We conducted seven focus groups with a total of 63 participants. Our sample included 37 smokers (32 current smokers who reported smoking in the past 30 days and 5 former smokers who reported having stopped smoking for at least 1 month) and 26 never smokers. In this paper, the term “smokers” will be used to reference both current and former smokers, and “nonsmokers” will be used to reference never smokers. Of the smokers, 97.30 % (n = 36) were male. Of the nonsmokers, 92.31 % (n = 24) were female. Smokers’ average age was 58 years (SD = 10.93). Nonsmokers’ average age was 53.58 years (SD = 11.08). Age was missing for two nonsmoking participants and one smoking participant. The average time lived in the United States was 11.49 years (SD = 11.63) among smokers and 8.95 years (SD = 5.95) among nonsmokers. Time lived in the U.S. was missing for one smoking participant. All participants were immigrants from China (including the Mainland and Hong Kong). Among the 17 nonsmokers who were recruited in household dyads with a smoker, two were the father of a smoker, one was the brother of a smoker, and the remaining 14 were the wife of a smoker.
Overview of Themes
The constant comparative analysis yielded nine themes, which were consistent across smokers and nonsmokers and were summarized with subcategories in Table 1. Table 1 also provides sample illustrative quotes from smokers and nonsmokers in support of each theme.
Focus on Irritating Odor from Smoking and Smoke Exposure
Participants had varying degrees of understanding about the health effects of smoking and SHS exposure, regardless of smoking status. Most participants focused on the irritating odor from smoking and SHS exposure. Negative comments about smoking were almost exclusively focused on the smell of cigarettes and the lingering odor on clothes and in the air.
Focus on Harms of Smoking to Smoker Not Nonsmokers
When smokers or nonsmokers described other negative consequences of smoking, they concentrated mainly on health harms for the smoker but not household members impacted by SHS exposure. At the same time, some participants acknowledged that SHS exposure could negatively impact the health of children in terms of allergies, asthma, or other respiratory discomforts.
Beliefs that Smoking is Healthful and Quitting is Harmful
Rather than accurate information about smoking consequences to motivate cessation, it was often inaccurate beliefs about smoking and quitting that pervaded the discussions for both smokers and nonsmokers and discouraged cessation. A recurrent theme in responses about how long it takes for SHS to affect one’s health was that it depends on the weakness of the person’s immune system or health. Participants stated that many Chinese smokers believe they will live a long life regardless of how much they smoke, citing Mao Zedong (the founder of the People’s Republic of China) as someone who chain-smoked yet lived past age 80. Comments about how quitting could be harmful were evident in participants’ examples of how relatives got sick or died after a quit attempt.
Beliefs that Quitting Requires Determination and Willpower
Most participants reported that a smoker’s ability to quit smoking depended on their determination. Those who could not quit were perceived as too weak-willed to overcome their addiction, and those who quit were portrayed as simply deciding to quit. One wife of a smoker stated her belief that quitting ultimately takes determination since the addiction is psychological. Her smoking husband stated, “In reality, everyone has the determination for 3 months. However, the determination will decrease after 3 months.” Though he also believed that determination was the key to cessation, he reflected on several occasions how easy it was for him to relapse when he made quit attempts.
Co-workers or Friends Keep Smokers Connected to Pro-smoking Norms
Many of the participants in the sample worked in ethnic businesses such as restaurants and factories. There, among coworkers, smoking was seen as a way to increase social harmony. Nonsmokers and smokers reflected on the workplace as a context that encourages smoking since other ethnic peers smoke. As one smoker stated, “offering you a cigarette demonstrates friendship, is a way of interaction. In the past, if you did not offer a cigarette when you came across a friend, it made you feel guilty.”
Conflict with Household Nonsmoker About Smoking
Smokers and nonsmokers stated that smoking was a source of conflict as household members attempted to negotiate the household environment, marital relationships, and parent–child relationships. No smokers stated that their nonsmoking household members condoned their smoking behaviors and all nonsmokers voiced their displeasure about the smoking behaviors of their household members. Many smokers reported feeling pressure from family members to refrain from smoking inside the home and responded by smoking outside the home and by cutting back on smoking. Some nonsmoking household members expressed their frustration at smokers’ inability to quit but verbal conflicts about smoking in the house did not necessarily have the desired effect for nonsmoking household members. Whereas these verbal conflicts were successful in motivating some smokers to reduce or quit smoking, other smokers reacted by smoking outside the home, sometimes in secret.
Family Harmony and Benefit for Children
Though many smokers reported feeling nagged to quit smoking, they understood that refraining from smoking—especially in the home—was one important way to increase relational harmony. Furthermore, some smokers stated their understanding of the value of cessation to protect their family members from SHS exposure. Comments focused on protecting adult nonsmokers from SHS exposure, however, were quite uncommon. Rather, it was more common for smokers and household members of smokers to focus on smoking as an annoying or odoriferous behavior.
Healthcare Environment Insufficient to Counter Pro-smoking Norms and Myths
Several smokers reported seeing medical providers when they were sick (usually related to heavy coughing) and being counseled to quit and improve their health, yet most reported being unable to sustain cessation. Generally, when smokers were acutely ill and were advised to quit smoking by medical providers, they did so. However, once they were no longer sick, and especially if they continued to socialize in environments with pro-smoking norms, smokers returned to smoking and rationalized their behaviors. Notably, few smokers discussed taking or being advised to take medications (e.g., nicotine gum or patches) to aid in cessation.
Acceptability of Smoking Depends on Social Context
Both smokers and nonsmokers were aware that smoking in public was not viewed favorably. Several smokers commented that their smoking was sometimes met with negative nonverbal reactions, such as people covering their noses and mouths. Such reactions made impacts on some smokers; one smoker reported putting out his cigarette, while others reported reducing cigarette consumption. Participants contrasted perceptions of smoking in the United States compared to China. Nonsmokers noted that their smoking household members cut back or quit smoking only after immigrating to the United States and several stated that visiting China often created opportunities to relapse or increase smoking intensity.