SHORT REPORT
The ‘state’ of tobacco: Perceptions of tobacco among Appalachian youth in Kentucky
Joy L. Hart 1, 2  
,  
Kandi L Walker 1, 2,  
Clara G. Sears 1, 2,  
Alexander S. Lee 1, 2,  
Allison Groom 2, 3,  
Robyn Landry 2, 3,  
Aida L. Giachello 2, 4,  
Thomas J. Payne 2, 5,  
Anshula Kesh 2, 3,  
Allison Siu 1, 2,  
Courteney Smith 1, 2,  
 
 
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1
University of Louisville, Louisville, United States
2
AHA Tobacco Regulation and Addiction Center, United States
3
American Heart Association, Texas, United States
4
Northwestern University, Illinois, United States
5
University of Mississippi Medical Center, Mississippi, United States
Publish date: 2018-01-18
Submission date: 2017-11-08
Final revision date: 2017-12-16
Acceptance date: 2018-01-05
 
Tob. Prev. Cessation 2018;4(January):3
KEYWORDS:
TOPICS:
ABSTRACT:
Introduction:
In Appalachia, youth tobacco-use rates remain higher than the U.S. national average. Past research has indicated that several factors are related to high rates of tobacco use among Appalachian youth (e.g. low socioeconomic status, rural lifestyles). Of the Appalachian states, Kentucky has one of the highest rates of youth tobacco use. The aim of this study was to explore views of tobacco among Kentucky youth living in Appalachian counties.

Methods:
In Fall 2014 - Spring 2015, focus group interviews were conducted with middle and high school students (N=109) in Appalachian counties in Kentucky. Each focus group session included open-ended questions and was conducted by trained facilitators. Focus group transcriptions and field notes were analyzed for themes.

Results:
Study participants described an entrenched culture of tobacco. Three themes exemplified this culture. First, adult behavior served to enable youth tobacco use (e.g. teachers ignoring dip use in class, adults smoking with youth). Second, tobacco is easily accessible to youth (e.g. restrictions on youth sales are often ignored, family members provide). Third, symbols of tobacco are prevalent (e.g. festivals celebrating tobacco heritage, tobacco barns, and tobacco marketing logos).

Conclusions:
Youth participants described a deeply rooted tobacco culture, which they believed was unlikely to change. Additional studies and health education efforts are needed in these rural communities. Further, stricter enforcement of tobacco sales and marketing restrictions may be helpful in protecting this vulnerable population.

CORRESPONDING AUTHOR:
Joy L. Hart   
University of Louisville, Dept. of Communication, 310 Strickler Hall, UofL, 40292 Louisville, United States
 
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