Getting "Down and Dirty" to Tackle Dip: Addressing Chewing Tobacco Among Rural Teens Using Digital Media

Background:  According to the CDC, higher rates of smokeless tobacco use can be found among young adult males, specifically in certain regions of the United States, including the South and Midwest. When further audience segmentation is performed to identify specific subcultures among teens and young adults, we find that those who fit into the “Country” subculture report the highest use of smokeless tobacco compared to young people in other subcultures. Moreover, it appears that traditional anti-tobacco mass media and policy approaches appear to be unable to reach this group effectively.

Program background: 

To address the high rate of smokeless tobacco use among young people that identify with the Country subculture, a behavior change campaign was developed called Down And Dirty (D&D). This campaign has been implemented in Virginia, Vermont, and Mississippi.  The D&D campaign uses a social marketing strategy that associates healthy behaviors with desirable lifestyles through interactive and highly-stylized marketing tactics. In addition to using trained brand ambassadors to model and promote the campaign’s tobacco-free values at events in their (often rural) communities, the campaign relies heavily on digital communication with the target audience. To effectively reach and engage the high-risk Country audience online, D&D uses a mix of paid and non-paid social media on Facebook and YouTube. However, to increase the likelihood that this audience will be receptive to an anti-smokeless tobacco message given that these products are culturally entrenched, all digital content aligned with the imagery, values, and lifestyles of Country youth. These values and interests were determined through multiple rounds of formative research.  

Evaluation Methods and Results: 

Evaluation relied on online surveys, administered in 2014 and 2015 in VT and VA. Survey recruitment utilized Facebook Interest-Based Targeting (IBT) advertisements. Surveys were conducted in Vermont between May and October 2014 (n=252), and between April and July 2015 (n=230). Surveys were conducted in Virginia between May and July 2014 (n=362), and between April and June 2015 (n=446). Chesapeake IRB approved the research evaluation protocol. In Vermont, there was a 45.5% reduction in 30-day tobacco use. Chew prevalence was 358.3% higher among core Country teens than non-core Country teens. In Virginia, there was a 32.6% reduction in 30-day tobacco use. Again, chew showed a notable difference between core Country and non-core Country teens. Core Country teens were 72.8% more likely to use chew tobacco.

Conclusions:  Not all youth are at risk for smokeless tobacco use. High prevalence is concentrated among those who identify with the Country subculture.

Implications for research and/or practice:  Using digital channels to communicate anti-smokeless tobacco messages can be a cost-effective way to reach this high-risk audience, but the messages must address the culturally motivated reasons why they use smokeless tobacco.