Intention to Try Tobacco Among Middle School Students in a Predominantly Rural Environment of Central Appalachia

Abstract

Background: Disparities in tobacco use exist across regions in the United States. The Central Appalachian region carries some of the very high rates of tobacco use prevalence but research on tobacco use initiation is sparse. Objective: To investigate the intention to try tobacco and its associated factors among non-smoking youth. Method: Data were obtained from school-based tobacco surveys (n=539) conducted in 11 middle schools (6th-8th grades; aged 10–15 years) in Northeast Tennessee in 2015–2016. Non-smoking participants without firm commitment to abstain from trying tobacco in the next year were considered to have an intention to try tobacco. The Full Information Maximum Likelihood estimation (FIML) method in Mplus was employed to conduct a multivariable logistic regression analysis to delineate correlates of intention to try tobacco. Results: Overall, 20.0% of participants had intention to try tobacco. Among participants with intention to try tobacco, 53.7% owned tobacco-branded item(s), 86.1% believed that tobacco users have more friends, and 88.9% lived with tobacco users. In the adjusted logistic model, ever use of tobacco products, home smoking rules, owning tobacco-branded item(s), living with tobacco users, believing that tobacco users have more friends, and perception of easy access to tobacco products were significantly associated with intention to try tobacco (p<0.02). Conclusion: This study suggests that individual, interpersonal and community level factors influence intention to try tobacco in this environment where tobacco preemption laws impede development of local tobacco control policies and regulations. Thus, efforts should focus on tobacco use initiation preventive programs, including school-based tobacco control programs.

Exploring Associations between Susceptibility to the Use of Electronic Nicotine Delivery Systems and E-Cigarette Use among School-Going Adolescents in Rural Appalachia

“…ENDS use among USA youths has surpassed all CTPs since 2014 [2,19,28]. However, studies involving youth in high-risk environments such as distressed rural areas that predispose youth to tobacco use and make them vulnerable to initiate ENDS use are sparse [10,[55][56][57][58]83]. This study explored the use of ENDS among students in an ARC-designated, distressed, rural county in Appalachian Tennessee in 2019.…”

“…Much of the susceptibility literature in the USA is centered on CTPs [37,39,45,47], although studies pertaining to ENDS use [2,36,37] continue to emerge within population subgroups [44,49]. The impetus for this study is the paucity of studies involving youth in rural areas, such as those in the high-risk environment of Central Appalachia [53][54][55][56][57][58].…”

Sociodemographic differences in single, dual, and poly tobacco use among Appalachian youth

“…Moreover, living with one or more tobacco user(s) is associated with youth using any tobacco, including use of multiple tobacco products. Previous work with Appalachian youth found significant associations between residing in a household with one or more tobacco users and intention to try a tobacco product 18 . Other research has documented positive associations between living with a tobacco user and youth use of tobacco products 19 - 22 .…”

“…The sample was predominantly White/ Caucasian (88.6%). The mean age was 13.7 years (SD=1.9) with a median of 14 years (range: [11][12][13][14][15][16][17][18][19]. The majority of respondents were from North Carolina (46.4%), followed by Kentucky (34.1%) and then New York (19.5%).…”

Sex differences in associations between receiving and sharing tobacco-related information and tobacco product use among Appalachian Youth

“…Many Appalachian youth are susceptible to tobacco uptake and use, and several factors may contribute to this susceptibility [21][22][23] . For example, living in poverty is associated with tobacco use 24 , and several Appalachian states have high poverty rates 25 .…”