HLTH 6403 Module 3 Sociological Influences Analysis Example

Crews, Coaches and Convenience Stores: The Sociological Influences Behind Oral Nicotine Use by Young Workers and Athletes on the Northern Plains

Student Name

American College of Education

HLTH6403: Theories and Principles of Behavior Change in Health Education

Module 3 Assignment

Instructor Name

January 26, 2026

Introduction

The first two modules explained oral nicotine use among young men in a composite Plains county through individual-level constructs: images of the typical user, willingness to accept an offer, attitudes and norms. Those constructs describe what happens in a young man's mind when a teammate or a crew leader holds out a tin. They do not explain why the tin is there, why older men carry it, why the rig bans cigarettes but not snuff or why a gas station forty miles from the nearest city stocks a dozen pouch flavors. This paper turns to those questions. It examines five sociological influences: social networks, cultural expectations of men, the organization of work, sports institutions and the commercial environment. For each, it asks what the influence is, what evidence supports it and what it means for health education.

Social Networks

Health behaviors travel through relationships. In a study of 12,067 people followed from 1971 to 2003 in the Framingham Heart Study, Christakis and Fowler (2008) found clusters of smokers and nonsmokers extending to three degrees of separation and showed that groups of connected people tended to quit together. When a spouse quit, a person's chance of smoking fell by 67%; for a friend the figure was 36%, and among people in small firms, a coworker's quitting reduced the chance by 34%. The study concerned cigarettes rather than oral nicotine, but its logic applies. In the county, focus group participants traced their first use to specific people, most often an older brother, a teammate or a man on their crew, and users described their friends as mostly users. If use spreads through ties, so can quitting, and the network is as much a target for health education as the individual.

Cultural Expectations of Men

Courtenay (2000) argued that many health-related behaviors are ways of demonstrating masculinity, and that practices harmful to men's health often serve as signs of manhood and tools for gaining status among other men. His relational theory also stresses that the form of masculinity men enact depends on economic status, education and social context. In this county, the kind of manhood most valued is tied to physical work, endurance, self-reliance and knowing how to handle discomfort without complaint. Dipping fits that image: it is associated with long days outdoors and with older men who are respected for their work. Pouches have been absorbed into a related but newer image, the disciplined athlete. Young men who decline the offer risk little in principle, but several focus group participants said that turning down a dip from an older hand on a first job felt like saying you did not belong.

The Organization of Work

The structure of work in ranching and the oilfield also shapes the behavior. Shifts on drilling and service rigs often run twelve hours or longer, with long drives before and after and weeks away from home. Many sites ban smoking because of fire risk, and moist snuff and pouches become the practical way to use nicotine on the job. Harvest and calving seasons bring long nights with little rest. In these settings nicotine is valued for staying alert, and the habit is learned from the older workers young men depend on for training and safety. No company in the county bans oral nicotine on site, and none offers cessation support. The workplace, in other words, is both a setting where the behavior is learned and a place where the institutional rules make one form of nicotine easier than another.

Sports Institutions

Baseball has a long association with smokeless tobacco, and high school and college teams remain an important setting. Institutional support matters: in a cluster-randomized trial of a spit tobacco intervention in 52 California colleges, athletes were less likely to start using smokeless tobacco when athletic trainers reported that the baseball coach supported prevention activities (Gansky et al., 2005). The county's high school prohibits tobacco on campus and at games, but coaches told the health department that enforcement on bus rides and at summer tournaments is difficult. Focus group athletes said pouches were easy to hide and that some players used them before games for a feeling of calm. The team, then, is a small institution whose norms, supervision and leaders can either protect or expose young men.

The Commercial Environment

The commercial environment determines which products are available, how they are priced and what images surround them. An updated scoping review reported that the U.S. pouch market grew more than threefold from 2021 to 2024, that marketing increasingly uses claims likely to appeal to young people and that online and social media channels are central to promotion (Travis et al., 2026). In the county, a health department audit of the eight stores selling tobacco found pouches displayed beside the register in seven, often next to energy drinks, while snuff was kept behind the counter. The pouch prototype of the clean, modern athlete described in Module 2 did not arise only among young men; it closely resembles the imagery used to sell the product.

How the Influences Interact

These influences reinforce one another. Networks carry the behavior from older to younger men; the cultural image of manhood makes accepting the offer feel like belonging; the organization of work provides the settings and the reasons; teams provide another setting with weak supervision; and the commercial environment supplies products designed to fit the settings and the images. Structural conditions also shape who is most exposed. Young men who go straight from high school to rig or ranch work enter the most intensive settings earliest, and they are also the least likely to have ongoing contact with school health programs or primary care.

What Individual Theories Miss

The prototype willingness model explains how a favorable image raises willingness, but it treats prototypes as mental images without asking where they come from. The sociological analysis supplies the answer: prototypes are drawn from real men in real networks and from commercial imagery, and they carry cultural meanings about manhood and work. Likewise, social cognitive theory's attention to modeling and environment is compatible with this analysis, but on its own it does not direct attention to the institutions, employers, teams and retailers, that set the rules. A health education response that addresses only individual beliefs will be working against forces that operate above the individual.

Implications for Health Education

The analysis suggests four directions. Network-based approaches could recruit respected older men, including crew leaders and coaches, to model quitting and to stop offering products to younger men. Messages should engage the valued image of a capable, independent working man rather than attack it, for example by framing dependence as a loss of control. Workplace partners could add oral nicotine to site tobacco policies and offer cessation support, and schools could strengthen supervision on team travel. At the community and policy levels, the health department could work with retailers on product placement and share its store audit with local officials. Module 4 will examine culture, values and norms more closely, and Module 5 will review the evidence on interventions.

Conclusion

Oral nicotine use among young men in this county is not only a set of individual decisions but a pattern produced by relationships, cultural expectations, working conditions, team institutions and commercial forces. Seeing those forces clarifies why individually focused education has limited reach and where a more complete strategy should intervene.

References

Christakis, N. A., & Fowler, J. H. (2008). The collective dynamics of smoking in a large social network. New England Journal of Medicine, 358(21), 2249-2258. https://doi.org/10.1056/NEJMsa0706154

Courtenay, W. H. (2000). Constructions of masculinity and their influence on men's well-being: A theory of gender and health. Social Science & Medicine, 50(10), 1385-1401. https://doi.org/10.1016/S0277-9536(99)00390-1

Gansky, S. A., Ellison, J. A., Rudy, D., Bergert, N., Letendre, M. A., Nelson, L., Kavanagh, C., & Walsh, M. M. (2005). Cluster-randomized controlled trial of an athletic trainer-directed spit (smokeless) tobacco intervention for collegiate baseball athletes: Results after 1 year. Journal of Athletic Training, 40(2), 76-87.

Travis, N., Warner, K. E., Hartmann-Boyce, J., Goniewicz, M. L., Ma, C., Meza, R., & Levy, D. T. (2026). Oral nicotine pouches and public health: Evidence from an updated scoping review. Nicotine & Tobacco Research. Advance online publication. https://doi.org/10.1093/ntr/ntag203