Patterns of tobacco consumption in the United States have evolved overtime, with changes occurring in recent years. Cigarette smoking continues to decline while smokeless tobacco (ST) use is becoming more common, and trends indicate heightened concurrent use of cigarettes and ST, referred to as dual use. Stable estimates about the prevalence of dual use are difficult to ascertain, as studies have used differing operational definitions (i.e. frequency of use and type of tobacco product) to describe the behavior. Project 3 involves a longitudinal characterization of diverse product preferences among a cohort of adults who are exclusive smokers, exclusive ST users, and dual users at baseline. The focus of Project 3 includes surveillance of diverse tobacco products consumed among different categories of users, especially with regard to the uptake of new and emerging tobacco products. Project #3 will establish an adult cohort that includes residents of six rural Appalachian counties and Columbus OH. The project will characterize the diversity of types of tobacco products used over a three year period of time.
The specific aims of the project are: 1) To compare the use of tobacco products (i.e. combustible, ST, new and emerging) over a three year period between rural and urban adults who are smokers, ST users, and dual tobacco users at baseline;2) To compare associations between individual factors (i.e. dependence, previous quit attempts, stage of change, cessation interest/efficacy, household smoking, and home and work indoor air policies);cognitive and affective factors (risk perceptions and risk-reduction beliefs);and purchasing factors (brand loyalty and price promotion use) and use of each type of tobacco product;and 3) To determine the association between purchasing factors (exposure to coupon, multi-pack special, special discount at point-of-sale (POS) tobacco retail outlets;and brand loyalty) and use of tobacco products among subsets ot rural and urban users. Tobacco retail outlets in rural and urban environments will also be compared for POS tobacco product price promotions. An innovative address-based sampling methodology will be used to enroll adults (final sample size = 796) who will be interviewed at baseline and every 6 months over a three year period. Exposure to price promotions will be assessed in subsets of the sample, using ecological momentary assessment (EMA) methods. This project addresses FDA research priorities in the areas of "Understanding the Diversity of Tobacco Products" and "Understanding Tobacco Marketing." Longitudinal surveillance and understanding of diverse tobacco product use patterns in underserved and vulnerable populations allows for recognition of trajectories and patterns of use. Surveillance of POS discounting and price promotions can inform FDA regulatory decisions about restricting price-related promotional activity.