A Qualitative Study to Explore the Factors Influencing Tobacco Chewing Behaviour and the Lifestyle Experience Among Adolescents.

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Jahnvi Patel, Suchismita Bhowmik, Milankumar Chauhan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8659503/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background of the study: Teenagers are the group most likely to start using tobacco products. As is now well known, the majority of adult tobacco users began using the drug when they were young or in their teens. Recent WHO surveys indicate that schoolchildren in India are consuming more tobacco products, and the majority of them begin taking drugs at an early age. Teenagers between the ages of 16 and 19 are particularly susceptible to the detrimental effects of maturing, peer pressure, popularity, and accessibility. Research methodology: In the present study qualitative phenomenological research approach was selected, and investigator selected urban slum area of Bharuch, Gujarat state. The sample size for the study was 8 adolescents. Data collection was done using snowball sampling technique. The data was analyzed and interpreted by using thematic analysis. Result of the study: The investigation reveled that a number of factors contribute to the lifestyle experiences that teenagers have. Teenagers start this behavior due to peer pressure, familial and professional pressure, tobacco taste, and a once-in-a-lifetime attempt. The workplace is one of the triggers for tobacco chewing. After meals, some teenagers also choose to smoke. They feel happier and have more focus after using tobacco. Certain physical and emotional changes result from insufficient amounts of tobacco. Adolescents that engage in this behavior may experience social stigma, eventual health concerns, and certain changes in lifestyle. Conclusion: Based on the results of the following study, it concluded that peer groups and family and co-worker behavior influence tobacco chewing initiation. Other reasons that cause the need to chew tobacco include the setting at work and the sensation of being provoked after eating. A lack of it causes specific psychological and bodily changes. Adolescents who exhibit this behavior face social shame, eventual health concerns, and lifestyle modifications. Explore Factors influencing Tobacco chewing behaviour Lifestyle experience Adolescents INTRODUCTION Addictions that start throughout childhood are probably going to last until adulthood. Teenagers today are exposed to a growing variety of shifting lifestyles that have a detrimental effect on their health. Parents and the community are unsure about how to handle situations like this. ( 1 ) Recent polls indicate that schoolchildren in India are increasingly utilizing tobacco products, and a significant portion of them begin taking drugs at an early age. ( 2 ) Among young individuals, late adolescents—those between the ages of 16 and 19—are particularly vulnerable due to the pressures of more demanding coursework, peer pressure, the lure of popularity, and accessibility. A bad prognosis and a lifetime of dishonesty and careless behavior are typically linked to early substance misuse initiation. ( 3 ) In the present world, preventing teenage tobacco use seems to be the best strategy for preventing noncommunicable diseases. Across national borders, adolescents are embracing similar practices. ( 4 ) Reducing this impact in India and other developing nations requires obtaining high-quality, empirically confirmed data on tobacco smoking trends that allow for both intra- and inter-country comparisons. ( 5 ) Numerous factors are said to have an impact on adolescent tobacco use. Experimental behavior, peer pressure, easy access to tobacco products, a family history of elder tobacco use, personality qualities, and underlying emotional and psychosocial problems are a few of these. ( 6 ) Social isolation, dependence, helplessness, and low levels of general self-efficacy and self-esteem all contribute to the tendency to use substances, including tobacco. ( 7 ) Social pressure to smoke seems to be one of the most significant factors in the formation of smoking habits. ( 8 ) Early tobacco use and other antisocial behaviors are more common among teenagers who reported higher levels of control and conflict within the family, as well as less affection, support, and supervision from their parents. ( 9 ) Tobacco use has been linked to a decline in teenagers' general self-efficacy and psychosocial factors, according to a number of studies. ( 10 ) OBJECTIVES OF THE STUDY : To explore the factors influencing tobacco chewing behaviour. To identify the lifestyle experience regarding tobacco chewing behaviour. RESEARCH METHODOLOGY Study design and setting A qualitative phenomenological research design was selected targeting the adolescents living in slum area- Kabir Sanskar Dham of the Bharuch district of Gujarat, India during the month of August, 2024. Inclusion and Exclusion criteria Inclusion Criteria: Adolescents who are, Willing to participate in the study. Having the habit of chewing tobacco at least once in a day. Chewing tobacco for more than 1 year. Understand Gujarati. Started tobacco chewing at or after the age of 10 years. Exclusion criteria Adolescents who are, Participants with mental disorders. Chronically ill. Undergoing any kind of therapy (Chemotherapy, Radiation therapy, Counselling sessions, etc.) Sample size and sampling technique: Total 8 adolescents having the habit of tobacco chewing were selected using snowball sampling technique. Data collection Semi-structured interview guide was prepared to assess the factors that increase the tobacco chewing behaviour. Formal permission obtained from Medical officer, Urban primary health center, Zadeshwar, Bharuch, Gujarat state. The investigators prepared the master data collection schedule plan for entire procedure. The data was conducted in the month of August, 2024 and written consent from the all the sample and their parents was taken before starting the study. Audios of the Interview with the participants was recorded and stored for the thematic analysis. Ethical Consideration The selection of participants and data collection was approved by the PPSU Ethical Review Committee (PERC) by letter no. PERC/PPSU/24/7A/01. PPSU Ethical Review Committee (PERC), functions as per the requirements of the ICH-GP, ICMR guidelines 2017 and their SOPs. Written informed consent was obtained from all participants. All participants were informed about the study’s objectives, data collection methods and potential risks to the participants. They were also informed of confidentiality and anonymity, and of their right to withdraw consent at any time. For adolescents, written informed consent was obtained from a legally authorized adult representative and from the minor themselves. ANALYSIS AND INTERPRETATION Analysis was done for the socio-demographic data. Various themes were emerged from the responses of the participants. SECTION I: findings related to analysis of socio-demographic data of adolescents