Chinese Adolescents' perspectives on tobacco use: A qualitative exploration of youth in the “new” China

China is the largest tobacco producing and consuming country in the world. Smoking prevention efforts targeted at adolescents are important for reducing the burden of future tobacco-related morbidity and mortality in China. School-based prevention programs are not common in China and the few attempts to modify successful Western prevention programs have largely shown little effect. Distinct cultural and social systems differences in China could explain why modified programs have been unsuccessful. This study examined smoking behavior from the perspective of Chinese adolescents as part of the development of a large, school-based intervention trial.

Sixteen focus groups with 128 participants were conducted in four high schools in the city of Chengdu in the Sichuan province of China. Groups lasted 45-60 minutes and included a mix of smokers and non-smokers.

Social attitudes towards boys who smoke are more accepting than for girls. Impressions of adolescent smokers were mixed, most seeing the behavior as common among boys. However, smokers were also seen as being overwhelmed and stressed. Smoking among girls appeared to be universally frowned-upon, but they were also seen as influenced by fashion and trendy.

Findings indicate students themselves have mixed opinions about smoking and smokers. Both positive and negative images of smokers could indicate different influences on tobacco use behavior and norms, for example peers and the media. With social norms changing rapidly in the “new” China, understanding what the new generation of Chinese youth thinks about smoking is critical in determining how to address and tailor prevention efforts.