Document Type : Original Article


1 Department of Medical‑Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

2 Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran

3 Department of Environmental Health Engineering, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran


BACKGROUND: Smokeless tobacco use is a public health problem. This study explored students’
beliefs about smokeless tobacco use in Chabahar, Iran.
MATERIALS AND METHODS: The qualitative study was conducted using three Focused Group
Discussions among 24 students aged 12–14 years in Chabahar City. Focus Group Guide Morgan
was used. Qualitative Content Analysis was used to explore and extract codes and themes. The
data analysis process was carried out in accordance with the stages of proposed by Graneheim and
Lundman. Guba and Lincoln criteria were used for evaluating research transferability.
RESULTS: Two main themes emerged from the analysis including; beliefs of being useful and
harmful. Each of these themes is divided into subthemes with useful or harmful physical and
psychological beliefs. Four subthemes included: beliefs of being useful physically, beliefs of being
useful psychologically, harmful beliefs physically, and harmful beliefs psychologically.
CONCLUSIONS: One of the more significant findings to emerge from this study is that many students
mentioned the benefits of using smokeless tobacco to reduce toothache, relieve headaches, and bad
breath. This information can be used to develop targeted interventions aimed at reducing smokeless
tobacco consumption. However, more research on this topic needs to be undertaken before the
association between kinds of beliefs and smokeless tobacco consumption is more clearly understood.