having tobacco chewing behaviour (N=8) Table 1: Frequency and percentage wise distribution of socio-demographic variables SR. NO. VARIABLE FREQUENCY PERCENTAGE 1. Gender Male 06 75% Female 02 25% 2. Education Primary 02 25% Secondary 02 25% Higher-secondary 00 0% Drop-out 04 50% 3. Income 10,000/- 05 62.5% 4. Significant medical history Yes 00 0% No 08 100% 5. Any other habits · Alcohol 00 0% · Smoking 00 0% · Others 00 0% Table 1: Shows… Among 8 adolescents, 6 (75%) were males and 2 (25%) females. Two (25%) adolescents had primary education, 2 (25%) had secondary education and 4 (50%) were school drop-out. One (12.5%) had an income of ₹5001–7000, two (25%) ₹7001–10,000, and five (62.5%) over ₹10,000. No significant medical history or other habits were reported. SECTION II: Thematic analysis for the factors influencing tobacco chewing behaviour Table 2: Answers given by the participants about Initiation SR. No. Theme Subtheme Code 1. Initiation Peer group influence Code 1, 2, 3, 5, 6, 7, 8 Code 5: “By watching my friends, I also started chewing tobacco.” Family influence Code 3, 7 Code 3: “My parents chew tobacco. So, I developed the same habit, too.” Influence by colleagues Code 2 Code 2: “I observed that my colleagues had the same habit.” Taste of tobacco Code 1 Code 1: “I liked the taste and gradually I started it every day.” Trying for once Code 4, 8 Code 4: “My friends insisted me to try it once. So, one day I tried and gradually my habit had started.” Table 2 represents the answers given by participants about initiation of tobacco chewing habit. The most of adolescents had peer group influence as a reason of initiation. Others were influenced by their family and colleagues. Some participants tried tobacco for once and gradually and developed the habit. One participant liked the taste of tobacco at first and developed the habit. Table 3: Answers given by the participants about Triggering situation SR. No. Theme Subtheme Code 2. Triggering situation Workplace environment Code 1, 2, 3, 4 Code 3: “If I don’t chew it, I can’t focus on my work.” Meals Code 3, 4, 5, 6, 8 Code 3: “I need it after meals, tea or water also, even after breakfast.” Table 3 shows the answers given by the participants about triggering situation for tobacco chewing. Some participants feel the urge to chew tobacco at their workplace. Others feel triggering situation after the meals. Only one participant had no any specific situation. Table 4: Answers given by the participants about Feeling after consumption SR. No. Theme Subtheme Code 3. Feeling after consumption More focused behaviour Code 2, 4, 7 Code 7: “I can focus on my work more effectively because of tobacco.” Improvement in mood Code 1, 2, 3, 4, 6, 7, 8 Code 1: “I feel good. And I also feel that I am fresh. It gives me energy and motivation to work effectively.” Table 4 shows the responses of participants about their feeling after the consumption of tobacco. Participants feel tobacco gives them focus at workplace. Majority of participants feel improvement in their mood after chewing tobacco. Only one participant had the same feeling as before. Table 5: Answers given by the participants about Insufficient amount SR. No. Theme Subtheme Code 4. Insufficient amount Physical symptoms Code 1, 2, 3, 4, 7 Code 7: “I feel headache and lack of energy that day. I feel weak on that whole day.” Changes in mood Code 1, 2, 3, 4, 6, 8 Code 1: “I don’t feel like working at my work place. I also can’t concentrate while working.” Table 5 represents the answers of participants about chewing insufficient amount of tobacco. Some participants feel physical symptoms and others feel changes in mood. Table 6: Answers given by the participants about Social stigma SR. No. Theme Subtheme Code 5. Social stigma Negative feedback at workplace Code 1, 2, 4, 7 Code 2: “My supervisor scolds me that it is bad. And the house owners say that “don’t spit it in our houses, don’t chew it inside the house etc.” Negative feedback from family Code 2, 3, 5, 6, 8 Code 3: “Right now, my parents don’t scold me. But in my initial days, they used to scold me that “don’t chew it, it has so many side effects, you will get sick”. Table 6 shows the responses given by the participants regarding social stigma felt by them. Some participants felt social stigma at their workplace. Other participants got negative feedback from their families. One participant does not have any experience regarding social stigma. Table 7: Answers given by the participants about Future of health with tobacco SR. No. Theme Subtheme Code 6. Future of health with tobacco Awareness of specific diseases Code 1, 2, 3, 5, 6, 7, 8 Code 1: “It leaves spots inside the body and mouth which are bad for health. It also causes ulcers inside the body.” Awareness of health hazards but no specific diseases Code 4 Code 4: “People say it causes cancer. I don’t have any idea about rest of the things.” Misconceptions of diseases Code 1, 6 Code 6: “I think the skin inside the mouth gets ulcerated or burns. The skin colour also gets changed.” Table 7 shows the answers of participants about their future of health with tobacco chewing habit. Majority of participants were aware about specific diseases caused by tobacco chewing. One participant did not had knowledge of specific diseases. Few participants had misconceptions about the diseases caused by tobacco chewing behaviour. Table 8: Answers given by the participants about Advice to others SR. No. Theme Subtheme Code 7. Advice to others Advice not to start tobacco chewing Code 1, 2, 3, 5, 7, 8 Code 3: “I will tell them not to start it. If they don’t listen to me, I will scold them and stop them.” No advice Code 4, 6 Code 4: “Whatever I say, no one will listen to me.” Table 8 indicates the responses given by the participants regarding advice given by them to others about tobacco chewing behaviour. Majority of participants were willing to advice others against this behaviour. Rest of the participants were not interested in giving advice to others as they believe no one will listen to their advice. Table 9: Answers given by the participants about Changes in lifestyle SR. No. Theme Subtheme Code 8. Changes in lifestyle Lack of savings Code 1, 2, 3, 4 Code 3: “I can’t save my money.” Urge to chew tobacco Code 1, 3, 7, 8 Code 8: “The urge to chew tobacco whole day is very high.” Physical changes Code 2 Code 2: “I can’t eat spicy food. Sometimes, I get ulcers in my mouth.” Increased debts Code 4, 6 Code 6: “If I don’t spare my money on tobacco, I may not have any debts on tobacco shops.” Table 9 depicts the responses given by the participants about changes in their lifestyle after starting tobacco chewing. Some participants had lack of savings as they spend their money on purchasing tobacco. Some participants were constantly feeling urge to chew tobacco. Few participants had physical changes and increased debts. One participant did not have any changes in the lifestyle. DISCUSSION The analysis revealed multiple factors behind adolescent tobacco use, including peer, family, and colleague influence, taste, and curiosity. Triggers included