Shisha smoking engagement dynamics of Chinese young adults: a constructivist grounded theory study

Abstract

Introduction: Notwithstanding the imposed risks to health, shisha smoking (SS) has gained popularity among the young adults in Hong Kong (HK). According to our previous survey (N=1288), 23.8% of HK university students had ever smoked shisha, while only 21.1% had ever smoked cigarettes. Despite its growing prevalence, SS dynamics amongst Chinese young adults in the HK context are poorly understood. Objectives: As smoking behaviours are shaped by ethnic and/or socio-cultural contexts, this study aimed to explore Chinese young adults’ dynamics of SS engagement using the theoretical framework of Health Brief Model. Methods: A constructivist grounded theory approach was adopted. Between May and October 2019, 49 Chinese young adults aged from 18 to 28 years and smoked shisha in the past 30 days, were recruited through purposive sampling for semi-structured in-depth interviews. All interview data were analysed using three coding methods; initial, focused, and theoretical coding. NVivo 12 was used for data management. Results: Three major dynamics of SS engagement were identified: 1) young adult’s socio-demographical characteristics (risk-taking behaviour, need for relatedness, need for autonomy, peer influence, and a lack of policy and education); 2) perception on SS (perceived severity [normalisation of SS], perceived susceptibility [misconception of low health risks], perceived barriers [expensive cost of SS and social bias of smoking] and perceived benefits [socialisation, relaxation and sense of adulthood through SS]); and 3) cue to SS engagement (social gathering, drinking at bars, curiosity, and mood). The participants constructed positive perception on SS, based on the socio-demographical characteristics, and the cue factors triggered them to engage SS. Conclusion(s): Through understanding of SS engagement dynamics in the HK context, health professionals can develop effective health promotion strategies to improve awareness of SS health risks. Policy makers can additionally initiate shisha-specific regulations to denormalise SS to achieve the tobacco endgame in HK.