AppalTRuST Project 2: Exposure to tobacco marketing for novel tobacco products and associations with future tobacco use in Appalachian young adults: tobacco regulatory science implications

ABSTRACT – Project 2 Federal tobacco regulatory policies enacted by the US Food and Drug Administration (FDA) are critical to curb the tobacco epidemic in rural Appalachia and reduce cancer burden. Kentucky (KY) is 50th in the nation for adult smoking rates with 21.4% of KY adults smoking cigarettes, a rate not seen nationally in 20 years. Kentucky also has wide geographic disparities between rural and urban residents particularly in Appalachian KY, an economically disadvantaged part of the state. In this context, Federal policies can be particularly influential in areas with weak tobacco control policies and high rates of tobacco use. In particular, (1) the introduction of novel non-combustible products, (2) product standards on flavored cigars/menthol cigarettes and (3) lowering nicotine in cigarettes have great potential to shift the tobacco marketplace, moving rural Appalachian residents to quit smoking, switch to potentially less harmful products, or never initiate tobacco use at all. Project 2 seeks to expand the evidence base about the extent to which marketing exposure, tobacco use behaviors, and attitude towards tobacco products differ across rural communities and the extent to which regulatory actions by the FDA can potentially reduce use of tobacco among young adults in these areas. Additionally, few studies examine how the retail environment, novel products, and potential policies could interact to reduce tobacco-related health disparities among young adult populations by rurality. Tobacco retailer density is higher in rural areas by population but little is known about how retailers’ market in stores in this region. The purpose of the study is to examine how marketing and product availability of such novel tobacco products may change over time and how these patterns may influence tobacco use attitudes and patterns in rural communities, providing guidance on future policy targets. To accomplish the study purpose, we will conduct several aims. (1) We will assess marketing trends over time in retail store and digital audits (store websites and social media) in tobacco retailers in 2 rural catchment areas of KY. (2) We will compare marketing exposure to and appeal and harm perceptions of novel products in young adults through ecological momentary assessment (EMA), evaluating differences by rurality at the individual and census tract level. (3) Finally, among EMA participants, we will assess the predictive validity of exposure to novel product marketing exposure on use of tobacco at 6-month and 12-month follow-up, and evaluate whether these outcomes are associated with rurality. For all of these activities, we will partner closely with the AppalTRUST team, cores, and local community advisory boards to disseminate lessons learned to communities about industry actions and potential regulatory policies. Achieving the aims of this Project will expand the evidence base of the potential impacts of FDA policies on reducing tobacco use and potential geographic equity impact of these policies to reduce tobacco, and ultimately cancer disparities.

摘要 - 项目2 美国食品药品监督管理局（FDA）制定的联邦烟草监管政策对于遏制至关重要 烟草在粗糙的阿巴拉契亚州流行并减少癌症伯嫩。肯塔基州（肯塔基州）在美国排名第50 21.4％的肯塔基州成年人吸烟的成年吸烟率，这是20年来全国范围内未见的。 肯塔基州在粗糙居民和城市居民之间也存在广泛的地理差异 肯塔（Ky），一个经济困扰的国家。在这种情况下，联邦政策尤其是 在烟草控制政策较弱且使用烟草使用率较高的地区的影响力。特别是（1） 引入新颖的非燃烧产品，（2）调味雪茄/薄荷香烟的产品标准 （3）降低香烟中的尼古丁具有转移烟草市场的巨大潜力 阿巴拉契亚居民戒烟，转向潜在的有害产品，或者从未启动烟草使用 根本。项目2旨在扩大有关营销暴露，烟草使用程度的证据基础 行为，对农村社区不同的烟草产品的态度和态度 FDA的监管行为可以潜在地减少这些地区的年轻人中烟草的使用。 此外，很少有研究研究零售环境，新产品和潜在政策如何 相互作用以减少年轻成人人群中与烟草相关的健康差异。烟草 农村地区的零售商密度较高，但对零售商在商店中的市场几乎一无所知 这个区域。该研究的目的是研究这种新颖的营销和产品可用性 烟草产品可能会随着时间而变化，这些模式可能如何影响烟草使用的情况和 粗糙社区的模式，为未来的政策目标提供指导。为了实现研究目的， 我们将实现几个目标。 （1）我们将评估零售商店和数字审核的随时间推移的营销趋势 （存储网站和社交媒体）在肯塔基州2个农村集水区的烟草零售商中。 （2）我们将比较 通过生态营销对新产品的营销和吸引力和伤害新产品的看法 瞬时评估（EMA），在个人和人口普查水平上通过粗糙度评估差异。 （3） 最后，在EMA参与者中，我们将评估接触新产品营销的预测有效性 在6个月和12个月的随访中使用烟草时使用烟草，并评估这些结果是否是 与粗糙度相关。对于所有这些活动，我们将与AppalTrust团队，核心， 以及当地社区咨询委员会，将经验教训传播给社区有关行业行动 和潜在的监管政策。实现该项目的目标将扩大 FDA政策对减少烟草使用和潜在地理公平影响的潜在影响 减少烟草并最终导致癌症分布的政策。