{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:32:12Z","timestamp":1788244332409,"version":"build-2803163510"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T00:00:00Z","timestamp":1734998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100018527","name":"Virginia Foundation for Healthy Youth","doi-asserted-by":"publisher","award":["852R010"],"award-info":[{"award-number":["852R010"]}],"id":[{"id":"10.13039\/100018527","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and Methods<\/jats:title>\n                    <jats:p>Youth (N\u2005=\u2005697) enrolled in grades 9\u201311 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One in five (n\u2005=\u2005144, 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)\u2005=\u200512.00 and X2(1)\u2005=\u200519.40, respectively (ps\u2005&amp;lt;\u2005.001). Greater exposure to pro-tobacco marketing on social media (odds ratio [OR]: 2.03, 95% CI [1.37 to 3.03]) and higher-grade level (OR: 1.77, 95% CI [1.29 to 2.43]) were significantly associated with a greater likelihood of reporting \u201cever-use\u201d of tobacco products, while controlling for mother\u2019s 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 to 1.86]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>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 social media\/text users were more likely to have used tobacco products. Exposure to tobacco marketing on social media and higher grade levels were associated with ever using tobacco. Higher grade levels were linked to increased susceptibility to tobacco use among nonusers. These results highlight the importance of resilience to pro-tobacco marketing on social media, and self-regulation of social media\/text use in interventions for tobacco ever users. Early interventions may benefit rural youth who never used tobacco.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ntr\/ntae309","type":"journal-article","created":{"date-parts":[[2024,12,22]],"date-time":"2024-12-22T23:21:27Z","timestamp":1734909687000},"page":"1127-1136","source":"Crossref","is-referenced-by-count":5,"title":["Tobacco Susceptibility and Use Among Rural Adolescents: The Role of Tobacco Marketing Exposure and Screen Media Use"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6405-162X","authenticated-orcid":false,"given":"Sunny Jung","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Social and Behavioral Sciences, School of Population Health, Virginia Commonwealth University , Richmond, VA ,","place":["USA"]},{"name":"Massey Comprehensive Cancer Center, Virginia Commonwealth University , Richmond, VA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendall","family":"Fugate-Laus","sequence":"additional","affiliation":[{"name":"Department of Psychology, Virginia Commonwealth University , Richmond, VA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4641-9176","authenticated-orcid":false,"given":"Jeremy","family":"Barsell","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Population Health, Virginia Commonwealth University , Richmond, VA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3503-1731","authenticated-orcid":false,"given":"Elizabeth K","family":"Do","sequence":"additional","affiliation":[{"name":"Schroeder Institute, Truth Initiative , Washington, DC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashelle B","family":"Hayes","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Virginia Commonwealth University , Richmond, VA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3550-0107","authenticated-orcid":false,"given":"Bernard F","family":"Fuemmeler","sequence":"additional","affiliation":[{"name":"Massey Comprehensive Cancer Center, Virginia Commonwealth University , Richmond, VA ,","place":["USA"]},{"name":"Department of Family Medicine and Population Health, Virginia Commonwealth University , Richmond, VA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,12,24]]},"reference":[{"key":"2026032805013863700_CIT0001","doi-asserted-by":"publisher","first-page":"tc","DOI":"10.1136\/tc-2022-057907","article-title":"Declines in cigarette smoking among US adolescents and young adults:","author":"Pierce","year":"2023","journal-title":"Tob Control."