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Factors Influencing Smokeless Tobacco Use in Rural Ohio Appalachia

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Abstract

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. Fifteen 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. Community 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.

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References

  1. Ramakrishnan, S., Thangjam, R., Roy, A., Singh, S., Ramakrishnan, L., Seth, S., et al. (2011). Acute effects of tobacco chewing on the systemic, pulmonary and coronary circulation. American Journal of Cardiovascular Drugs, 11(2), 109–114.

    Article  PubMed  Google Scholar 

  2. Greer, R. O., Jr. (2011). Oral manifestations of smokeless tobacco use. Otolaryngologic Clinics of North America, 44(1), 31–56.

    Article  PubMed  Google Scholar 

  3. Tomar, S. L. (2007). Epidemiologic perspectives on smokeless tobacco marketing and population harm. American Journal of Preventative Medicine, 33(6 Suppl), S387–397.

    Article  Google Scholar 

  4. 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 and Prevention, 13(1), 55–58.

    Article  PubMed  CAS  Google Scholar 

  5. England, L. J., Levine, R. J., Mills, J. L., Klebanoff, M. A., Yu, K. F., & Cnattingius, S. (2003). Adverse pregnancy outcomes in snuff users. American Journal of Obstetrics and Gynecology, 189(4), 939–943.

    Article  PubMed  Google Scholar 

  6. U.S. Department of Health and Human Services. (1986). Consensus development panel statement: Health implications of smokeless tobacco use. Washington, D.C: National Institutes of Health.

  7. Cullen, J. W., Blot, W., Henningfield, J., Boyd, G., Mecklenburg, R., & Massey, M. M. (1986). Health consequences of using smokeless tobacco: Summary of the advisory committee’s report to the surgeon general. Public Health Reports, 101(4), 355–373.

    PubMed  CAS  Google Scholar 

  8. Hatsukami, D. K., & Severson, H. H. (1999). Oral spit tobacco: Addiction, prevention and treatment. Nicotine & Tobacco Research, 1(1), 21–44.

    Article  CAS  Google Scholar 

  9. U.S. Surgeon General. (1986). The health consequences of using smokeless tobacco: A report of the surgeon general. Washington, D.C: Office on Smoking and Health.

  10. Rodu, B., & Cole, P. (2009). Smokeless tobacco use among men in the United States, 2000 and 2005. Journal of Oral Pathology and Medicine, 38(7), 545–550.

    Article  PubMed  Google Scholar 

  11. Welte, J. W., Barnes, G. M., Tidwell, M. C., & Hoffman, J. H. (2011). Tobacco use, heavy use, and dependence among adolescents and young adults in the United States. Substance Use and Misuse, 46(9), 1090–1098.

    Article  PubMed  Google Scholar 

  12. Mumford, E. A., Levy, D. T., Gitchell, J. G., & Blackman, K. O. (2006). Smokeless tobacco use 1992–2002: Trends and measurement in the current population survey-tobacco use supplements. Tobacco Control, 15(3), 166–171.

    Article  PubMed  CAS  Google Scholar 

  13. Centers for Disease Control and Prevention (CDC). (2010). State-specific prevalence of cigarette smoking and smokeless tobacco use among adults—United States, 2009. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21048561.

  14. Latimer, W., & Zur, J. (2010). Epidemiologic trends of adolescent use of alcohol, tobacco, and other drugs. Child & Adolescent Psychiatric Clinics of North America, 19(3), 451–464.

    Article  Google Scholar 

  15. Bell, R. A., Arcury, T. A., Chen, H., Anderson, A. M., Savoca, M. R., Kohrman, T., et al. (2009). Use of tobacco products among rural older adults: Prevalence of ever use and cumulative lifetime use. Addictive Behaviors, 34(8), 662–667.

    Article  PubMed  Google Scholar 

  16. Nelson, D. E., Mowery, P., Tomar, S., Marcus, S., Giovino, G., & Zhao, L. (2006). Trends in smokeless tobacco use among adults and adolescents in the United States. American Journal of Public Health, 96(5), 897–905.

    Article  PubMed  Google Scholar 

  17. Substance Abuse and Mental Health Services Administration. (2009). Results from the 2008 national survey on drug use and health. Rockville, MD: Office of Applied Studies.

  18. Noland, M. P., Kryscio, R. J., Riggs, R. S., Linville, L. H., Perritt, L. J., & Tucker, T. C. (1990). Use of snuff, chewing tobacco, and cigarettes among adolescents in a tobacco-producing area. Addictive Behaviors, 15(6), 517–530.

    Article  PubMed  CAS  Google Scholar 

  19. Rhew, I. C., David Hawkins, J., & Oesterle, S. (2011). Drug use and risk among youth in different rural contexts. Health & Place, 17(3), 775–783.

    Article  Google Scholar 

  20. Appalachian Regional Commission (ARC). (2009). Population estimates, 2009: Appalachian Ohio. Retrieved from http://www.arc.gov/region_report.asp?FIPS-39999&REPORT_ID-40.

  21. Ohio Family Health Survey. (2010). Ohio Family Health Survey. Unpublished raw data.

  22. Appalachian Regional Commission (ARC). (2011). County economic status in Appalachia, FY 2012. Retrieved from http://www.arc.gov/research/MapsofAppalachia.asp?MAP_ID-55.

  23. Haaga, J. (2004). Demographic and socioeconomic change in Appalachia: Educational attainment in Appalachia. Retrieved from http://www.arc.gov/assets/research_reports/EducationalAttainmentinAppalachia.pdf.

  24. Wewers, M. E., Ahijevych, K. L., Chen, M. S., Dresbach, S., Kihm, K. E., & Kuun, P. A. (2000). Tobacco use characteristics among rural Ohio Appalachians. Journal of Community Health, 25(5), 377–388.

