Towards a better understanding of the psychosocial determinants associated with adults' use of smokeless tobacco in the Jazan Region of Saudi Arabia: a qualitative study.

Shammah use was associated with uncertainty about Shammah composition and quitting knowledge, social acceptability, influence from family/friends, a range of positive and negative attitudinal beliefs toward its use and high quitting efficacy beliefs. Future interventions targeting Shammah should address the acknowledged triggers and barriers in the present study including the dual use of Shammah and Khat.