work and post-meal times. Tobacco use boosted mood and focus but caused physical, mood, social, health, and lifestyle issues. Exploring the factors influencing tobacco chewing behaviour For the first objective, 8 adolescents with tobacco chewing behavior were selected through snowball sampling for interviews. The investigation revealed that peer, family, and professional pressure, tobacco taste, and curiosity drive adolescents to chew tobacco. Workplace and post-meal environments act as triggers, while tobacco use boosts mood and focus. Identifying the lifestyle experience regarding tobacco chewing behaviour For the second objective, thematic analysis showed that lack of tobacco causes psychological and physical changes. Adolescents face social stigma, health risks, and lifestyle changes due to this behavior. MAJOR FINDINGS OF THE STUDY: The data were analysed and interpreted in terms of objectives. Thematic analysis is used for data analysis. Data were organized and presented in the following manner. Section I: Socio-demographic data: The study found that 6 (75%) adolescents were male and 2 (25%) female, all were dropouts. One (12.5%) had an income of ₹5001–7000, two (25%) earned ₹7001–10,000, and 5 (62.5%) had >₹10,000. No significant medical history or other habits were reported. Section II: Data Analysis of participant interview: The investigation revealed that peer, family, and professional pressure, tobacco taste, and curiosity drive adolescents to chew tobacco. Workplace and post-meal environments trigger use. Tobacco improves mood and focus but causes physical, emotional, social, health, and lifestyle changes. LIMITATIONS: The small sample size of only 8 participants limits the generalizability of the findings to the broader adolescent population. The study was confined to a single slum area (Kabir Sanskar Dham) in Bharuch district, which may not reflect the experiences of adolescents in other slum areas or regions. The qualitative nature of the study does not allow for statistical analysis or quantification of behaviours. DELIMITATIONS: The study was restricted to adolescents aged 10 years and above who had been chewing tobacco for more than one year. Only adolescents residing in the selected slum area of Kabir Sanskar Dham, Bharuch, were included in the study. The research focused solely on tobacco chewing behaviour and related lifestyle experiences, excluding other forms of tobacco or substance use. Data collection was limited to those participants willing to participate and available during the study period. The study included only adolescents who could understand and respond in Gujarati. CONCLUSION The conclusion highlights that tobacco chewing initiation is influenced by peer, family, and colleague behavior, with triggers including workplace and post-meal environments. Insufficient amounts cause physical and mood changes, leading to social stigma, health concerns, and lifestyle changes. Abbreviations WHO World Health Organization COTPA Cigarettes and Other Tobacco Products Act SLT Smoke-less Tobacco GATS Global Adult Tobacco Survey PPE Personal Protective Equipment COVID 19 Corona Virus Disease of 2019 OPD Out Patient Department FTNDS Fagerstrom Test for Nicotine Dependence scale ENDS Electronic Nicotine Delivery System STP Structured Teaching Program HNC Head and Nech Cancer FGD Focus Group Discussion GNI Gross National Income LCC Little Cigar and Cigarillo ATP Adenosine Triphosphate SPSS Special Package of Social Science FDA Food and Drug Administration Declarations ETHICS APPROVAL AND CONSENT TO PARTICIPATE The ethical clearance for this study was taken from PPSU Ethical Review Committee on 02/09/2024 , Letter No. PERC/PPSU/24/7A/01 . PPSU Ethical Review Committee follows ICMR guidelines year 2017. As the study samples were adolescents, consent from adolescents and their guardians were taken by using the local language. The objectives were clearly mentioned to the participants and their guardians. Confidentiality and anonymity of the interview was maintained throughout the study. They were also informed to withdraw the consent whenever they are not willing to participate. CONSENT FOR PUBLICATION Not Applicable COMPETING INTERESTS The Authors declare that they have no competing interests. FUNDING There is no any funding for the Study Design, Collection & analysis of data and drafting of the manuscript, this was the role of authors. The writing of this manuscript has not been funded. Author Contribution The Study protocol was written by JP & SB. Data collection was performed by the JP. MC prepared the manuscript. JP, SB &MC Provided Comments Acknowledgement We would like to express our gratitude to the Medical Officer of Urban Primary Health Centre, Zadeshwar, Bharuch, Gujarat for letting us conduct the study in the urban area. We would really appreciate the participants and their guardians for the cooperation. Without them, the study would be impossible to conduct. Data Availability The authors have collected and stored the audio recordings of the participant interviews. Later, the transcripts of the same was prepared. The transcripts cannot be shared due to confidentiality of the identity of the participants as the consent was taken prior to the data collection. The transcripts are available from the corresponding author upon request due to confidentiality. References Olando Y, Majumdar A, Sreedev A, Sun MC, Jennings C, Tibazarwa K et al. A qualitative study exploring the views on tobacco use and cessation support among patients in Kenya. Afr J Alcohol Drug Abuse AJADA. 2020;1–1. Jitnarin N, Poston WS, Jahnke SA, Haddock CK, Kelley HN, Severson HH. A qualitative study to assess perceptions, barriers, and motivators supporting smokeless tobacco cessation in the US fire service. PLoS ONE. 2021;16(5). Arora S. A Study to Assess Prevalence of Tobacco Use Among Adolescents and Assess the Effectiveness of Structured Teaching Program Regarding Ill Effects of Tobacco Use and Its Prevention Among Adolescents in Selected Community of New Delhi. 2023;778:23–38. Ramakrishnan S, Thangjam R, Roy A, Singh S, Ramakrishnan L, Seth S, et al. Acute effects of tobacco chewing on the systemic, pulmonary and coronary circulation. Am J Cardiovasc Drugs. 2011;11:109–14. Roditis M, Delucchi K, Cash D, Halpern-Felsher B. Adolescents’ perceptions of health risks, social risks, and benefits differ across tobacco products. J Adolesc Health. 2016;58(5):558–66. Vu M, Getachew B, Payne JB, Kirchner TR, Berg CJ. Initiation, continuation of use and cessation of alternative tobacco products among young adults: A qualitative study. Tob Prev Cessat. 2018;4. Gupte HA, Costa M, Chaudhuri L. Why do adolescents initiate and continue using tobacco and areca nut? A qualitative study tracing pathways of use among school-going adolescents in Mumbai, India. Nicotine Tob Res. 2020;22:2022–31. Critchley JA, Unal B. Health effects associated with smokeless tobacco: a systematic review. Thorax. 2003;58(5):435–43. Giovenco DP, Spillane TE, Maggi RM, Lee EY, Philbin MM. Multi-level drivers of tobacco use and purchasing behaviors during COVID-19 lockdown: a qualitative study in the United States. Int J Drug Policy. 