    Article  PubMed  CAS  Google Scholar 

  25. Meyer, M. G., Toborg, M. A., Denham, S. A., & Mande, M. J. (2008). Cultural perspectives concerning adolescent use of tobacco and alcohol in the Appalachian mountain region. Journal of Rural Health, 24(1), 67–74.

    Article  PubMed  Google Scholar 

  26. Sorensen, G., Barbeau, E., Hunt, M. K., & Emmons, K. (2004). Reducing social disparities in tobacco use: A social-contextual model for reducing tobacco use among blue-collar workers. American Journal of Public Health, 94(2), 230–239.

    Article  PubMed  Google Scholar 

  27. Sorensen, G., Emmons, K., Hunt, M. K., Barbeau, E., Goldman, R., Peterson, K., et al. (2003). Model for incorporating social context in health behavior interventions: Applications for cancer prevention for working-class, multiethnic populations. Preventative Medicine, 37(3), 188–197.

    Article  Google Scholar 

  28. Liu, S. T., Nemeth, J. M., Klein, E. G., Ferketich, A. K., Kwan, M.-P., Wewers, M. E. (2012). Perceived health effects and relative safety of smokeless tobacco products among adolescents and adults in Appalachia, Ohio. Poster presented at the Society for Research on Nicotine and Tobacco Annual Meeting, Houston TX.

  29. Courtenay, W. H. (2000). Constructions of masculinity and their influence on men’s well-being: A theory of gender and health. Social Science and Medicine, 50(10), 1385–1401.

    Article  PubMed  CAS  Google Scholar 

  30. Helme, D. W., Cohen, E. L., & Parrish, A. J. (2011). Health, masculinity and smokeless tobacco use among college-aged men. Health Communication, 1–11. doi:10.1080/10410236.2011.610257.

  31. Mahalik, J. R., Burns, S. M., & Syzdek, M. (2007). Masculinity and perceived normative health behaviors as predictors of men’s health behaviors. Social Science and Medicine, 64(11), 2201–2209.

    Article  PubMed  Google Scholar 

  32. Hunt, K., Hannah, M. K., & West, P. (2004). Contextualizing smoking: Masculinity, femininity and class differences in smoking in men and women from three generations in the west of Scotland. Health Education Research, 19(3), 239–249.

    Article  PubMed  Google Scholar 

  33. Maxwell, A. (2006). “Such a smoking nation as this I never saw…”: Smoking, nationalism, and manliness in nineteenth-century Hungary. The Social History of Alcohol and Drugs, 21(1), 6–22.

    PubMed  Google Scholar 

  34. Ng, N., Weinehall, L., & Ohman, A. (2007). ‘If I don’t smoke, I’m not a real man’—Indonesian teenage boys’ views about smoking. Health Education Research, 22(6), 794–804.

    Article  PubMed  Google Scholar 

  35. Pachankis, J. E., Westmaas, J. L., & Dougherty, L. R. (2011). The influence of sexual orientation and masculinity on young men’s tobacco smoking. Journal of Consulting and Clinical Psychology, 79(2), 142–152.

    Article  PubMed  Google Scholar 

  36. Carpenter, C. M., Connolly, G. N., Ayo-Yusuf, O. A., & Wayne, G. F. (2008). Developing smokeless tobacco products for smokers: An examination of tobacco industry documents. Tobacco Control, 18, 54–59.

    Article  PubMed  Google Scholar 

  37. Mejia, A. B., & Ling, P. M. (2010). Tobacco industry consumer research on smokeless tobacco users and product development. American Journal of Public Health, 100(1), 78–87.

    Article  PubMed  Google Scholar 

  38. Cortese, D. K., & Ling, P. M. (2011). Enticing the new lad: Masculinity as a product of consumption in tobacco industry-developed lifestyle magazines. Men and Masculinities, 14(1), 4–30.

    Article  PubMed  Google Scholar 

  39. Berkowitz, A. D. (2004). The social norms approach: Theory, research, and annotated bibliography. Retrieved from http://www.alanberkowitz.com/articles/social_norms.pdf.

  40. Master Settlement Agreement. (1998). Retrieved from http://ag.ca.gov/tobacco/pdf/1msa.pdf.

  41. Schroeder, S. A. (2004). Tobacco control in the wake of the 1998 Master Settlement Agreement. New England Journal of Medicine, 350(3), 293–301.

    Article  PubMed  CAS  Google Scholar 

  42. Shibuya, K., Ciecierski, C., Guindon, E., Bettcher, D. W., Evans, D. B., & Murray, C. J. L. (2003). WHO framework convention on tobacco control: Development of an evidence based global public health treaty. BMJ: British Medical Journal (International Edition), 327(7407), 154.

    Article  Google Scholar 

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Acknowledgments

This research was funded by the National Institutes of Health R21 CA129907.

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Authors and Affiliations

  1. Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, 349 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA

    Julianna M. Nemeth, Sherry T. Liu, Elizabeth G. Klein & Mary Ellen Wewers

  2. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA

    Amy K. Ferketich

  3. Department of Geography, College of Public Health, The Ohio State University, Columbus, OH, USA

    Mei-Po Kwan

Authors
  1. Julianna M. Nemeth
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  2. Sherry T. Liu
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  5. Mei-Po Kwan
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  6. Mary Ellen Wewers
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Correspondence to Mary Ellen Wewers.

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Nemeth, J.M., Liu, S.T., Klein, E.G. et al. Factors Influencing Smokeless Tobacco Use in Rural Ohio Appalachia. J Community Health 37, 1208–1217 (2012). https://doi.org/10.1007/s10900-012-9556-x

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  • DOI: https://doi.org/10.1007/s10900-012-9556-x

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