mHealth app-based ecological momentary assessment to ascertain tobacco retail outlet exposure, tobacco marketing, tobacco use, and susceptibility among rural youth.

BACKGROUND

Rising use of electronic nicotine delivery systems (ENDS) and tobacco products among rural youth challenges tobacco control efforts, with higher use rates compared to urban youth. Exposure to tobacco retail outlets (TROs) and marketing influences tobacco use, but the longitudinal pathways of these factors in rural youth are underexplored.

PURPOSE: This study examines the feasibility of app-based ecological momentary assessment (EMA) in capturing real-time exposure to TROs and tobacco marketing and its link to tobacco use and susceptibility among rural youth.

METHODS

Participants (n = 25) residing in Southwest Virginia were recruited for a 14-day EMA sub-study via the Effortless Assessment Research System (EARS) app. We assessed exposure to TROs and tobacco marketing as predictors and tobacco use susceptibility and past 24-hour tobacco use as outcomes. GPS data identified exposure to TROs within 100 m, and associations with tobacco outcomes were examined using generalized linear mixed-effect regression models.

RESULTS

Most participants were 9th graders (36%; range 9th grade-12th grade) and white (56%), with slightly more female (56%) than male (44%). One-third were tobacco-susceptible, and 13% had used tobacco. TRO exposure was higher in activity space outside of the home and school (M = 7.2 exposures) than near home (4.1) or school (2.1). Over 14 days, 328 EMA responses were collected from 25 participants (72.9% response rate), demonstrating EMA's feasibility. TRO exposure was positively associated with recent tobacco use (P = .04) and negatively associated with recalling combustible tobacco ads (P = .03).

CONCLUSIONS

This study examined the feasibility of app-based EMAs to track rural youth's exposure to TROs, tobacco marketing, and tobacco outcomes. Findings demonstrate the feasibility of EMA for capturing tobacco-related exposures among adolescents.