Abstract:Abstract: OBJECTIVE To investigate the current status of cigarette and e-cigarette use among middle school students in Hangzhou and identify its associated factors,thereby providing evidence for the development of targeted tobacco control strategies. METHODS Using a multistage stratified cluster sampling method,a questionnaire survey was conducted in 2023 among 1,739 students from 36 classes in 12 middle schools in Hangzhou.Data were collected using the“2023 China Secondary School Students'Tobacco Survey Questionnaire.”After weighting the data,statistical analysis was performed using SPSS 23.0 software.Intergroup comparisons were conducted using the x²test,and the analysis of influencing factors employed a multivariable logistic regression model.RESULTS The prevalence of tobacco use among secondary school students in Hangzhou was 6.92%,with rates of current cigarette smoking ande-cigarette use at 5.04%and 4.06%,respectively;the current tobacco use rate was 1.44%,with current cigarette smoking and e-cigarette use rates of 1.01%and 0.51%,respectively.Multivariate analysis result revealed that being female,attending junior high school,and having no tobacco exposure in indoor sttings in the past 7 days were protective factors against curent cigarette smoking;having friends who do not smoke was a protective factor against curent e-cigarette use;and not believing that smoke is harmful was a common risk factor for both curent cigarette and e-cigarette use.CONCLUSION Significant group differences exist in smoking behavior among middle school students in Hangzhou,with gender,school type,and social environment having significant influences.Efforts should focus on key populations,strengthen retail and online regulation,promote coordinated tobacco control among families,schools,and communities,and create smoke-free environments