},{"issue":"44","key":"2026032805013863700_CIT0002","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.15585\/mmwr.mm7244a1","article-title":"Tobacco product use among U.S. middle and high school students \u2013 National Youth Tobacco Survey, 2023","volume":"72","author":"Birdsey","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"2","key":"2026032805013863700_CIT0003","doi-asserted-by":"publisher","first-page":"e2020025122","DOI":"10.1542\/peds.2020-025122","article-title":"Use of e-cigarettes and other tobacco products and progression to daily cigarette smoking","volume":"147","author":"Pierce","year":"2021","journal-title":"Pediatrics."},{"issue":"6","key":"2026032805013863700_CIT0004","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1080\/00952990.2020.1771723","article-title":"Association of E-cigarettes with adolescent alcohol use and binge drinking-drunkenness: a systematic review and meta-analysis","volume":"46","author":"Rothrock","year":"2020","journal-title":"Am J Drug Alcohol Abuse."},{"key":"2026032805013863700_CIT0005","doi-asserted-by":"publisher","first-page":"106716","DOI":"10.1016\/j.phrs.2023.106716","article-title":"Nicotine on the developing brain","volume":"190","author":"Castro","year":"2023","journal-title":"Pharmacol Res."},{"key":"2026032805013863700_CIT0006","doi-asserted-by":"publisher","first-page":"106239","DOI":"10.1016\/j.ypmed.2020.106239","article-title":"Shared and unique risk factors for tobacco use among rural versus urban adolescents","volume":"140","author":"Roberts","year":"2020","journal-title":"Prev Med."},{"issue":"2","key":"2026032805013863700_CIT0007","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1111\/jrh.12610","article-title":"Rural disparities in adolescent smoking prevalence","volume":"38","author":"Kim","year":"2022","journal-title":"J Rural Health."},{"issue":"4","key":"2026032805013863700_CIT0008","doi-asserted-by":"publisher","first-page":"1384","DOI":"10.3390\/ijerph18041384","article-title":"The intersection of rural residence and minority race\/ethnicity in cancer disparities in the United States","volume":"18","author":"Zahnd","year":"2021","journal-title":"Int J Environ Res Public Health."},{"issue":"6","key":"2026032805013863700_CIT0009","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1007\/s10900-012-9556-x","article-title":"Factors influencing smokeless tobacco use in rural Ohio Appalachia","volume":"37","author":"Nemeth","year":"2012","journal-title":"J Community Health."},{"issue":"2","key":"2026032805013863700_CIT0010","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1080\/00952990.2018.1549562","article-title":"Exposures to the tobacco retail environment among adolescent boys in urban and rural environments","volume":"45","author":"Burgoon","year":"2019","journal-title":"Am J Drug Alcohol Abuse."},{"issue":"2","key":"2026032805013863700_CIT0011","doi-asserted-by":"publisher","first-page":"173","DOI":"10.2190\/DE.40.2.e","article-title":"Stress and tobacco use among African-American adolescents: the buffering effect of cultural factors","volume":"40","author":"Belgrave","year":"2010","journal-title":"J Drug Educ."},{"issue":"8","key":"2026032805013863700_CIT0012","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.1177\/0193945919828061","article-title":"Disparities in rural tobacco use, smoke-free policies, and tobacco taxes","volume":"41","author":"Buettner-Schmidt","year":"2019","journal-title":"West J Nurs Res."},{"issue":"8","key":"2026032805013863700_CIT0013","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1093\/ntr\/ntu266","article-title":"Addressing the social determinants of health to reduce tobacco-related disparities","volume":"17","author":"Garrett","year":"2015","journal-title":"Nicotine Tob Res."},{"issue":"10","key":"2026032805013863700_CIT0014","doi-asserted-by":"publisher","first-page":"Cd003439","DOI":"10.1002\/14651858.CD003439.pub2","article-title":"Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours","volume":"2011","author":"Lovato","year":"2011","journal-title":"Cochrane Database Syst Rev."},{"issue":"5","key":"2026032805013863700_CIT0015","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss7105a1","article-title":"Tobacco product use and associated factors among middle and high school students \u2013 National Youth Tobacco Survey, United States, 2021","volume":"71","author":"Gentzke","year":"2022","journal-title":"MMWR Surveill Summ."},{"issue":"3","key":"2026032805013863700_CIT0016","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1136\/tc-2022-057348","article-title":"Tobacco promotion restriction policies on social media","volume":"33","author":"Kong","year":"2022","journal-title":"Tob Control."