title: Smokeless Tobacco Decision-Making Among Rural Adolescent Males in California.
abstract: Smokeless tobacco (ST) use among US high school males living in rural areas exceeds national levels. Subgroups at heightened risk of ST use have been identified, but less is known regarding ST decision-making within high-risk groups. The study objective was to describe rural adolescent males' perceived ST acceptability, health risks, and social implications and how those perceptions differ between ST users and never-users. Semi-structured individual interviews were conducted with a purposeful sample of 55 male students (32 ST ever-users) at three rural California high schools. Interviews were audio recorded and professionally transcribed. Investigators collaboratively developed a codebook based on thematic content and then independently coded transcripts, reconvening frequently to achieve consensus. Coded text was systematically organized into themes following a general inductive approach. ST users and non-users shared multiple ST-related perceptions, including: that ST is a common, normative way of life in rural "country" culture among certain groups; that ST use conveys oral health risks; and that the decision to use (or not to use) is rooted in personal choice. ST users' and never-users' perceptions differed regarding the immediacy, severity, and inevitability of health risks, particularly relative to cigarette smoking. Other differences included perceived parental permissiveness and the expected social benefits of ST use, such as peer acceptance and conveying maturity. Within this population of rural male adolescents, ST users emphasized the social benefits of ST use, while acknowledging but discounting health risks. Differences and similarities in tobacco perceptions among adolescents living in similar environments may inform effective health communication.
authors: Department of Preventive and Restorative Dental Sciences, University of California San Francisco, 3333 California Street, Suite 495, San Francisco, CA, 94143-1361, USA. elizabeth.couch@ucsf.edu.
authors: Elizabeth T
authors: ET
authors: Couch
authors: Department of Preventive and Restorative Dental Sciences, University of California San Francisco, 3333 California Street, Suite 495, San Francisco, CA, 94143-1361, USA.|Division of Epidemiology, School of Public Health, University of California Berkeley, 101 Haviland Hall, Berkeley, CA, 94720-7358, USA.
authors: Ellen
authors: E
authors: Darius
authors: Department of Preventive and Restorative Dental Sciences, University of California San Francisco, 3333 California Street, Suite 495, San Francisco, CA, 94143-1361, USA.
authors: Margaret M
authors: MM
authors: Walsh
authors: Department of Preventive and Restorative Dental Sciences, University of California San Francisco, 3333 California Street, Suite 495, San Francisco, CA, 94143-1361, USA.
authors: Benjamin W
authors: BW
authors: Chaffee
mesh_terms: D000293:Adolescent; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D000073599:Health Risk Behaviors; D006801:Humans; D008297:Male; D012424:Rural Population / Q000706:statistics & numerical data*; D064424:Tobacco Use / Q000453:epidemiology* / Q000523:psychology*; D014030:Tobacco, Smokeless
keywords: Adolescents; Health behaviors; Risk perceptions; Rural health; Smokeless tobacco