Investigating the Reasons for Using Smokeless Tobacco Among Adults: A Qualitative Study Based on the Grounded Theory Approach

Background: The use of smokeless tobacco is a public health problem worldwide. The use of these substances can cause various diseases and increase mortality. Objectives: The aim of this qualitative study was to explain the reasons for using smokeless tobacco based on the grounded theory approach. Patients and Methods: We conducted a qualitative study using the grounded theory approach in 2020 - 2021. Participants were adult users of smokeless tobacco in Chabahar city, southeast Iran. The strategy for choosing participants was based on purposeful sampling and continued till theoretical saturation was achieved. Thirty adults who were smokeless tobacco users participated in the interviews voluntarily. We used techniques such as asking questions, constant comparisons, and writing memos to collect data, which were analyzed based on the grounded theory presented by Corbin and Strauss in 2008. Results: Two themes emerged from data analysis (the context of consumption and the need for effective supervision), each of which had several subcategories. The opportunity for consumption was the first main category of the contextual factors frequently mentioned by the participants, whose subcategories included consumption culture, individual and general beliefs, and consumption by family members. Insufficient supervision was the second main category, which included three subcategories, profitable market, insufficient supervision, and easy access. Conclusions: In general, two main themes explain the tendency of adults to consume smokeless tobacco: The context of consumption and the need for effective supervision. Concepts such as the consumer’s culture, individual and public beliefs, family members and friends being users, profitable market, the need for effective supervision, and easy access were the key factors pushing people of different ages toward using smokeless tobacco in Chabahar city.