A growing geographic disparity: Rural and urban cigarette smoking trends in the United States

Abstract

Rural areas of the United States have a higher smoking prevalence than urban areas. However, no recent studies have rigorously examined potential changes in this disparity over time or whether the disparity can be explained by demographic or psychosocial characteristics associated with smoking. The present study used yearly cross sectional data from the National Survey on Drug Use and Health from 2007 through 2014 to examine cigarette smoking trends in rural versus urban areas of the United States. The analytic sample included 303,311 respondents. Two regression models were built to examine (a) unadjusted rural and urban trends in prevalence of current smoking and (b) whether differences remained after adjusting for demographic and psychosocial characteristics. Results of the unadjusted model showed disparate and diverging cigarette use trends during the 8-year time period. The adjusted model also showed diverging trends, initially with no or small differences that became more pronounced across the 8-year period. We conclude that differences reported in earlier studies may be explained by differences in rural versus urban demographic and psychosocial risk factors, while more recent and growing disparities appear to be related to other factors. These emergent differences may be attributable to policy-level tobacco control and regulatory factors that disproportionately benefit urban areas such as enforcement of regulations around the sale and marketing of tobacco products and treatment availability. Strong federal policies and targeted or tailored interventions may be important to expanding tobacco control and regulatory benefits to vulnerable populations including rural Americans.

Rural Versus Urban Use of Traditional and Emerging Tobacco Products in the United States, 2013–2014

“…Urban/rural differences for cigarillos and dual/poly use of emerging tobacco products became non-significant after controlling for covariates. Overall, findings support previous arguments that there may be something unique about rurality as a risk factor 12, 13 and suggest that tailored interventions accounting for “rural culture” 10 may have promise.…”

“…These urban/rural tobacco-use differences do not appear to be fully explained by differences in income, 12,13 although prevalences are often highest among the rural poor. 12 Urban/rural differences in tobacco use are also present for both males and females alone (prevalence is particularly high among rural males), and the largest urban/rural differences appear in the South region of the country.…”

“…12 Other work examining national trends from 2007–2014 has shown that although there is a declining cigarette smoking rate in the U.S., the decline is more pronounced for urban than for rural populations. 13 …”

Geographic Representativeness of a Web-Based Smoking Cessation Intervention: Reach Equity Analysis (Preprint)

“…[5] While there has been a substantial decline in smoking prevalence in urban populations, smoking rates between 2007 and 2014 remained stagnant in rural areas. [6] Rural residence has been shown to be an independent predictor of this difference in smoking trends, even after controlling for important covariates. [6,7] The geographic disparity in smoking rates has been found to be greater for women than for men.…”

“…[6] Rural residence has been shown to be an independent predictor of this difference in smoking trends, even after controlling for important covariates. [6,7] The geographic disparity in smoking rates has been found to be greater for women than for men. [8] Understanding this geographic disparity and reducing the higher rates of smoking among rural Americans has been acknowledged as a public health priority.…”