Examining Smoking Prevalence Disparities in Virginia Counties by Rurality, Appalachian Status, and Social Vulnerability, 2011–2019

Abstract

Objectives. To estimate county-level cigarette smoking prevalence in Virginia and examine cigarette use disparities by rurality, Appalachian status, and county-level social vulnerability. Methods. We used 2011–2019 Virginia Behavioral Risk Factor Surveillance System proprietary data with geographical information to estimate county-level cigarette smoking prevalence using small area estimation. We used the Centers for Disease Control and Prevention’s social vulnerability index to quantify social vulnerability. We used the 2-sample statistical t test to determine the differences in cigarette smoking prevalence and social vulnerability between counties by rurality and Appalachian status. Results. The absolute difference in smoking prevalence was 6.16 percentage points higher in rural versus urban counties and 7.52 percentage points higher in Appalachian versus non-Appalachian counties in Virginia (P < .001). Adjusting for county characteristics, a higher social vulnerability index is associated with increased cigarette use. Rural Appalachian counties had 7.41% higher cigarette use rates than did urban non-Appalachian areas. Tobacco agriculture and a shortage of health care providers were significantly associated with higher cigarette use prevalence. Conclusions. Rural Appalachia and socially vulnerable counties in Virginia have alarmingly high rates of cigarette use. Implementation of targeted intervention strategies could reduce cigarette use, ultimately reducing tobacco-related health disparities. (Am J Public Health. 2023;113(7):811–814. https://doi.org/10.2105/AJPH.2023.307298 )

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“…This region is also characterized by a high level of social vulnerability, which measures socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. In a study comparing social vulnerability levels in Virginia, social vulnerability was on average 0.49 in Virginia compared to 0.63 in rural areas and 0.58 in rural Appalachian counties (range =0–1, with higher values indicating more vulnerability), and social vulnerability was directly correlated with smoking rates [ 5 ]. Smokers living in rural Appalachia are more likely to start smoking at a younger age, smoke daily and in excess of 15 cigarettes per day, and have poorer cessation-related outcomes [ 6 , 7 ].…”