Tobacco use and harm perceptions among Appalachian youth

Delvon T. Mattingly, Lindsay K. Tompkins, Jayesh Rai, Clara G. Sears, Kandi L. Walker, Joy L. Hart

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Appalachian youth tobacco use rates exceed the national average. Additional inquiry is needed to better understand youth product perceptions and use patterns. This study examined tobacco harm perceptions and their relationship with tobacco use among Appalachian youth. From 2014 to 2016, a survey of Appalachian middle and high school students (N = 1,136) was conducted. Tobacco harm perceptions were assessed by tobacco use status, categorized as never user, cigarette only user, smokeless only user, e-cigarette only user, or polytobacco user. Descriptive characteristics were compared by tobacco use status and harm perceptions. Adjusted multivariable logistic regression models assessed the relationship between tobacco use status and harm perceptions. Over one-third of participants were tobacco users (34.6%; 4.7% cigarette only users, 3.3% smokeless only users, 5.6% e-cigarette only users, and 21.0% polytobacco users). Approximately half agreed that e-cigarettes cause health problems (54.4%), and 64.7% agreed that e-cigarettes are addictive. Most participants (83.4–92.3%) agreed that smoking and smokeless tobacco cause health problems and are addictive. Tobacco users more often disagreed that tobacco products cause health problems than did never users. Compared to never users, e-cigarette only users were more likely to disagree that smoking (AOR: 2.99, 95% CI: 1.30–6.90) and e-cigarettes cause health problems (AOR: 2.79, 95% CI: 1.64–4.75) and that e-cigarettes cause addiction (AOR: 2.48, 95% CI: 1.48–4.16). Most youth were aware of health dangers associated with smoking, but perceptions were split on whether e-cigarettes were associated with health problems or addiction. The findings indicate the need for additional youth tobacco use prevention efforts.

Original languageEnglish
Article number101089
JournalPreventive Medicine Reports
StatePublished - Jun 2020

Bibliographical note

Funding Information:
Research reported in this publication was supported, in part, by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) and FDA Center for Tobacco Products under Award Numbers P50HL120163 and U54HL120163. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, the Food and Drug Administration, or the American Heart Association. The funding sponsors had no role in study design; data collection, analyses, or interpretation; manuscript preparation; or the decision to publish the results.

Funding Information:
We extend thanks to the University of Louisville's research computing group and the Cardinal Research Cluster, whose resources facilitated facets of this work. We also thank Shesh Rai for analysis assistance and Alex Lee, Allison Siu, and Courteney Smith for help with questionnaire distribution. The authors declare that there are no conflicts of interest.

Publisher Copyright:
© 2020 The Authors


  • Adolescent
  • Appalachian region
  • Cigarettes
  • Electronic cigarettes
  • Tobacco products
  • Tobacco use

ASJC Scopus subject areas

  • Health Informatics
  • Public Health, Environmental and Occupational Health


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