Protective factors and tobacco-free male adolescents in rural Virginia

Initiation and progression of tobacco use occurs primarily during adolescence and tobacco use is the leading cause of death in the United States. Use of tobacco products by male adolescents in the rural south is very concerning since they have the highest smoking and smokeless tobacco (ST) rates. One primary aim of this qualitative study conducted in two rural, tobacco-producing counties of Virginia is to elicit attitudes, beliefs, and strategies that promote tobacco-free norms among African American (AA) and Caucasian American (CA) tobacco-free males 16-17 years of age. Participants to date include seven AA and five CA male adolescents. This study is designed to increase our understanding of factors that promote being tobacco-free among rural adolescent males and to compare these factors with data from our previous studies of rural female adolescent nonsmokers and adolescent nonsmokers from a mid-sized southern city. A health behavior framework guided the development of semi-structured questions on attitudes, beliefs, and norms associated with being a nonsmoker or nonuser of ST. We interviewed separate groups of AA and CA male adolescents who had never tried smoking or using ST, or who had experimented but never progressed to occasional smoking or using ST. We compared qualitative analysis of interviews for agreement related to tobacco-protective themes across groups. Rural male adolescents consistently expressed concerns about “living a healthy life,” being “athletes,” “smelling better and looking better,” “not wasting money,” and “making good choices” as reasons for not using tobacco. Most of the rural male adolescents mentioned family members that smoked or used ST and knew of a family member with cancer. Yet approval of parents and friends, users or nonusers, reinforced their decision to be tobacco-free. The CAs who never tried tobacco stated that it was “abnormal … if they do not smoke or chew in this area.” Further examination of culturally relevant information about adolescent tobacco-free beliefs and behavior is a potentially important contribution in the field of youth tobacco prevention. The study team will use these findings to develop culturally appropriate interventions that are effective in preventing tobacco use by high-risk rural adolescent populations.