Abstract
Appalachian youth tobacco use rates exceed the national average. Additional inquiry is needed to better understand youth product perceptions and use patterns. This study examined tobacco harm perceptions and their relationship with tobacco use among Appalachian youth. From 2014 to 2016, a survey of Appalachian middle and high school students (N=1,136) was conducted. Tobacco harm perceptions were assessed by tobacco use status, categorized as never user, cigarette only user, smokeless only user, e-cigarette only user, or polytobacco user. Descriptive characteristics were compared by tobacco use status and harm perceptions. Adjusted multivariable logistic regression models assessed the relationship between tobacco use status and harm perceptions. Over one-third of participants were tobacco users (34.6%; 4.7% cigarette only users, 3.3% smokeless only users, 5.6% e-cigarette only users, and 21.0% polytobacco users). Approximately half agreed that e-cigarettes cause health problems (54.4%), and 64.7% agreed that e-cigarettes are addictive. Most participants (83.4-92.3%) agreed that smoking and smokeless tobacco cause health problems and are addictive. Tobacco users more often disagreed that tobacco products cause health problems than did never users. Compared to never users, e-cigarette only users were more likely to disagree that smoking (AOR: 2.99, 95% CI: 1.30-6.90) and e-cigarettes cause health problems (AOR: 2.79, 95% CI: 1.64-4.75) and that e-cigarettes cause addiction (AOR: 2.48, 95% CI: 1.48-4.16). Most youth were aware of health dangers associated with smoking, but perceptions were split on whether e-cigarettes were associated with health problems or addiction. The findings indicate the need for additional youth tobacco use prevention efforts.
Highlights
More preventable diseases and deaths result from tobacco use in the United States (U.S.) than any other cause
High school students were more likely than middle school students to agree that smoking causes health problems and that using smokeless tobacco is addictive. These findings indicate that the Appalachian youth surveyed are generally aware of the health dangers associated with the use of conventional tobacco products and that they are less certain regarding potential health dangers of e-cigarette use
Our findings suggest that, the Appalachian youth surveyed generally agreed that tobacco use causes health problems and addiction, the subset using tobacco products may be vulnerable to continued use as many dispute or question the harmful and/or addictive properties of these products
Summary
More preventable diseases and deaths result from tobacco use in the United States (U.S.) than any other cause. 90% of smokers tried their first cigarette prior to turning 18 (U.S Department of Health and Human Services, 2012; U.S Department of Health and Human Services, 2014). Because they have a lifetime of potential tobacco purchasing, youth are often targeted by tobacco company marketing and advertising (Marynak et al, 2018; Perks et al, 2018; HHS, 2016), despite restrictions limiting such communication. Given that most tobacco use patterns begin in adolescence and tobacco companies target young people, considerable concern exists in the U.S surrounding preventing youth tobacco uptake and reducing use in youth who consume tobacco products Despite these concerns, a number of U.S youth use tobacco
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