Project 1: Urban and Rural Male Youth Cohort Study of Tobacco Use p138-171

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The focus of this project is on youth initiators of smokeless tobacco (ST) and dual use of ST and cigarettes, arid the marketing, advertising and other environmental factors that may contribute to initiation. ST products include chewing tobacco, snuff, and snus, as well as the emerging dissolvable products. The rate of ST use among high school males in Ohio is nearly twice as high as the national rate. Moreover, two-thirds of ST users also smoke, and about one-third of smokers also use ST. With new snus products on the market and the shift in snus marketing that now targets urban users and smokers, youth may be even more likely to initiate ST and dual use. This project will establish a cohort of rural (the Appalachian region of Ohio) and urban (Columbus, Ohio) male youth ages 11-14, and their families, to examine ST and dual use initiation over 3 years. Project 1 will focus on environmental factors that may lead to ST and dual use initiation, such as retail outlet density and exposure to tobacco marketing. Other related measures will include cognitive and affective reactions youth have to tobacco advertising and smoking media literacy, or a youth's ability to critically evaluate media messages. The goal is to examine these marketing-related factors as predictors of ST and dual use initiation and compare them between rural and urban youth. This project will estimate the three-year initiation rate of ST use and dual use of ST and cigarettes among male youth in rural and urban regions of Ohio in order to complete the following aims 1) To examine how cognitive and affective responses and attitudes towards tobacco advertisements relate to initiation of ST and dual use of smoking and ST; 2) To examine how exposure to tobacco marketing and the level of smoking media literacy relate to initiation of ST and dual use; 3) Exploratory Aim: In an exploratory study we will use ecological momentary assessment (EMA) to compare real-time exposures between tobacco users and nonusers. This project addresses several FDA research priorities, namely in the areas of "Understanding the diversity of Tobacco Products" and "Understanding Tobacco Marketing." The data collected in this project are critical to FDA decision making regarding potential restrictions on ST marketing and advertising, and the FDA's analysis of new product applications and modified risk tobacco product claims for ST products. Project 1 data can also assist the FDA in developing more effective communication programs targeting youth.