CPH Faculty and Alumni Publish on Alternative Tobacco in Appalachian Tennessee

Dr. Daniel Owusu, alumnus of the Doctor of Public Health program in East Tennessee State University College of Public Health, has authored an article in the Journal of Health Care for the Poor and Underserved.  The article, “The Usage and Associated Factors of Alternative Tobacco Products among School-going Youth in Central Appalachia,” is the result of a collaborative effort between academia, local health departments, and the community.

Drs. Hadii Mamudu, Liang Wang, and Mary Ann Littleton are faculty co-authors.  College of Public Health alumni Crystal Robertson Besse and Candice Collins along Nashville State Community College faculty member Rafie Boghozian are additional co-authors.

Tobacco use in the United States (U.S.) has declined from one-in-two adults in the 1950s and 1960s to less than one-in-five currently.  However, this decline has not been uniform across the country, with large disparities among population subgroups and geographic areas.  Tobacco use consists of a broad array of combustible and non-combustible tobacco products.  There is an uptake of non-cigarette or alternative tobacco products such as hookahs/waterpipes, smokeless tobacco, and electronic cigarettes (e-cigarettes) among youth in the U.S.  Specifically, the National Youth Tobacco Survey (NYTS) data showed that the use of e-cigarettes among middle school children increased from 0.6% in 2011 to 3.9% in 2014.

In 2015, the research team was contracted by the Tennessee Health Department to develop a comprehensive plan to prevent tobacco use initiation, protect non-smokers against exposure to secondhand smoke, and to promote tobacco use cessation in Northeast Tennessee. They identified the lack of research on youth tobacco use in the region as a major challenge to tobacco control in the region.  The present study is an integral part of efforts to fill this gap by generating data to guide the region-specific interventions to prevent tobacco initiation in the Appalachian parts of Tennessee.

Data from 573 recorded school-based tobacco surveys in 11 middle schools in Appalachian Tennessee were analyzed. More than one-tenth (13.2%) of participants have ever used alternative tobacco products.  The following factors were significantly associated with ever use of the products: believing tobacco users have more friends, owning tobacco-branded item(s), living with a tobacco user, having ever smoked cigarettes, and living in homes where smoking is allowed.

Although there is an ongoing national effort to regulate alternative tobacco products in the country through the Food and Drug Administration's Deeming Rule, many successful tobacco policies began at the local level before being adopted on the state or national level.  Thus, a region-specific intervention in Northeast or Appalachian Tennessee has a great potential in reducing the high prevalence of tobacco use in the region.