  1. Yadav A, Ling P, Glantz S. Smokeless tobacco industry’s brand
    stretching in India. Tob Control 2020;29:147‑49
    2. Lokhande S, Glover M, Selket K. Chewing tobacco use among
    South‐East Asian men in Auckland. Int J Migrat Health Soc Care
    3. Group RCoPoLTA. Harm Reduction in Nicotine Addiction:
    Helping People who Can’t Quit. London: Royal College of
    Physicians of London; 2007.
    4. Solhi M, Fattahi E, Barati H, Mohammadi M, Kasmaei P,
    Rastaghi S. Smokeless tobacco use in Iran: A systematic review.
    Addict Health 2020;12(3):225‑34
    5. Solhi M, Moradi E, Pouresmaeil M, Ziapour A, Fattahi E. Problem
    description: Five tips in research about relations between social
    determination and cardiovascular disease. J Educ Health Promot
    6. Khaitan T, Shukla AK, Gupta P, Naik SR, Verma P, Kumar S.
    Liver and thyroid profile in educating smokeless tobacco users
    and its role in oral health promotion. J Educ Health Promot
    7. Casey B, Jones RM. Neurobiology of the adolescent brain and
    behavior: implications for substance use disorders. J Am Acad
    Child Adolescent Psychiatry 2010;49:1189‑201.
    8. Dobe M, Sinha DN, Rahman K. Smokeless tobacco use and its
    implications in WHO South East Asia Region. Indian J Public
    Health 2006;50:70.
    9. Fattahi E, Tavousi M, Niknami S, Zareban I, Hidarnia A.
    Effectiveness of an Educational Intervention for Reducing Paan
    Consumption Among Adolescent; 2013.
    10. Fattahi E. The necessity for appropriate research in the field of
    pan‑prague use. ZJRMS 2018;20 (12); 87207
    11. Solhi M, Fattahi E, Barati H, Mohammadi M, Kasmaei P,
    Rastaghi S. Smokeless tobacco use in Iran: A systematic review.
    Addict Health 2020;12:225‑34.
    12. Solhi M, Mehrabian F, Rastaghi S, Fattahi E. Use of smokeless
    tobacco among students in the city of chabahar: A cross‑sectional
    study. Int J High Risk Behav Addict 2019 ; 8 (2): 91023
  2. 13. Lebni JY, Ziapour A, Qorbani M, Khosravi B, Mirzaei A, Safari O,
    et al. Explaining the causes of crystal addiction in Tehran:
    A qualitative approach. J Public Health 2019; 2:1‑7.
    14. SarveswaranG, KrishnamoorthyY, SakthivelMN, VijayakumarK,
    MarimuthuY, ChinnakaliP. Level of neighborhood environmental
    factors related to noncommunicable diseases in selected wards of
    urban Puducherry, South India. J Educ Health Promot 2019;8:34
    15. Gadiyar A, Ankola A, Rajpurohit L. Awareness of anti‑tobacco
    advertisements and its influence on attitude toward tobacco
    use among 16 to 18‑year‑old students in Belgaum city:
    A cross‑sectional study. J Educ Health Promot 2018;7:85
    16. Morgan DL. Focus group interviewing. Handbook of interview
    research: Context Method 2002:141‑59.
    17. Morgan DL, Kreuger R. When to use Focus Groups and Why in
    Morgan DL (Ed.) Successful Focus Groups. London: Sage; 1993.
    18. Morgan DL. Focus Groups as Qualitative Research. London: Sage
    publications; 1996.
    19. Morgan RM, Hunt SD. The commitment‑trust theory of
    relationship marketing. J Mark Res 1994;58:20‑38.
    20. Krueger R, Casey MA. Focus Groups: A Practical Guide for
    Applied Research, Sage. CA: Thousand Oaks; 2000.
    21. Greenbaum TL. Moderating Focus Groups: A Practical Guide for
    Group Facilitation. London: Sage Publications; 1999.
    22. Prince M. Moderator teams: an extension to focus group
    methodology. Qualitative Market Res 2001;4:207‑16.
    23. Graneheim UH, Lundman B. Qualitative content analysis in
    nursing research: concepts, procedures and measures to achieve
    trustworthiness. Nurse Educ Today 2004;24:105‑12.
    24. Nazari N, Salahshoor MR, Özdenk GD, Zangeneh A, Lebni JY,
    Foroughinia S, et al. A study of the components of research
    self‑efficacy in postgraduate students at Kermanshah University
    of Medical Sciences in 2018. J Public Health 2020;1:1‑8.
    25. Yoosefi Lebni J, Khorami F, Ebadi Fard Azar F, Khosravi B,
    Safari H, Ziapour A. Experiences of rural women with damages
    resulting from an earthquake in Iran: A qualitative study. BMC
    Public Health 2020;20:1‑13.
    26. Schwandt TA, Lincoln YS, Guba EG. Judging interpretations: But
    is it rigorous? Trustworthiness and authenticity in naturalistic
    evaluation. New Dir Eval 2007;114:11‑25.
    27. Madewell ZJ, Kolaja CA. Smokeless tobacco warnings in Indian
    mass media: Intention and attempts to quit. Indian J Med Paediatr
    Oncol 2019;40:413.
    28. Mukherjea A, Morgan PA, Snowden LR, Ling PM, Ivey SL. Social
    and cultural influences on tobacco‑related health disparities
    among South Asians in the USA. Tob Control 2012;21:422‑8.
    29. Nemeth JM, Liu ST, Klein EG, Ferketich AK, Kwan MP,
    Wewers ME. Factors influencing smokeless tobacco use in rural
    Ohio Appalachia. J Community Health 2012;37:1208‑17.
    30. Agbor M, Azodo C, Tefouet T. Smokeless tobacco use, tooth loss
    and oral health issues among adults in Cameroon. Afr Health Sci
    31. Banerjee SC, Ostroff JS, Bari S, D’Agostino TA, Khera M,
    Acharya S, et al. Gutka and tambaku paan use among South
    Asian immigrants: A focus group study. J Immigr Minor Health
    32. Mirbalouchzehi A, Rakhshani F, Khammarnia M, Nasernia MR.
    Causes and preventive measures of pan consumption in
    high school male students, zahedan. Zahedan J Res Med Sci
    33. Adnan ZZ, editor Knowledge, Attitudes and Beliefs on the
    Assocition Between Paan Chewing and Oral Cancer among the
    Kenyan Asian Community Living in Nairobi. The 13th World
    Conference on Tobacco OR Health; 2006.
    34. Couch ET, Darius EF, Walsh MM, Chaffee BW. ST product
    characteristics and relationships with perceptions and behaviors
    among rural adolescent males: A qualitative study. Health Educ
    Res 2017;32:537‑45.
    35. Shahjahan M, Harun MG, Chowdhury AA, Ahmed K,
    Khan HT. Factors influencing the initiation of smokeless
    tobacco consumption among low socioeconomic community in
    Bangladesh: a qualitative investigation. Int Q Community Health
    Educ 2017;37:181‑7.
    36. Adedigba MA, Aransiola J, Arobieke RI, Adewole O, Oyelami T.
    Between traditions and health: Beliefs and perceptions of health
    effects of smokeless tobacco among selected users in Nigeria.
    Subst Use Misuse 2018;53:565‑73.
    37. Sinha D. Gutka advertisement and smokeless tobacco use
    by adolescents in Sikkim, India. Indian J Community Med
    38. Pouresmaeil M, Abbas J, Solhi M, Ziapour A, Fattahi E. Prioritizing
    health promotion lifestyle domains in students of Qazvin
    University of Medical Sciences from the students and professors’
    perspective. J Educ Health Promot 2019;8 (1):228.
    39. Fattahi E, Solhi M, Abbas J, Kasmaei P, Rastaghi S, Pouresmaeil M,
    et al. Prioritization of needs among students of University of
    Medical Sciences: A needs assessment. J Educ Health Promot
    40. Karim AA, Inam S, Zaidi AB. Inadequate checks on smokeless
    tobacco usage in Pakistan: cultural heritage or policy neglect?
    JPMA 2020;70 (1):134‑138
    41. Yoosefi Lebni J, Ziapour A, Qorbani M, Baygi F, Mirzaei A,
    Safari O, et al. The consequences of regular methamphetamine
    use in Tehran: qualitative content analysis. Subst Abuse Treat
    Prev Policy 2020;15:1‑10.