Uncorrected Proof Int J High Risk Behav Addict. 2022 September; 11(3):e127480. Published online 2022 October 6. doi: 10.5812/ijhrba-127480. Research Article Investigating the Reasons for Using Smokeless Tobacco Among Adults: A Qualitative Study Based on the Grounded Theory Approach Mahnaz Solhi 1 , Fardin Mehrabian 2 , Seyed Saeed Hashemi Nazari 3 , Esmaeil Fattahi 2, * , Hadis Barati 3 , Iraj Zareban 4 and Zahra Sadat Manzari 5 1 Department of Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, IR Iran 2 Department of Health Education and Promotion, Research Center of Health and Environment, School of Health, Guilan University of Medical Sciences, Rasht, IR Iran 3 Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran 4 Health Promotion Research Centre, Zahedan University of Medical Sciences, Zahedan, IR Iran 5 Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran * Corresponding author: Assistant Professor, Department of Health Education and Promotion, Research Center of Health and Environment, School of Health, Guilan University of Medical Sciences, Rasht, IR Iran. Email: esmaeil.fattahi1@gmail.com Received 2022 May 06; Revised 2022 August 20; Accepted 2022 August 29. Abstract 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 men- tioned 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 consump- tion 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. Keywords: Smokeless Tobacco, Adults, Qualitative Research, Grounded Theory 1. Background The use of smokeless tobacco is a public health prob- lem worldwide (1, 2) with a history that dates back to Asian countries nearly 2,000 years ago (3, 4). India is the world- leading in the production and consumption of smokeless tobacco. Asian countries such as Pakistan, Bangladesh, Nepal, and other countries are in the next rank (5). The con- sumption of these substances is also increasing in Euro- pean, American, and African countries, and even Australia (6). According to previous studies, smokeless tobacco is used in a hundred and forty countries around the world. There are three hundred million consumers in the world, of whom 206 million (68.7%) abode in India (7). In addition, the use of smokeless tobacco in Iran is more commonplace in Sistan and Baluchistan province and mainly in Chaba- har city, where 11% to 45% of adolescents and students are estimated to be consumers (8-14). Smokeless tobacco con- sists of substances such as tobacco and various additives consumed by chewing, sucking, or sniffing (15). In general, different types of smokeless tobacco are available in hand- made and industrial forms. Many studies have reported that the use of these substances can cause various diseases and increase mortality (16). Unfortunately, few interventions have been performed to address the problem in affected areas, and usually, the interventions performed have been the least effective with- out promising outcomes (17). One of the reasons for the Copyright © 2022, Author(s). 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