2021;94. Pooja NM, Rani R. Tobacco chewing habits and barriers in cessation among tobacco users: a survey from Western Rajasthan, India. Int J Community Med Public Health. 2020;7:3617–22. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8659503","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":603661200,"identity":"67d5464a-7cdb-4772-b6c5-7b8bf4786112","order_by":0,"name":"Jahnvi Patel","email":"data:image/png;base64,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","orcid":"","institution":"Parul University","correspondingAuthor":true,"prefix":"","firstName":"Jahnvi","middleName":"","lastName":"Patel","suffix":""},{"id":603661201,"identity":"111efe87-7797-46ec-b7c0-d248bb703502","order_by":1,"name":"Suchismita Bhowmik","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Suchismita","middleName":"","lastName":"Bhowmik","suffix":""},{"id":603661202,"identity":"b7f6ec1b-8fad-4fd9-887f-aeae45bf2096","order_by":2,"name":"Milankumar Chauhan","email":"","orcid":"","institution":"Parul University","correspondingAuthor":false,"prefix":"","firstName":"Milankumar","middleName":"","lastName":"Chauhan","suffix":""}],"badges":[],"createdAt":"2026-01-21 12:00:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8659503/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8659503/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104958263,"identity":"d1184de7-739c-4185-803d-17585c5cb00a","added_by":"auto","created_at":"2026-03-19 08:27:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1421126,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8659503/v1/f2ece76d-e242-49c7-a5d7-645b25424392.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eA Qualitative Study to Explore the Factors Influencing Tobacco Chewing Behaviour and the Lifestyle Experience Among Adolescents.\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAddictions that start throughout childhood are probably going to last until adulthood. Teenagers today are exposed to a growing variety of shifting lifestyles that have a detrimental effect on their health. Parents and the community are unsure about how to handle situations like this.\u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eRecent polls indicate that schoolchildren in India are increasingly utilizing tobacco products, and a significant portion of them begin taking drugs at an early age.\u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e Among young individuals, late adolescents\u0026mdash;those between the ages of 16 and 19\u0026mdash;are particularly vulnerable due to the pressures of more demanding coursework, peer pressure, the lure of popularity, and accessibility. A bad prognosis and a lifetime of dishonesty and careless behavior are typically linked to early substance misuse initiation.\u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the present world, preventing teenage tobacco use seems to be the best strategy for preventing noncommunicable diseases. Across national borders, adolescents are embracing similar practices.\u003csup\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e Reducing this impact in India and other developing nations requires obtaining high-quality, empirically confirmed data on tobacco smoking trends that allow for both intra- and inter-country comparisons.\u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNumerous factors are said to have an impact on adolescent tobacco use. Experimental behavior, peer pressure, easy access to tobacco products, a family history of elder tobacco use, personality qualities, and underlying emotional and psychosocial problems are a few of these.\u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/sup\u003e Social isolation, dependence, helplessness, and low levels of general self-efficacy and self-esteem all contribute to the tendency to use substances, including tobacco.\u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e Social pressure to smoke seems to be one of the most significant factors in the formation of smoking habits.\u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e Early tobacco use and other antisocial behaviors are more common among teenagers who reported higher levels of control and conflict within the family, as well as less affection, support, and supervision from their parents.\u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e Tobacco use has been linked to a decline in teenagers' general self-efficacy and psychosocial factors, according to a number of studies.\u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eOBJECTIVES OF THE STUDY\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo explore the factors influencing tobacco chewing behaviour.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo identify the lifestyle experience regarding tobacco chewing behaviour.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"RESEARCH METHODOLOGY","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eA qualitative phenomenological research design was selected targeting the adolescents living in slum area- Kabir Sanskar Dham of the Bharuch district of Gujarat, India during the month of August, 2024.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion and Exclusion criteria\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eInclusion Criteria:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAdolescents who are,\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWilling to participate in the study.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHaving the habit of chewing tobacco at least once in a day.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eChewing tobacco for more than 1 year.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eUnderstand Gujarati.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eStarted tobacco chewing at or after the age of 10 years.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAdolescents who are,\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eParticipants with mental disorders.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eChronically ill.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eUndergoing any kind of therapy (Chemotherapy, Radiation therapy, Counselling sessions, etc.)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e\n\u003ch3\u003eSample size and sampling technique:\u003c/h3\u003e\n\u003cp\u003eTotal 8 adolescents having the habit of tobacco chewing were selected using snowball sampling technique.