Background
Research over the past few decades has shown that smoking has become a possible fatal risk to health. According to the World Health Organization (WHO), one person dies of smoking-related diseases every ten seconds worldwide.
In view of the severity of smoking-related problems, the Taiwanese Government has enforced the Tobacco Hazards Prevention Act since 1997. Due to the limitation of expenditure and human resources, since the tobacco health and welfare surcharge was introduced in 2002, the government has had sufficient expenditure to promote the campaigns for prevention on national tobacco hazards. Besides, due to the huge amount of taxation incurred on this campaign, the Legislative Yuan, related organizations and the public have expressed deep concerns and placed high expectations on this campaign.
In 2004, HPA worked with the US Center for Disease Control and Prevention (CDC), adopted the questionnaire design of WHO Global Youth Tobacco Survey (GYTS) and launched Youth Tobacco Survey in Taiwan. It is a survey on tobacco use among junior and senior high school students. It collected data such as the ratio of tobacco use behavior among these students, their perceptions of and attitude toward tobacco hazards, their exposure to second hand smoking, and any changes and tendencies, as references for relative authorities to plan and evaluate the campaign of preventing tobacco hazards on campus.

Aim of the Survey
● To understand the tobacco use behavior, perceptions and attitude among youth aged 12 to 18 and the implementation of smoking bans on campus in every county and city.
● To compile data of tobacco use behavior, perceptions and attitude among youth, and any changes and tendencies at county / city / national levels, which can constitute concrete evidence for HPA and local health bureaus to follow up and monitor the implementation and effectiveness of intervening and preventing tobacco hazards from young people.
● To implement International Collaborative Research Project on Global Youth Tobacco Survey, increase Taiwan’s publicity and to promote academic exchanges at international level.

Sampling Design
The population for the survey was students in junior high schools, local senior high schools, vocational schools and 1st to 3rd years in junior colleges, enrolled in 2011.
However, the administrative costs and the effectiveness of analysis in the future were taken into account. Therefore, the total number of sample students in every county and city was predetermined (about 800 to 2000) and then sampling was conducted. During the process of selecting sample schools, schools were first categorized into regular schools and evening schools. Secondly, the estimated number of sample schools in each category was calculated. Thirdly, the total number of sample students was estimated. Then, the result of the formula below served as the sampling interval:
‘Total Number of Students divided by Estimated Number of Sample Students’. Then the system randomly selected sample schools with such sampling interval.
Next, sample classes in each sample school were selected according to (in the following order) types of classes, grades and disciplines. As a result, the system randomly sampled three to six classes. The numbers of students in these classes, about 38,378 in total, were selected as the survey samples.

Survey Methods
A self-administered questionnaire was answered by students anonymously. Three to six staff from the local health bureaus, after receiving a one-day training of hosting a questionnaire survey provided by HPA, coordinated with sample schools and decided the conducting dates and times. The survey was conducted in the classroom of the sample schools. If local health bureaus were short of human resources, HPA would support and designate its staff. To avoid sample students from discussing with each other about the questionnaire, which might have affected the result, all sample students in each school took the survey simultaneously.
To make sample students respond to the questionnaire willingly and truthfully, all school staff were not present on the site during the survey. Staff from local health bureaus or HPA provided sample students with standardized instructions. This included explaining the purpose of the survey, the importance of their representation of the selected sample students and how to complete the questionnaire. They were assured anonymity in the survey, that the survey’s sole purpose was for statistical and analytical purpose, and they were guaranteed confidentiality of personal details. In order to enhance the confidentiality of the data and increase the data-scanning speed, open-ended questions were avoided at the designing stage and answers to be circled and filled in black by respondents with 2B-lead pencils provided by HPA.

Survey Result
In order to provide more timely results for policy reference, the GYTS has been conducted annually since 2011 with city-county representative samples of middle and high school students. The GYTS surveys were completed in June 2013: 34,893 students completed the GYTS with a response rate of 90.92%.
Results of the survey are published in the format of survey reports, press releases and conference or journal paper.