Abstract 2196: Susceptibility to tobacco use among rural adolescents: Examining the role of tobacco marketing exposure and media use intensity

Abstract Background: Rural youth have higher rates of electronic nicotine delivery systems (ENDS) and tobacco product use compared to their urban counterparts. Prior literature confirms that marketing exposure increases pro-tobacco attitudes and susceptibilities, yet the extent to which tobacco product marketing and advertising messages relate to tobacco use susceptibility among rural adolescents is understudied. Objectives: To examine the association between tobacco marketing exposure and susceptibility to tobacco use and ever tobacco use among a population of rural youth. Methods: Youth (aged 14-18 years), enrolled in grades 9-11, able to speak and write in English, and residing in rural counties in Virginia (n = 697) were recruited to participate in the Southern Virginia - Adolescents, Place, and Behavior study. At baseline, eligible participants were asked to answer survey questions, including demographics (e.g., age, race/ethnicity, and gender), tobacco product (e.g., e-cigarettes/vapes, cigarettes, and cigars), tobacco use susceptibility (e.g., “do you think you will try any type of tobacco product in the next year?”), digital media use (e.g., “how many hours do you spend visiting social networking sites on both a typical weekday and a typical weekend day?"), and interaction and exposure to tobacco advertisements. Results: The majority of participants were female (51.9%), White (62.4%) and non-Hispanic (86.6%), with an average age of 15.1 years old (SD = .96). Less than a quarter (20.7%) of participants reported ever using any tobacco products. Heavy social media users and text users were more likely to be tobacco ever-users than those who were light social media users, X2(1) = 12.00, p < .001. Multivariate logistic regression models report that exposure to online ads promoting tobacco products (OR: 2.03, 95% CI [1.37 - 3.03]) and higher grade level (OR: 1.77, 95% CI [1.29 - 2.43]) were significantly associated with the likelihood of ever using tobacco products, while controlling for mother’s education, gender, and ethnicity. Among adolescents who never used tobacco products, higher grade levels (OR: 1.40, 95% CI [1.05 - 1.86]) were associated with greater susceptibility to initiating tobacco product use while controlling for the covariates. Conclusions: Greater social media use and exposure to ads promoting tobacco products were significantly associated with tobacco ever use. For never tobacco users, social media use or tobacco ad exposure was not associated with greater susceptibility to tobacco use. Higher grade levels were associated with both tobacco ever use and greater susceptibility to tobacco product use. Identification of these risk factors may help inform potential targets for future tobacco prevention campaigns. Citation Format: Sunny Jung Kim, Kendall Fugate-Laus, Jeremy Barsell, Elizabeth K. Do, Rashelle Hayes, David Wheeler, Bernard Fuemmeler. Susceptibility to tobacco use among rural adolescents: Examining the role of tobacco marketing exposure and media use intensity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2196.