Smokeless Tobacco Decision-Making Among Rural Adolescent Males in California
- 257 Downloads
Smokeless tobacco (ST) use among US high school males living in rural areas exceeds national levels. Subgroups at heightened risk of ST use have been identified, but less is known regarding ST decision-making within high-risk groups. The study objective was to describe rural adolescent males’ perceived ST acceptability, health risks, and social implications and how those perceptions differ between ST users and never-users. Semi-structured individual interviews were conducted with a purposeful sample of 55 male students (32 ST ever-users) at three rural California high schools. Interviews were audio recorded and professionally transcribed. Investigators collaboratively developed a codebook based on thematic content and then independently coded transcripts, reconvening frequently to achieve consensus. Coded text was systematically organized into themes following a general inductive approach. ST users and non-users shared multiple ST-related perceptions, including: that ST is a common, normative way of life in rural “country” culture among certain groups; that ST use conveys oral health risks; and that the decision to use (or not to use) is rooted in personal choice. ST users’ and never-users’ perceptions differed regarding the immediacy, severity, and inevitability of health risks, particularly relative to cigarette smoking. Other differences included perceived parental permissiveness and the expected social benefits of ST use, such as peer acceptance and conveying maturity. Within this population of rural male adolescents, ST users emphasized the social benefits of ST use, while acknowledging but discounting health risks. Differences and similarities in tobacco perceptions among adolescents living in similar environments may inform effective health communication.
KeywordsSmokeless tobacco Adolescents Rural health Health behaviors Risk perceptions
Thank you to Joanna Hill, Archnaa Rajasekaran, and Janelle Urata, all of the University of California San Francisco, for administrative and technical support. The authors would also like to acknowledge Bonnie Halpern-Felsher, of Stanford University, and Maria Roditis and Janine Cataldo, of the University of California San Francisco, in the development of the interview guide. The authors acknowledge the passing Dr. Margaret Walsh, whose exceptional leadership and scholarship over 37 years at the University of California will have a lasting impact in the field of tobacco control.
This work was supported by the US National Institutes of Health, National Cancer Institute and Food and Drug Administration Center for Tobacco Products [Grant No. P50CA180890] and the NIH National Center for Advancing Translational Sciences [Grant No. KL2TR000143]. The content is solely the responsibility of the authors and does not necessarily represent the views of the NIH or FDA. The authors affirm that there are no conflicts of interest related to the publication of this work.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
- 1.Alguacil, J., & Silverman, D. T. (2004). Smokeless and other noncigarette tobacco use and pancreatic cancer: A case-control study based on direct interviews. Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 13(1), 55–58.CrossRefGoogle Scholar
- 15.Hewitt, M. E. (1989). Defining” rural” areas: Impact on health care policy and research. Collingdale: DIANE Publishing.Google Scholar
- 17.Merriam, S. B. (2014). Qualitative research: A guide to design and implementation. Hoboken: John Wiley & Sons.Google Scholar
- 18.Wray, R. J., Jupka, K., Berman, S., Zellin, S., & Vijaykumar, S. (2012). Young adults’ perceptions about established and emerging tobacco products: results from eight focus groups. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 14(2), 184–190. doi: 10.1093/ntr/ntr168.CrossRefGoogle Scholar
- 20.Hecht, S. S., Carmella, S. G., Murphy, S. E., et al. (2007). Similar exposure to a tobacco-specific carcinogen in smokeless tobacco users and cigarette smokers. Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 16(8), 1567–1572.CrossRefGoogle Scholar
- 21.Rostron, B. L., Chang, C. M., van Bemmel, D. M., Xia, Y., & Blount, B. C. (2015). Nicotine and toxicant exposure among U.S. smokeless tobacco users: Results from 1999 to 2012 National Health and Nutrition Examination Survey Data. Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 24(12), 1829–1837. doi: 10.1158/1055-9965.EPI-15-0376.CrossRefGoogle Scholar
- 22.Hatsukami, D. K., Stepanov, I., Severson, H., Jensen, J. A., Lindgren, B. R., Horn, K., et al. (2015). Evidence supporting product standards for carcinogens in smokeless tobacco products. Cancer Prevention Research (Philadelphia, Pa.), 8(1), 20–26. doi: 10.1158/1940-6207.CAPR-14-0250.CrossRefGoogle Scholar
- 23.Stepanov, I., Jensen, J., Hatsukami, D., & Hecht, S. S. (2008). New and traditional smokeless tobacco: comparison of toxicant and carcinogen levels. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 10(12), 1773–1782. doi: 10.1080/14622200802443544.CrossRefGoogle Scholar
- 28.Alcalá, H. E., von Ehrenstein, O. S., & Tomiyama, A. J. (2016). Adverse childhood experiences and use of cigarettes and smokeless tobacco products. Journal of Community Health, 1–8. doi: 10.1007/s10900-016-0179-5
- 29.Pierce, J. P., Evans, N., Farkas, A., et al. (1994). Tobacco use in California: An evaluation of the tobacco control program, 1989–1993. A report to the California Department of Health Services.Google Scholar
- 30.Press Announcements > FDA launches first ad campaign focused on dangers of smokeless tobacco among rural teens. Retrieved 23 Aug, 2016, from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm496631.htm.