Exploring Gambling-like Behaviors in Children's Cigarette Card Games and Parental Pro-game Perceptions in China: A Qualitative Study.

Cigarette card games emerged as a popular yet controversial pastime among children in China, raising concerns on the potential to foster gambling-like behaviors. This study explored children's experiences and perceptions of cigarette card games, as well as parental attitudes and facilitation practices. Semi-structured interviews were conducted with 21 child-parent dyads (19 boys, 2 girls) from September to December 2024. Purposive and snowball sampling techniques were adopted to recruit children who had played cigarette card games in the past 1 month. Separate interview protocols were developed for children and parents to ensure age-appropriate communication. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically following Braun and Clarke's framework, with dual coding and triangulation. Four key themes emerged: (1) Chance and reward-driven engagement, where children linked the thrill of obtaining rare cards to gambling; (2) Peer influence and social reinforcement, which strengthened friendships but risked excluding non-players; (3) Parental misperceptions, viewing the games as healthier alternatives to screen time that promote outdoor activity; and (4) Parental facilitation, including sourcing cards through networks and rationalizing support as aiding socialization. These patterns indicate that cigarette card games may expose children to gambling-like reward systems and normalize tobacco-related imagery, with parental participation further amplifying such exposure and acceptance. Cigarette card games blend gambling-like features with early tobacco normalization, amplified by parental pro-game practices. Public health interventions should target both children and parents, promoting awareness of gambling risks and guiding families toward safe, prosocial forms of play.