},{"key":"2026032805013863700_CIT0017","doi-asserted-by":"publisher","first-page":"107842","DOI":"10.1016\/j.ypmed.2023.107842","article-title":"The mediating roles of mental health problems and racial differences in the linkage between social media use and E-cigarette use among American youth","volume":"179","author":"Zheng","year":"2024","journal-title":"Prev Med."},{"issue":"1","key":"2026032805013863700_CIT0018","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1177\/13591045221106608","article-title":"Using TikTok for public and youth mental health \u2013 a systematic review and content analysis","volume":"28","author":"McCashin","year":"2022","journal-title":"Clin Child Psychol Psychiatry."},{"issue":"6","key":"2026032805013863700_CIT0019","doi-asserted-by":"publisher","first-page":"e2020017921","DOI":"10.1542\/peds.2020-017921","article-title":"Smoking susceptibility and tobacco media engagement among youth never smokers","volume":"147","author":"Coreas","year":"2021","journal-title":"Pediatrics."},{"issue":"5","key":"2026032805013863700_CIT0020","doi-asserted-by":"publisher","first-page":"e20162593","DOI":"10.1542\/peds.2016-2593","article-title":"Children and adolescents and digital media","volume":"138","author":"Reid Chassiakos","year":"2016","journal-title":"Pediatrics."},{"key":"2026032805013863700_CIT0021","author":"Nielsen","year":"2018"},{"key":"2026032805013863700_CIT0022","doi-asserted-by":"publisher","DOI":"10.3886\/ICPSR38018.v1","volume-title":"Data from: The Common Sense Census: Media use by Tweens and Teens in America, a Common Sense Media Research Study, United States, 2015","author":"Rideout","year":"2021"},{"key":"2026032805013863700_CIT0023","author":"Anderson","year":"2023"},{"issue":"9","key":"2026032805013863700_CIT0024","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1001\/jamapediatrics.2022.2223","article-title":"Association between exposure to tobacco content on social media and tobacco use: a systematic review and meta-analysis","volume":"176","author":"Donaldson","year":"2022","journal-title":"JAMA Pediatrics"},{"issue":"3","key":"2026032805013863700_CIT0025","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1093\/ntr\/ntaa113","article-title":"Exploring how social media exposure and interactions are associated with ENDS and tobacco use in adolescents from the PATH study","volume":"23","author":"Cavazos-Rehg","year":"2021","journal-title":"Nicotine Tob Res."},{"key":"2026032805013863700_CIT0026","doi-asserted-by":"publisher","first-page":"106758","DOI":"10.1016\/j.ypmed.2021.106758","article-title":"Exploring how tobacco advertisements are associated with tobacco use susceptibility in tobacco naive adolescents from the PATH study","volume":"153","author":"Li","year":"2021","journal-title":"Prev Med."},{"issue":"6","key":"2026032805013863700_CIT0027","doi-asserted-by":"publisher","first-page":"e14303","DOI":"10.2196\/14303","article-title":"Mechanisms of social media effects on attitudes toward e-cigarette use: motivations, mediators, and moderators in a national survey of adolescents","volume":"21","author":"Cho","year":"2019","journal-title":"J Med Internet Res."},{"key":"2026032805013863700_CIT0028","doi-asserted-by":"publisher","first-page":"106418","DOI":"10.1016\/j.ypmed.2021.106418","article-title":"Identifying emerging predictors for adolescent electronic nicotine delivery systems use: a machine learning analysis of the Population Assessment of Tobacco and Health Study","volume":"145","author":"Han","year":"2021","journal-title":"Prev Med."},{"key":"2026032805013863700_CIT0029","volume-title":"Data from: Measuring Rurality: Rural-Urban Continuum Codes","author":"Cromartie","year":"2013"},{"issue":"2","key":"2026032805013863700_CIT0030","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap) \u2013 a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform."},{"key":"2026032805013863700_CIT0031","doi-asserted-by":"publisher","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform."},{"issue":"5","key":"2026032805013863700_CIT0032","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1037\/\/0278-6133.15.5.355","article-title":"Validation of susceptibility as a predictor of which adolescents take up smoking in the United States","volume":"15","author":"Pierce","year":"1996","journal-title":"Health Psychol."},{"issue":"3","key":"2026032805013863700_CIT0033","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/j.jadohealth.2023.09.001","article-title":"Examining the bidirectional associations between sleep duration, screen time, and internalizing symptoms in the ABCD study","volume":"74","author":"Zink","year":"2024","journal-title":"J Adolesc Health."