Factors Influencing Smokeless Tobacco Use in Rural Ohio Appalachia

Abstract

Background The burden of smokeless tobacco (ST) use disproportionally impacts males in rural Ohio Appalachia. The purpose of this study was to describe the cultural factors contributing to this disparity and to articulate the way in which culture, through interpersonal factors (i.e. social norms and social networks) and community factors (i.e. marketing and availability), impacts ST initiation and use of ST among boys and men in Ohio Appalachia. Methods Fifteen focus groups and twenty-three individual qualitative interviews were conducted with adult (n=63) and adolescent (n=53) residents in Ohio Appalachian counties to ascertain factors associated with ST use and the impact of ST marketing. Transcriptions were independently coded according to questions and themes. Results ST use appears to be a rite of passage in the development of masculine identity in Ohio Appalachian culture. Interpersonal factors had the greatest influence on initiation and continued use of ST. Ohio Appalachian boys either emulated current ST users or were actively encouraged to use ST through male family and peer networks. Users perceived their acceptance into the male social network as predicated on ST use. Community factors, including ST advertisement and access to ST, reinforced and normalized underlying cultural values. Conclusions In addition to policy aimed at reducing tobacco marketing and access, interventions designed to reduce ST use in Ohio Appalachia should incorporate efforts to 1) shift the perception of cultural norms regarding ST use and 2) address male social networks as vehicles in ST initiation.

Risk Perceptions of Smokeless Tobacco Among Adolescent and Adult Users and Nonusers

“…For these adult ST users, the benefits associated with ST use, such as social acceptance or desirability, may outweigh the negative health risks. ST use is part of the Appalachian identity and central to the development of masculinity in the Appalachian community (Nemeth et al, 2012). Social norms around tobacco use in Ohio Appalachia are largely influenced by tobacco's role as a primary cash crop in the region, which grows approximately 97% of all burley tobacco (Meyer et al, 2008; Wood, 1998).…”

Cigarettes, Smokeless Tobacco, and Poly-Tobacco Among Workers in Three Dusty Industries

“…For example, in some Appalachian communities, use of SLT is considered a symbol of manhood. 31 Advertising campaigns for major traditional SLT brands such as Skoal and Copenhagen may appeal FIGURE 1. Prevalence with 95% confidence intervals 1 of current tobacco use by industry.…”

Rural tobacco use across the United States: How rural and urban areas differ, broken down by census regions and divisions

“…4 These resultant social norms often include stronger acceptance and support for tobacco use. 13,15,16 Targeted tobacco marketing, which frequently promotes images of masculinity, toughness, and the outdoors, can further reinforce rural pro-tobacco norms. 15 …”