The Impact of Social Media Use and Gaming on Initiation of Smokeless Tobacco Use Among Rural Male Youth.

PURPOSE: Smokeless tobacco (SLT) use is more common among White male youth in rural locations than among other youth. Previous literature documents risk factors for SLT use (e.g., perceived harm). However, no research has examined whether SLT initiation is associated with the use of social media and video games, despite the high prevalence of those behaviors among adolescent males. METHODS: As part of the evaluation of "The Real Cost" smokeless prevention campaign, we conducted a baseline survey of a cohort of US males aged 11-16 in 2016 and four follow-up surveys conducted approximately every 8 months. We used discrete-time survival analysis to examine factors associated with SLT initiation. Logistic regression estimated the odds of initiation as a function of lagged values of key predictors (social media use in tertiles and frequency of gaming) and other baseline and lagged correlates. The model controlled for campaign exposure. RESULTS: Relative to the lowest tertile of social media use, moderate (odds ratio [OR] = 1.80) or high use (OR = 2.77) was associated with increased risk of SLT initiation at the subsequent survey wave. Relative to playing every few weeks or less, playing video games once a day (OR = 0.50) or several times a day (OR = 0.33) was associated with decreased risk of SLT initiation. DISCUSSION: SLT initiation was positively associated with social media use and negatively associated with gaming. Future research should explore reasons for the protective nature of gaming (e.g., social support, improved mood) and whether parental supervision of social media use could mitigate its negative impact.

"The Real Cost" Smokeless campaign: changes in beliefs about smokeless tobacco among rural boys, a longitudinal randomized controlled field trial.

BACKGROUND: The prevalence of current smokeless tobacco (SLT) use in 2019 among high school students was 4.8%, and the overall rate of SLT use was higher among high school boys (7.5%) than girls (1.8%). The U.S. Food and Drug Administration (FDA) launched "The Real Cost" Smokeless media campaign in April 2016 to educate rural youth about the dangers of SLT use. In this study, we evaluate the effectiveness of "The Real Cost" Smokeless campaign. METHODS: We use a 3-year (Jan 2016 - Dec 2018) randomized controlled longitudinal field trial that consists of a baseline survey of boys and a parent/guardian and four follow-up surveys of the boys. The cohort includes 2200 boys who were 11 to 16 years old at baseline and lived in the rural segments of 30 media markets (15 treatment markets and 15 control). "The Real Cost" Smokeless campaign targets boys who are 12 to 17 years old in 35 media markets. It focuses primarily on graphic depictions of cosmetic and long-term health consequences of SLT use. The key outcome measures include beliefs and attitudes toward SLT that are targeted (explicitly or implicitly) by campaign messages. RESULTS: Using multivariate difference-in-difference analysis (conducted in 2019 and 2020), we found that agreement with 4 of the 11 explicit campaign-targeted belief and attitude measures increased significantly from baseline to post-campaign launch among boys 14 to 16 years old in treatment vs. control markets. Agreement did not increase for boys 11-13 years old in treatment vs. control markets and only increased for one targeted message for the overall sample. CONCLUSIONS: These findings suggest that "The Real Cost" Smokeless campaign influenced beliefs and attitudes among older boys in campaign markets and that a campaign focused on health consequences of tobacco use can be targeted to rural boys, influence beliefs about SLT use, and potentially prevent SLT use.

Comparing characteristics of epilepsy treatment providers on the Kenyan coast: implications for treatment-seeking and intervention.

INTRODUCTION: Existing studies have identified demographic and resource-related barriers to treatment-seeking and have focused on treatment seekers in exploring and modeling decision-making. While the treatment-seeking literature acknowledges the role of the characteristics of treatment providers, few studies have adopted an explicit focus on these determinants, nor have they approached the study of treatment-seeking with an in-depth ethnographic focus on the providers themselves. The following article analyzes the structural aspects of treatment provision as one influence on how families in Kilifi, Kenya seek care for a child with chronic epilepsy. While not a comprehensive decision model, the study examines the ways in which treatment-seeking may be facilitated or deterred by the characteristics of available treatment options. METHODS: Ethnographic methods were applied, including interviews, participant observations and surveys, to examine factors that may affect the choice of families on the coast of Kenya between traditional healing and biomedical care for epilepsy. RESULTS: Traditional healers were found to have a profound influence in the treatment of epilepsy in Kilifi. Their treatments differ from those available at health facilities in the following key dimensions: explanations of causation, communication styles, social roles, referral practices, location and systems of payment. CONCLUSIONS: The article identified key differences between biomedical and traditional treatments that may help to explain the existence of the biomedical treatment gap in Kilifi. This study suggests that comparing data on treatment providers reveals barriers to obtaining biomedical care, thereby offering an important tool in intervention design research.