Chinese male adolescents resisting cigarettes from peers: qualitative research on tactics, perceptions and contextual characteristics

Abstract

Aims: Cigarette passing and sharing contribute to early smoking onset among Chinese male youth. Refusal efficacy, considered pivotal in smoking prevention, has not been addressed in published research regarding specific refusal tactics and resistant communication behaviours. This focus group study aimed to uncover cigarette resistance responses, cigarette-offering agents’ reactions to refusal, social barriers, and contextual characteristics among targeted Chinese male adolescents. Methods: Twenty focus groups with 7–10 male smoking and nonsmoking students per group from vocational and junior colleges (N = 165) were interviewed in two cities in China. The data were coded and analysed. Findings: Non-confrontational refusal tactics were frequently used. Of the nine identified cigarette refusal categories, consistent and firm declarations of the non-smoking status were considered most effective. Upon rejection, a majority of people offering cigarettes made no further attempts. Most participants expressed neutral attitudes towards cigarette refusals, in contrast with the assumption in the literature that teenagers pervasively dislike such refusals. Conclusions: Health educators likely can use the finding of peer agents’ general neutral (rather than negative) attitudes towards cigarette refusal to relieve teenagers’ apprehension about rejecting cigarettes and thereby help build their refusal confidence. The reported effective strategies should be further tested prior to implementation for training teenagers.