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003e Semi-structured interview guide was prepared to assess the factors that increase the tobacco chewing behaviour. Formal permission obtained from Medical officer, Urban primary health center, Zadeshwar, Bharuch, Gujarat state. The investigators prepared the master data collection schedule plan for entire procedure. The data was conducted in the month of August, 2024 and written consent from the all the sample and their parents was taken before starting the study. Audios of the Interview with the participants was recorded and stored for the thematic analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical Consideration\u003c/h3\u003e\n\u003cp\u003eThe selection of participants and data collection was approved by the PPSU Ethical Review Committee (PERC) by letter no. PERC/PPSU/24/7A/01. PPSU Ethical Review Committee (PERC), functions as per the requirements of the ICH-GP, ICMR guidelines 2017 and their SOPs. Written informed consent was obtained from all participants. All participants were informed about the study\u0026rsquo;s objectives, data collection methods and potential risks to the participants. They were also informed of confidentiality and anonymity, and of their right to withdraw consent at any time. For adolescents, written informed consent was obtained from a legally authorized adult representative and from the minor themselves.\u003c/p\u003e"},{"header":"ANALYSIS AND INTERPRETATION","content":"\u003cp\u003eAnalysis was done for the socio-demographic data. Various themes were emerged from the responses of the participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSECTION I: findings related to analysis of socio-demographic data of adolescents having tobacco chewing behaviour (N=8)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Frequency and percentage wise distribution of socio-demographic variables\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"555\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSR. NO.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVARIABLE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFREQUENCY\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePERCENTAGE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eMale\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eFemale\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePrimary\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSecondary\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eHigher-secondary\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eDrop-out\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026lt;5000/-\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e5001/- - 7000/-\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e12.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e7001/- - 10,000/-\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026gt;10,000/-\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e62.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSignificant medical history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eYes\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eNo\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny other habits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Alcohol\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Smoking\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u0026middot;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Others\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e \u003cstrong\u003eShows\u0026hellip;\u003c/strong\u003e\u003c/p\u003e\n\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003eAmong 8 adolescents, 6 (75%) were males and 2 (25%) females.\u003c/li\u003e\n \u003cli\u003eTwo (25%) adolescents had primary education, 2 (25%) had secondary education and 4 (50%) were school drop-out.\u003c/li\u003e\n \u003cli\u003eOne (12.5%) had an income of ₹5001\u0026ndash;7000, two (25%) ₹7001\u0026ndash;10,000, and five (62.5%) over ₹10,000.\u003c/li\u003e\n \u003cli\u003eNo significant medical history or other habits were reported.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSECTION II: Thematic analysis for the factors influencing tobacco chewing behaviour\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Answers given by the participants about Initiation\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSR. No.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubtheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitiation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003ePeer group influence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eCode 1, 2, 3, 5, 6, 7, 8\u003c/p\u003e\n \u003cp\u003eCode 5: \u0026ldquo;By watching my friends, I also started chewing tobacco.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eFamily influence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eCode 3, 7\u003c/p\u003e\n \u003cp\u003eCode 3: \u0026ldquo;My parents chew tobacco. So, I developed the same habit, too.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eInfluence by colleagues\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eCode 2\u003c/p\u003e\n \u003cp\u003eCode 2: \u0026ldquo;I observed that my colleagues had the same habit.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eTaste of tobacco\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eCode 1\u003c/p\u003e\n \u003cp\u003eCode 1: \u0026ldquo;I liked the taste and gradually I started it every day.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eTrying for once\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eCode 4, 8\u003c/p\u003e\n \u003cp\u003eCode 4: \u0026ldquo;My friends insisted me to try it once. So, one day I tried and gradually my habit had started.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e represents the answers given by participants about initiation of tobacco chewing habit. The most of adolescents had peer group influence as a reason of initiation. Others were influenced by their family and colleagues. Some participants tried tobacco for once and gradually and developed the habit. One participant liked the taste of tobacco at first and developed the habit. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Answers given by the participants about Triggering situation\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSR. No.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubtheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTriggering situation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eWorkplace environment\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eCode 1, 2, 3, 4\u003c/p\u003e\n \u003cp\u003eCode 3:\u0026nbsp;\u0026ldquo;If I don\u0026rsquo;t chew it, I can\u0026rsquo;t focus on my work.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eMeals\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eCode 3, 4, 5, 6, 8\u003c/p\u003e\n \u003cp\u003eCode 3:\u0026nbsp;\u0026ldquo;I need it after meals, tea or water also, even after breakfast.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003eshows the answers given by the participants about triggering situation for tobacco chewing. Some participants feel the urge to chew tobacco at their workplace. Others feel triggering situation after the meals. Only one participant had no any specific situation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Answers given by the participants about Feeling after consumption\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSR. No.