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Abstract: Objective To determine the prevalence and determinants of smoking in middle school students in priority areas for HIV control in Liangshan of Sichuan Province. Methods Students were randomly selected in all of the schools located in the priority areas for HIV control in Liangshan. A questionnaire survey was conducted, collecting data in relation to socio-demographic characteristics of the participants, their smoking behavior, drug abuse in family members, and HIV infections in family members. Risk factors associated with smoking were identified using univariate and multivariate statistical analyses. Results About 21.3% of respondents were smoking at the time of survey; 33.4% attempted smoking; 5% were heavy smokers; and 16.8% started smoking before 13 years old. The Logistic regression analysis identified male gender, senior high school students, poor academic records, low household income, rural residency, family drug abuse and HIV infections as predictors of attempted smoking. Male gender, minority ethnicity, average academic records, broken family, medium and high household income, family drug abuse and HIV infections were identified as predictors of smoking. Male gender, senior high school students, low or medium academic records, rural residency, and family drug abuse were identified as predictors of heavy smoking. Male gender, broken family, average academic records, medium or high household income, family drug abuse and HIV infections were associated with smoking before thirteen. Conclusions Smoking rate in middle school students in the priority areas for HIV control in Liangshan is high. They start smoking at a young age. School smoking control programs should place priorities on those who are in the groups of boys, minority ethnicity, senior high school students, rural residency, poor academic records, and those with family drug abuse and HIV infections.