AppalTRuST Project 2: Exposure to tobacco marketing for novel tobacco products and associations with future tobacco use in Appalachian young adults: tobacco regulatory science implications

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ABSTRACT – Project 2 Federal tobacco regulatory policies enacted by the US Food and Drug Administration (FDA) are critical to curb the tobacco epidemic in rural Appalachia and reduce cancer burden. Kentucky (KY) is 50th in the nation for adult smoking rates with 21.4% of KY adults smoking cigarettes, a rate not seen nationally in 20 years. Kentucky also has wide geographic disparities between rural and urban residents particularly in Appalachian KY, an economically disadvantaged part of the state. In this context, Federal policies can be particularly influential in areas with weak tobacco control policies and high rates of tobacco use. In particular, (1) the introduction of novel non-combustible products, (2) product standards on flavored cigars/menthol cigarettes and (3) lowering nicotine in cigarettes have great potential to shift the tobacco marketplace, moving rural Appalachian residents to quit smoking, switch to potentially less harmful products, or never initiate tobacco use at all. Project 2 seeks to expand the evidence base about the extent to which marketing exposure, tobacco use behaviors, and attitude towards tobacco products differ across rural communities and the extent to which regulatory actions by the FDA can potentially reduce use of tobacco among young adults in these areas. Additionally, few studies examine how the retail environment, novel products, and potential policies could interact to reduce tobacco-related health disparities among young adult populations by rurality. Tobacco retailer density is higher in rural areas by population but little is known about how retailers’ market in stores in this region. The purpose of the study is to examine how marketing and product availability of such novel tobacco products may change over time and how these patterns may influence tobacco use attitudes and patterns in rural communities, providing guidance on future policy targets. To accomplish the study purpose, we will conduct several aims. (1) We will assess marketing trends over time in retail store and digital audits (store websites and social media) in tobacco retailers in 2 rural catchment areas of KY. (2) We will compare marketing exposure to and appeal and harm perceptions of novel products in young adults through ecological momentary assessment (EMA), evaluating differences by rurality at the individual and census tract level. (3) Finally, among EMA participants, we will assess the predictive validity of exposure to novel product marketing exposure on use of tobacco at 6-month and 12-month follow-up, and evaluate whether these outcomes are associated with rurality. For all of these activities, we will partner closely with the AppalTRUST team, cores, and local community advisory boards to disseminate lessons learned to communities about industry actions and potential regulatory policies. Achieving the aims of this Project will expand the evidence base of the potential impacts of FDA policies on reducing tobacco use and potential geographic equity impact of these policies to reduce tobacco, and ultimately cancer disparities.