},{"key":"2026032805013863700_CIT0034","doi-asserted-by":"publisher","volume-title":"Data from: Population Assessment of Tobacco and Health (PATH) Study [United States] Special Collection Public-Use Files","author":"U.S. Department of Health and Human Services","DOI":"10.3886\/ICPSR37786.v8"},{"key":"2026032805013863700_CIT0035","article-title":"corrplot: Visualization of a correlation matrix (R package version 0.92)","author":"Wei"},{"key":"2026032805013863700_CIT0036","author":"Gallup","journal-title":"Teens Spend Average of 4.8 Hours on Social Media Per Day"},{"issue":"6","key":"2026032805013863700_CIT0037","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1080\/10810730.2024.2355291","article-title":"Characteristics of adolescents\u2019 and young adults\u2019 exposure to and engagement with nicotine and tobacco product content on social media","volume":"29","author":"Vogel","year":"2024","journal-title":"J Health Commun."},{"issue":"8","key":"2026032805013863700_CIT0038","doi-asserted-by":"publisher","first-page":"966","DOI":"10.1177\/0013916518806686","article-title":"Outdoor time, screen time, and connection to nature: troubling trends among rural youth","volume":"51","author":"Larson","year":"2019","journal-title":"Environ Behav"},{"issue":"1","key":"2026032805013863700_CIT0039","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s40359-023-01166-7","article-title":"The associations between screen time and mental health in adolescents: a systematic review","volume":"11","author":"Santos","year":"2023","journal-title":"BMC Psychol"},{"issue":"3","key":"2026032805013863700_CIT0040","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/j.jadohealth.2022.09.025","article-title":"The impact of social media use and gaming on initiation of smokeless tobacco use among rural male youth","volume":"72","author":"Pepper","year":"2023","journal-title":"J Adolesc Health."},{"issue":"2","key":"2026032805013863700_CIT0041","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1002\/ijop.12036","article-title":"Neuroscientific evidence for defensive avoidance of fear appeals","volume":"49","author":"Kessels","year":"2014","journal-title":"Int J Psychol"},{"issue":"5","key":"2026032805013863700_CIT0042","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1177\/1090198106291963","article-title":"Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview","volume":"34","author":"Hinyard","year":"2007","journal-title":"Health Educ Behav."},{"key":"2026032805013863700_CIT0043","author":"Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System (YRBSS): 2015 results","year":"2016"},{"key":"2026032805013863700_CIT0044","volume-title":"National Survey on Drug Use and Health (NSDUH): 2019-2020 National Results","author":"Substance Abuse and Mental Health Services Administration","year":"2020"},{"key":"2026032805013863700_CIT0045","doi-asserted-by":"publisher","first-page":"109935","DOI":"10.1016\/j.drugalcdep.2023.109935","article-title":"Exposure to tobacco retail outlet tobacco marketing and initiation of cigarette and e-cigarette use: depressive symptoms as a moderator","volume":"248","author":"Pasch","year":"2023","journal-title":"Drug Alcohol Depend."},{"issue":"2","key":"2026032805013863700_CIT0046","doi-asserted-by":"publisher","first-page":"197","DOI":"10.5127\/jep.008310","article-title":"Best practices for using median splits, artificial categorization, and their continuous alternatives","volume":"2","author":"DeCoster","year":"2011","journal-title":"J Exp Psychopathol"}],"container-title":["Nicotine and Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntae309\/61268625\/ntae309.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/27\/6\/1127\/61268625\/ntae309.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/27\/6\/1127\/61268625\/ntae309.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T09:01:45Z","timestamp":1774688505000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/article\/27\/6\/1127\/7931818"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,24]]},"references-count":46,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,12,24]]},"published-print":{"date-parts":[[2025,5,22]]}},"URL":"https:\/\/doi.org\/10.1093\/ntr\/ntae309","relation":{},"ISSN":["1469-994X"],"issn-type":[{"value":"1469-994X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,6]]},"published":{"date-parts":[[2024,12,24]]}}}