Focus Group Findings of Smoking Onset Among Male Youth in China.

Background: Adolescence is associated with smoking initiation among men in China. The lack of qualitative studies using Chinese adolescent samples can pose challenges to enacting effective smoking prevention messages that resonate with male Chinese teenagers' thoughts, needs, and wishes. Objective: This focus group study was designed to obtain in-depth contextual information on early smoking among male teenagers in China. Methods: Twenty focus groups of 7-10 male students from vocational and junior colleges (N = 165) were conducted, approximately half in Shanxi and half in Guangdong. Results: A large number of early smoking activities occurred in homes and schools, and teenagers considered school toilets and dorms safe havens for smoking. Many participants' first cigarettes were offered to them by peers, others first smoked during social interactions, and some started smoking of their own volition. Teenagers were curious about the attributes of cigarette products, smoking techniques, and physical reactions. More participants disclosed negative first smoking experiences than positive experiences. Negative first physical experiences motivated some participants to acquire better smoking techniques. Smoking experimentation was sustained in part by reciprocated cigarette offers. Heavy experimentation occurred before graduation from high school. Conclusions/Importance: The current findings provide an empirical basis for developing intervention strategies that are alternative or complementary to the current conventional health education. These strategies include cognitive response methods to enhance antismoking beliefs, smoke-free social interaction norms, and school-based (e.g., peer education) and home-based (e.g., involving family members) intervention programs.