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubtheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFeeling after consumption\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eMore focused behaviour\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 2, 4, 7\u003c/p\u003e\n \u003cp\u003eCode 7: \u0026ldquo;I can focus on my work more effectively because of tobacco.\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eImprovement in mood\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 1, 2, 3, 4, 6, 7, 8\u003c/p\u003e\n \u003cp\u003eCode 1: \u0026ldquo;I feel good. And I also feel that I am fresh. It gives me energy and motivation to work effectively.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003eshows the responses of participants about their feeling after the consumption of tobacco. Participants feel tobacco gives them focus at workplace. Majority of participants feel improvement in their mood after chewing tobacco. Only one participant had the same feeling as before. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Answers given by the participants about Insufficient amount\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSR. No.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubtheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInsufficient amount\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003ePhysical symptoms\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 1, 2, 3, 4, 7\u003c/p\u003e\n \u003cp\u003eCode 7: \u0026ldquo;I feel headache and lack of energy that day. I feel weak on that whole day.\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eChanges in mood\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 1, 2, 3, 4, 6, 8\u003c/p\u003e\n \u003cp\u003eCode 1: \u0026ldquo;I don\u0026rsquo;t feel like working at my work place. I also can\u0026rsquo;t concentrate while working.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u0026nbsp;\u003c/strong\u003erepresents the answers of participants about chewing insufficient amount of tobacco. Some participants feel physical symptoms and others feel changes in mood.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6: Answers given by the participants about Social stigma\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSR. No.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubtheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial stigma\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative feedback at workplace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 1, 2, 4, 7\u003c/p\u003e\n \u003cp\u003eCode 2: \u0026ldquo;My supervisor scolds me that it is bad. And the house owners say that \u0026ldquo;don\u0026rsquo;t spit it in our houses, don\u0026rsquo;t chew it inside the house etc.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative feedback from family\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 2, 3, 5, 6, 8\u003c/p\u003e\n \u003cp\u003eCode 3: \u0026ldquo;Right now, my parents don\u0026rsquo;t scold me. But in my initial days, they used to scold me that \u0026ldquo;don\u0026rsquo;t chew it, it has so many side effects, you will get sick\u0026rdquo;.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u0026nbsp;\u003c/strong\u003eshows the responses given by the participants regarding social stigma felt by them. Some participants felt social stigma at their workplace. Other participants got negative feedback from their families. One participant does not have any experience regarding social stigma.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7: Answers given by the participants about Future of health with tobacco\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSR. No.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubtheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFuture of health with tobacco\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAwareness of specific diseases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 1, 2, 3, 5, 6, 7, 8\u003c/p\u003e\n \u003cp\u003eCode 1: \u0026ldquo;It leaves spots inside the body and mouth which are bad for health. It also causes ulcers inside the body.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAwareness of health hazards but no specific diseases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 4\u003c/p\u003e\n \u003cp\u003eCode 4: \u0026ldquo;People say it causes cancer. I don\u0026rsquo;t have any idea about rest of the things.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMisconceptions of diseases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 1, 6\u003c/p\u003e\n \u003cp\u003eCode 6: \u0026ldquo;I think the skin inside the mouth gets ulcerated or burns. The skin colour also gets changed.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7\u0026nbsp;\u003c/strong\u003eshows the answers of participants about their future of health with tobacco chewing habit. Majority of participants were aware about specific diseases caused by tobacco chewing. One participant did not had knowledge of specific diseases. Few participants had misconceptions about the diseases caused by tobacco chewing behaviour.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8: Answers given by the participants about Advice to others\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSR. No.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubtheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdvice to others\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdvice not to start tobacco chewing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 1, 2, 3, 5, 7, 8\u003c/p\u003e\n \u003cp\u003eCode 3: \u0026ldquo;I will tell them not to start it. If they don\u0026rsquo;t listen to me, I will scold them and stop them.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo advice\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 4, 6\u003c/p\u003e\n \u003cp\u003eCode 4: \u0026ldquo;Whatever I say, no one will listen to me.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8\u0026nbsp;\u003c/strong\u003eindicates the responses given by the participants regarding advice given by them to others about tobacco chewing behaviour. Majority of participants were willing to advice others against this behaviour. Rest of the participants were not interested in giving advice to others as they believe no one will listen to their advice.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9: Answers given by the participants about Changes in lifestyle\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSR. No.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubtheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChanges in lifestyle\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLack of savings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 1, 2, 3, 4\u003c/p\u003e\n \u003cp\u003eCode 3: \u0026ldquo;I can\u0026rsquo;t save my money.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrge to chew tobacco\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 1, 3, 7, 8\u003c/p\u003e\n \u003cp\u003eCode 8: \u0026ldquo;The urge to chew tobacco whole day is very high.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical changes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 2\u003c/p\u003e\n \u003cp\u003eCode 2: \u0026ldquo;I can\u0026rsquo;t eat spicy food. Sometimes, I get ulcers in my mouth.