title: Determinants of youth tobacco use in West Virginia: a comparison of smoking and smokeless tobacco use.
abstract: OBJECTIVE
  To identify and compare the determinants of different types of tobacco use among rural youths and discuss the implication of these differences for youth tobacco use cessation.
  
  
  METHODS
  Ninth grade participants (n = 883) were 95% white, between 13 and 19 years old with a mean age of 14.6 years. Students were classified into four exclusive groups: non-tobacco use, smoking only, smokeless tobacco (ST) use only, and conjoint smoking and ST use. The influences of 14 specific risk factors on tobacco use were investigated for each group using separate multiple logistic regression analyses.
  
  
  RESULTS
  Among participants, 20% were smokers only, 6% were ST users only, and 10% were conjoint users. Students who had more friends (odds ratio [OR] =] 2.75) and siblings (OR = 1.96) who smoke, family problems (OR = 1.70), and favorable attitudes toward tobacco use (OR = 1.12) were more likely to smoke than were other students. Among students who used only ST, gender was a primary determinant (95% were male). Excluding gender, sibling ST use (OR = 4.28), friends' ST use (OR = 1.71), and favorable attitudes (OR = 1.11) were the most significant risk factors. Male students were also more likely to use both cigarettes and ST (OR = 8.62). In addition, among students who used both tobacco products, siblings' and friends' ST use were significant (OR = 3.09 and 2.13, respectively), as well as family problems (OR = 2.41) and attitude (OR = 1.15). Unlike smokers only or ST users only, lack of knowledge about tobacco was a significant determinant among conjoint users (OR = 1.39).
  
  
  CONCLUSIONS
  Findings revealed that 7 of 14 factors were significant predictors of tobacco use. Some factors predicted smoking only, ST only, and conjoint use; however, the pattern of predictors varied for these three categories. Implications for these findings as they relate to tobacco use interventions are discussed.
authors.affiliation: West Virginia University, Department of Community Medicine and Prevention Research Center, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Horn
authors.forename: X
authors.initials: X
authors.lastname: Gao
authors.forename: G A
authors.initials: GA
authors.lastname: Dino
authors.forename: S
authors.initials: S
authors.lastname: Kamal-Bahl
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D008297:Male; D010947:Plants, Toxic; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D012932:Social Facilitation; D012959:Socioeconomic Factors; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000523:psychology; D014030:Tobacco, Smokeless; D014903:West Virginia / Q000453:epidemiology