Tobacco susceptibility and use among rural adolescents: The role of tobacco marketing exposure and screen media use.

Introduction: Tobacco marketing has been found to increase pro-tobacco attitudes and susceptibilities; yet its impact on rural adolescents lacks research. We aim to examine the association between tobacco marketing exposure, screen use, and susceptibility and use of tobacco among a rural youth sample.

Methods: Youth (N = 697) enrolled in grades 9-11 that resided in rural counties in Virginia were recruited to participate in a survey in September 2022. We assessed demographics, tobacco use, susceptibility to tobacco use, screen media use, and exposure to tobacco marketing and warning messages.

Results: One in five (n= 144, 20.66%) participants reported using any tobacco products and 394 (56.53%) indicated susceptibility. High engagement in social media and texting were more likely to be tobacco ever-users than those who had low engagement with those screen media, X2(1) = 12.00 and X2(1) = 19.40, respectively (ps <.001). Greater exposure to pro-tobacco marketing on social media (OR: 2.03, 95% CI [1.37 - 3.03]) and higher-grade level (OR: 1.77, 95% CI [1.29 - 2.43]) were significantly associated with a greater likelihood of reporting "ever-use" of tobacco products, while controlling for mother's education, gender, and ethnicity. Among adolescents who never used tobacco products, a higher-grade level was associated with greater susceptibility to initiating tobacco product use (OR: 1.40, 95% CI [1.05 - 1.86]).

Conclusions: In this rural sample, greater social media/text use and exposure to pro-tobacco marketing on social media were significantly associated with tobacco ever use. Identification of these risk factors can help inform potential targets and timing for future tobacco prevention campaigns for rural youth.

Implications: Screen media use, tobacco marketing/warning exposure, and their associations with tobacco use and susceptibility were examined in a study with 697 rural Virginia youth. Heavy socia.