Predictors of Smokeless Tobacco Susceptibility, Initiation, and Progression Over Time Among Adolescents in a Rural Cohort

Introduction:
This article reports on a study examining the factors associated with smokeless tobacco (ST) use among rural adolescent male athletes over time. The study aimed to identify risk factors for ST use among a cohort of high school baseball players in rural California. The study also examined the relationship between ST use and the use of other tobacco products, such as electronic cigarettes and waterpipe.

Key Points:

* The study followed a prospective cohort of male high school baseball players in rural California over three years.
* At baseline, 36% of participants had ever tried ST, and 17% were current ST users.
* Among baseline ST never-users, 13% tried ST within one year, and this was associated with perceiving ST as less harmful and having friends who use ST.
* Among baseline experimenters, 17% became current experienced ST users at one-year follow-up. This was associated with identifying as Non-Hispanic White and expecting to use ST within one year.
* Having tried non-ST tobacco products was strongly associated with baseline ST use and with ST susceptibility and initiation among baseline never-users.
* Cigarette and e-cigarette use were not associated with ST initiation, but cigar and waterpipe use were.
* Alcohol use was higher among more experienced ST users and was positively associated with ST susceptibility and expectation at baseline.

Main Message:
The study highlights the persistence of elevated ST use among rural adolescent male athletes and identifies several socio-demographic, family, peer, behavioral, and psycho-social factors that are associated with ST use and predictive of future ST use. The findings suggest that interventions aimed at reducing ST use in especially susceptible subpopulations, such as rural youth, may be effective in improving overall health. The study also highlights the importance of considering the use of other tobacco and nicotine products in ST interventions, as well as the need for interventions prior to high school.

Chaffee, Benjamin W., Elizabeth T. Couch, Janelle Urata, Stuart A. Gansky, Gwen Essex, and Jing Cheng. “Predictors of Smokeless Tobacco Susceptibility, Initiation, and Progression Over Time Among Adolescents in a Rural Cohort.” Substance Use & Misuse 54, no. 7 (June 7, 2019): 1154–66. https://doi.org/10.1080/10826084.2018.1564330.