Predictors of Smokeless Tobacco Susceptibility, Initiation, and Progression Over Time Among Adolescents in a Rural Cohort

Abstract

Background: Use of smokeless tobacco (ST, moist snuff and chewing tobacco) is elevated among male rural youth, particularly participants in certain sports, including baseball. Objectives: This study aimed to assess factors associated with adolescent male athletes' STrelated behaviors over time, including: baseline use, initiation, and progression in use intensity in a school-based longitudinal cohort. Methods: Baseline and one-year follow up questionnaires assessed socio-demographic characteristics, environmental factors, and tobacco-related perceptions and behaviors among 9-12th grade interscholastic baseball players in 36 rural California schools. Population characteristics were compared among ST use categories (never, experimental, and experienced users). Multivariable models using generalized estimating equations were estimated for outcomes among baseline ST never-users (ST susceptibility and future initiation) and experimenters (ST expectations and progression in ST use). Results: Of 594 participants, over half (57%) had ever tried a tobacco product and the most common products tried were ST (36%) and electronic cigarettes (36%). Being older, perceiving less ST harm, being Non-Hispanic White, using alcohol or other tobacco products, having family or friends who use ST, and being receptive to advertising were associated with greater baseline ST use. Baseline alcohol consumption, lower perceived ST harm, peer use, and susceptibility and expectations were predictive of ST initiation and/or progression at one-year follow-up. Conclusion/Importance: Certain environmental, socio-demographic, cognitive, and behavioral factors predict ST susceptibility and later initiation and progression in use. Interventions addressing these factors have potential to prevent ST uptake and continued use within this highrisk adolescent population.

Correlates of tobacco product initiation among youth and young adults between waves 1–4 of the population assessment of tobacco and Health (PATH) study (2013–2018)

“…[14][15][16] Similar to previous studies, we found alcohol use was associated with new hookah use in youth and young adults, 12 as was marijuana and previous tobacco use. 27 For smokeless tobacco, consistent with other studies of youth, alcohol use was associated with new smokeless tobacco use, 13 although the same was not true of young adults. Few studies have examined initiation of cigars in youth, although our study found correlates of initiation for cigars was similar to those of cigarettes.…”

“…The exception is Kasza et al, who recently documented correlates of initiation across products through Wave 3 [W3] of the PATH Study, finding that previous tobacco use consistently predicted tobacco product initiation, and some demographic predictors (sex, race/ethnicity and sexual orientation) varied across products. 11 Other studies have found that correlates of non-cigarette products have included alcohol use, 12,13 exposure to others using the products, [14][15][16] mental health, 9 peer use, 7 and receptivity to tobacco advertising. 8 The aim of this study is to expand upon previous PATH Study analyses 5,8,9,11,14,[17][18][19][20] by presenting population estimates of tobacco product initiation and correlates of initiation of each product among youth and young adults between W1 (2013-2014) and Wave 4 (W4, 2016-Jan 2018 ).…”

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

“…A rural North Carolina study showed that Black and Native American persons were more likely to use “snuff”, whereas Native Americans were more likely to use chewing tobacco compared to their White counterparts [ 102 ]. Another study showed that among a rural cohort of adolescents in California, non-Hispanic White teens were more likely to use smokeless tobacco compared to their rural Hispanic counterparts [ 103 ].…”

Associations between Cognitive and Affective Responses to Tobacco Advertisements and Tobacco Use Incidence: A Four-Year Prospective Study among Adolescent Boys

“…Increased exposure to tobacco marketing is consistently associated with cigarette smoking, SLT use, and e-cigarette use among youth [ 4 , 5 , 6 , 7 , 8 ]. Youths’ receptivity to tobacco advertisements (operationalized as their ability to name a favorite brand and owning or being willing to own a tobacco promotional item) is also associated with use of these products [ 9 , 10 , 11 ].…”

“…Although this theoretical framework exists, our understanding of the associations between cognitive and affective responses to tobacco advertisements and tobacco use outcomes among youth is limited. A large body of research has investigated the associations between advertisement exposures, advertisement receptivity, and tobacco use [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Beyond receptivity, much less is understood about associations between youths’ other cognitive and affective responses toward advertisements and tobacco use.…”