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncreased debts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eCode 4, 6\u003c/p\u003e\n \u003cp\u003eCode 6: \u0026ldquo;If I don\u0026rsquo;t spare my money on tobacco, I may not have any debts on tobacco shops.\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9\u0026nbsp;\u003c/strong\u003edepicts the responses given by the participants about changes in their lifestyle after starting tobacco chewing. Some participants had lack of savings as they spend their money on purchasing tobacco. Some participants were constantly feeling urge to chew tobacco. Few participants had physical changes and increased debts. One participant did not have any changes in the lifestyle.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe analysis revealed multiple factors behind adolescent tobacco use, including peer, family, and colleague influence, taste, and curiosity. Triggers included work and post-meal times. Tobacco use boosted mood and focus but caused physical, mood, social, health, and lifestyle issues.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eExploring the factors influencing tobacco chewing behaviour\u003c/h2\u003e \u003cp\u003eFor the first objective, 8 adolescents with tobacco chewing behavior were selected through snowball sampling for interviews.\u003c/p\u003e \u003cp\u003eThe investigation revealed that peer, family, and professional pressure, tobacco taste, and curiosity drive adolescents to chew tobacco. Workplace and post-meal environments act as triggers, while tobacco use boosts mood and focus.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eIdentifying the lifestyle experience regarding tobacco chewing behaviour\u003c/h2\u003e \u003cp\u003eFor the second objective, thematic analysis showed that lack of tobacco causes psychological and physical changes. Adolescents face social stigma, health risks, and lifestyle changes due to this behavior.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eMAJOR FINDINGS OF THE STUDY:\u003c/h2\u003e \u003cp\u003eThe data were analysed and interpreted in terms of objectives. Thematic analysis is used for data analysis. Data were organized and presented in the following manner.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSection I: Socio-demographic data:\u003c/h2\u003e \u003cp\u003eThe study found that 6 (75%) adolescents were male and 2 (25%) female, all were dropouts. One (12.5%) had an income of ₹5001\u0026ndash;7000, two (25%) earned ₹7001\u0026ndash;10,000, and 5 (62.5%) had \u0026gt;₹10,000. No significant medical history or other habits were reported.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSection II: Data Analysis of participant interview:\u003c/h2\u003e \u003cp\u003eThe investigation revealed that peer, family, and professional pressure, tobacco taste, and curiosity drive adolescents to chew tobacco. Workplace and post-meal environments trigger use. Tobacco improves mood and focus but causes physical, emotional, social, health, and lifestyle changes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLIMITATIONS:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe small sample size of only 8 participants limits the generalizability of the findings to the broader adolescent population.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe study was confined to a single slum area (Kabir Sanskar Dham) in Bharuch district, which may not reflect the experiences of adolescents in other slum areas or regions.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe qualitative nature of the study does not allow for statistical analysis or quantification of behaviours.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eDELIMITATIONS:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe study was restricted to adolescents aged 10 years and above who had been chewing tobacco for more than one year.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOnly adolescents residing in the selected slum area of Kabir Sanskar Dham, Bharuch, were included in the study.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe research focused solely on tobacco chewing behaviour and related lifestyle experiences, excluding other forms of tobacco or substance use.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eData collection was limited to those participants willing to participate and available during the study period.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe study included only adolescents who could understand and respond in Gujarati.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe conclusion highlights that tobacco chewing initiation is influenced by peer, family, and colleague behavior, with triggers including workplace and post-meal environments. Insufficient amounts cause physical and mood changes, leading to social stigma, health concerns, and lifestyle changes.\u003c/p\u003e"},{"header":"Abbreviations","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eWHO\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eWorld Health Organization\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eCOTPA\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eCigarettes and Other Tobacco Products Act\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSLT\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSmoke-less Tobacco\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eGATS\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eGlobal Adult Tobacco Survey\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePPE\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003ePersonal Protective Equipment\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eCOVID 19\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eCorona Virus Disease of 2019\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eOPD\u003c/span\u003e\u003c/div\u003e 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\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eAdenosine Triphosphate\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSPSS\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSpecial Package of Social Science\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eFDA\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eFood and Drug Administration\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE\u003c/strong\u003e \u003cp\u003eThe ethical clearance for this study was taken from PPSU Ethical Review Committee on \u003cb\u003e02/09/2024\u003c/b\u003e, Letter No. \u003cb\u003ePERC/PPSU/24/7A/01\u003c/b\u003e. PPSU Ethical Review Committee follows ICMR guidelines year 2017. As the study samples were adolescents, consent from adolescents and their guardians were taken by using the local language. The objectives were clearly mentioned to the participants and their guardians. Confidentiality and anonymity of the interview was maintained throughout the study. They were also informed to withdraw the consent whenever they are not willing to participate.