Factors Influencing Smokeless Tobacco Use in Rural

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. Fif- teen focus groups and 23 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. 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. Com- munity factors, including ST advertisement and access to ST, reinforced and normalized underlying cultural values. 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.

[1]  M. Noland,et al.  Use of snuff, chewing tobacco, and cigarettes among adolescents in a tobacco-producing area. , 1990, Addictive behaviors.

[2]  L. Weinehall,et al.  'If I don't smoke, I'm not a real man'--Indonesian teenage boys' views about smoking. , 2006, Health education research.

[3]  Christopher J L Murray,et al.  WHO Framework Convention on Tobacco Control: development of an evidence based global public health treaty , 2003, BMJ : British Medical Journal.

[4]  R. Greer.  Oral manifestations of smokeless tobacco use. , 2011, Otolaryngologic clinics of North America.

[5]  P. Ling,et al.  Tobacco industry consumer research on smokeless tobacco users and product development. , 2010, American journal of public health.

[6]  S. Cnattingius,et al.  Adverse pregnancy outcomes in snuff users. , 2003, American journal of obstetrics and gynecology.

[7]  P. West,et al.  Contextualizing smoking: masculinity, femininity and class differences in smoking in men and women from three generations in the west of Scotland. , 2004, Health education research.

[8]  D. Silverman,et al.  Smokeless and Other Noncigarette Tobacco Use and Pancreatic Cancer , 2004, Cancer Epidemiology Biomarkers & Prevention.

[9]  S. Seth,et al.  Acute Effects of Tobacco Chewing on the Systemic, Pulmonary and Coronary Circulation , 2011, American journal of cardiovascular drugs : drugs, devices, and other interventions.

[10]  S. Schroeder,et al.  Tobacco control in the wake of the 1998 master settlement agreement. , 2004, The New England journal of medicine.

[11]  J. Mahalik,et al.  Masculinity and perceived normative health behaviors as predictors of men's health behaviors. , 2007, Social science & medicine.

[12]  W. Latimer,et al.  Epidemiologic trends of adolescent use of alcohol, tobacco, and other drugs. , 2010, Child and adolescent psychiatric clinics of North America.

[13]  Karen Emmons,et al.  Reducing social disparities in tobacco use: a social-contextual model for reducing tobacco use among blue-collar workers. , 2004, American journal of public health.

[14]  G. Connolly,et al.  Developing smokeless tobacco products for smokers: an examination of tobacco industry documents , 2008, Tobacco Control.

[15]  D. Helme,et al.  Health, Masculinity and Smokeless Tobacco Use Among College-Aged Men , 2012, Health communication.

[16]  S. Tomar.  Epidemiologic perspectives on smokeless tobacco marketing and population harm. , 2007, American journal of preventive medicine.

[17]  Sabrina Oesterle,et al.  Drug use and risk among youth in different rural contexts. , 2011, Health & place.

[18]  S. Quandt,et al.  Use of tobacco products among rural older adults: prevalence of ever use and cumulative lifetime use. , 2009, Addictive behaviors.

[19]  P. Cole,et al.  Smokeless tobacco use among men in the United States, 2000 and 2005. , 2009, Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology.

[20]  P. Ling,et al.  Enticing the New Lad: Masculinity as a Product of Consumption in Tobacco Industry—Developed Lifestyle Magazines , 2011, Men and masculinities.

[21]  J. Pachankis,et al.  The influence of sexual orientation and masculinity on young men's tobacco smoking. , 2011, Journal of consulting and clinical psychology.

[22]  W. Courtenay.  Constructions of masculinity and their influence on men's well-being: a theory of gender and health. , 2000, Social science & medicine.

[23]  K. Emmons,et al.  Model for incorporating social context in health behavior interventions: applications for cancer prevention for working-class, multiethnic populations. , 2003, Preventive medicine.

[24]  D. Hatsukami,et al.  Oral spit tobacco: addiction, prevention and treatment. , 1999, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[25]  D. Levy,et al.  Smokeless tobacco use 1992–2002: trends and measurement in the Current Population Survey-Tobacco Use Supplements , 2006, Tobacco Control.

[26]  Mary J. Mande,et al.  Cultural perspectives concerning adolescent use of tobacco and alcohol in the Appalachian mountain region. , 2008, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[27]  G. Giovino,et al.  Trends in smokeless tobacco use among adults and adolescents in the United States. , 2006, American journal of public health.

[28]  W. Blot,et al.  Health consequences of using smokeless tobacco: summary of the Advisory Committee's report to the Surgeon General. , 1986, Public health reports.

[29]  Moon S. Chen,et al.  Tobacco Use Characteristics Among Rural Ohio Appalachians , 2000, Journal of Community Health.

[30]  Marie-Cecile O. Tidwell,et al.  Tobacco Use, Heavy Use, and Dependence Among Adolescents and Young Adults in the United States , 2011, Substance use & misuse.