weight loss practices. In the logistic regression models, controlled for sociodemographic variables, smoking was significantly associated with all health-risk behaviors except physical inactivity. In particular, associations of alcohol drinking and sexual intercourse with smoking were strong. Among male students, statistically significant odds ratios existed for alcohol drinking, sexual intercourse, and nonuse of seat belts. Among female students, all of the odds ratios for health-risk behaviors were statistically significant, except for physical inactivity. Generally, the odds ratios of female students were higher than those of male students. In conclusion, high school students who smoked cigarettes in this study may be at higher risk for engaging in other health-risk behaviors. Particularly, alcohol drinking and sexual intercourse are more likely to co-occur with smoking. These findings suggest that smoking prevention programs should be integrated with other health-risk behaviors.

Covariation of Cigarette Smoking and Other Health-risk Behaviors among Japanese High School Students: a Preliminary Study.