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCONSENT FOR PUBLICATION\u003c/strong\u003e \u003cp\u003eNot Applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCOMPETING INTERESTS\u003c/strong\u003e \u003cp\u003eThe Authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFUNDING\u003c/h2\u003e \u003cp\u003eThere is no any funding for the Study Design, Collection \u0026amp; analysis of data and drafting of the manuscript, this was the role of authors. The writing of this manuscript has not been funded.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe Study protocol was written by JP \u0026amp; SB. Data collection was performed by the JP. MC prepared the manuscript. JP, SB \u0026amp;MC Provided Comments\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to express our gratitude to the Medical Officer of Urban Primary Health Centre, Zadeshwar, Bharuch, Gujarat for letting us conduct the study in the urban area. We would really appreciate the participants and their guardians for the cooperation. Without them, the study would be impossible to conduct.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe authors have collected and stored the audio recordings of the participant interviews. Later, the transcripts of the same was prepared. The transcripts cannot be shared due to confidentiality of the identity of the participants as the consent was taken prior to the data collection. The transcripts are available from the corresponding author upon request due to confidentiality.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOlando Y, Majumdar A, Sreedev A, Sun MC, Jennings C, Tibazarwa K et al. A qualitative study exploring the views on tobacco use and cessation support among patients in Kenya. Afr J Alcohol Drug Abuse AJADA. 2020;1\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJitnarin N, Poston WS, Jahnke SA, Haddock CK, Kelley HN, Severson HH. A qualitative study to assess perceptions, barriers, and motivators supporting smokeless tobacco cessation in the US fire service. PLoS ONE. 2021;16(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArora S. A Study to Assess Prevalence of Tobacco Use Among Adolescents and Assess the Effectiveness of Structured Teaching Program Regarding Ill Effects of Tobacco Use and Its Prevention Among Adolescents in Selected Community of New Delhi. 2023;778:23\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamakrishnan S, Thangjam R, Roy A, Singh S, Ramakrishnan L, Seth S, et al. Acute effects of tobacco chewing on the systemic, pulmonary and coronary circulation. Am J Cardiovasc Drugs. 2011;11:109\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoditis M, Delucchi K, Cash D, Halpern-Felsher B. Adolescents\u0026rsquo; perceptions of health risks, social risks, and benefits differ across tobacco products. J Adolesc Health. 2016;58(5):558\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVu M, Getachew B, Payne JB, Kirchner TR, Berg CJ. Initiation, continuation of use and cessation of alternative tobacco products among young adults: A qualitative study. Tob Prev Cessat. 2018;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupte HA, Costa M, Chaudhuri L. Why do adolescents initiate and continue using tobacco and areca nut? A qualitative study tracing pathways of use among school-going adolescents in Mumbai, India. Nicotine Tob Res. 2020;22:2022\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCritchley JA, Unal B. Health effects associated with smokeless tobacco: a systematic review. Thorax. 2003;58(5):435\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiovenco DP, Spillane TE, Maggi RM, Lee EY, Philbin MM. Multi-level drivers of tobacco use and purchasing behaviors during COVID-19 lockdown: a qualitative study in the United States. Int J Drug Policy. 2021;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePooja NM, Rani R. Tobacco chewing habits and barriers in cessation among tobacco users: a survey from Western Rajasthan, India. Int J Community Med Public Health. 2020;7:3617\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Explore, Factors influencing, Tobacco chewing behaviour, Lifestyle experience, Adolescents","lastPublishedDoi":"10.21203/rs.3.rs-8659503/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8659503/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground of the study:\u003c/h2\u003e \u003cp\u003eTeenagers are the group most likely to start using tobacco products. As is now well known, the majority of adult tobacco users began using the drug when they were young or in their teens. Recent WHO surveys indicate that schoolchildren in India are consuming more tobacco products, and the majority of them begin taking drugs at an early age. Teenagers between the ages of 16 and 19 are particularly susceptible to the detrimental effects of maturing, peer pressure, popularity, and accessibility.\u003c/p\u003e\u003ch2\u003eResearch methodology:\u003c/h2\u003e \u003cp\u003eIn the present study qualitative phenomenological research approach was selected, and investigator selected urban slum area of Bharuch, Gujarat state. The sample size for the study was 8 adolescents. Data collection was done using snowball sampling technique. The data was analyzed and interpreted by using thematic analysis.\u003c/p\u003e\u003ch2\u003eResult of the study:\u003c/h2\u003e \u003cp\u003eThe investigation reveled that a number of factors contribute to the lifestyle experiences that teenagers have. Teenagers start this behavior due to peer pressure, familial and professional pressure, tobacco taste, and a once-in-a-lifetime attempt. The workplace is one of the triggers for tobacco chewing. After meals, some teenagers also choose to smoke. They feel happier and have more focus after using tobacco. Certain physical and emotional changes result from insufficient amounts of tobacco. Adolescents that engage in this behavior may experience social stigma, eventual health concerns, and certain changes in lifestyle.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eBased on the results of the following study, it concluded that peer groups and family and co-worker behavior influence tobacco chewing initiation. Other reasons that cause the need to chew tobacco include the setting at work and the sensation of being provoked after eating. A lack of it causes specific psychological and bodily changes. Adolescents who exhibit this behavior face social shame, eventual health concerns, and lifestyle modifications.\u003c/p\u003e","manuscriptTitle":"A Qualitative Study to Explore the Factors Influencing Tobacco Chewing Behaviour and the Lifestyle Experience Among Adolescents.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-11 09:11:19","doi":"10.21203/rs.3.rs-8659503/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6f312e91-b052-469d-9b2e-ad9afcd0c287","owner":[],"postedDate":"March 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-19T08:26:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-11 09:11:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8659503","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8659503","identity":"rs-8659503","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}