Smokeless Tobacco Decision-Making Among Rural Adolescent Males in California.

Area of Science:

• Public Health
• Adolescent Health
• Tobacco Control

Background:

• Smokeless tobacco (ST) use is prevalent among rural US high school males, exceeding national averages.
• Understanding decision-making processes regarding ST use in high-risk adolescent groups is crucial but underexplored.

Purpose of the Study:

• To explore rural adolescent males' perceptions of smokeless tobacco acceptability, health risks, and social implications.
• To identify differences in these perceptions between smokeless tobacco users and never-users.

Main Methods:

• Semi-structured individual interviews were conducted with 55 male students from three rural California high schools (32 ST ever-users).
• Interviews were audio-recorded, transcribed, and analyzed using thematic content analysis with a general inductive approach.

Main Results:

• Both users and non-users recognized ST as a rural cultural norm and acknowledged oral health risks, viewing use as a personal choice.
• ST users and never-users differed in their perceptions of health risk immediacy, severity, and inevitability compared to cigarette smoking.
• Differences also emerged regarding perceived parental permissiveness and expected social benefits like peer acceptance and perceived maturity.

Conclusions:

• Rural adolescent male ST users emphasize social benefits while downplaying health risks, despite acknowledging them.
• Similarities and differences in perceptions between users and non-users in similar environments can inform targeted health communication strategies.