title: Mental Health, Racial Discrimination, and Tobacco Use Differences Across Rural-Urban California.
abstract: Disparities in tobacco use persist despite successful policies reducing use within the United States. In particular, the prevalence of tobacco use in rural and certain minority communities is significantly higher compared to that of their counterparts. In this work, we examine the impact of rurality, mental health, and racial discrimination on tobacco use.
  
  
  
  Data come from the 2003 California Health Interview Survey (n = 42,044). Modified Poisson regression models were adjusted for age, sex, race/ethnicity, birth origin, education, income, insurance, and marital status.
  
  
  
  Compared to urban residents, rural residents had a significantly higher risk for smoking after adjustment (RR = 1.10, 95% CI: 1.01-1.19). Those who reported having experienced racial discrimination also had a significantly greater risk for smoking compared to those who did not (RR = 1.17, 95% CI: 1.07-1.27). Additionally, those who reported higher stress had a significantly greater risk for smoking (RR = 1.61, 95% CI: 1.07-1.67). There was evidence of interaction between rurality and race/ethnicity, and rurality and gender (P < .05).
  
  
  
  Residing in rural areas was associated with an increased risk for smoking, above and beyond sociodemographics. There were no significant differences across rural-urban environments for the relationship between stress and tobacco use-an indication that the impact of stress and discrimination is not buffered or exacerbated by environmental characteristics potentially found in either location. Mechanisms that explain rural-urban tobacco use disparities need to be explored, and smoking cessation programs and policies should be tailored to target these factors within rural communities.
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Amenah A
authors.initials: AA
authors.lastname: Agunwamba
authors.affiliation: Social Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: Social Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: David R
authors.initials: DR
authors.lastname: Williams
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lila J
authors.initials: LJ
authors.lastname: Finney Rutten
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Wilson
authors.affiliation: Social Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Kasisomayajula
authors.initials: K
authors.lastname: Viswanath
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D016012:Poisson Distribution; D015995:Prevalence; D044469:Racial Groups / Q000706:statistics & numerical data; D063505:Racism / Q000706:statistics & numerical data; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D064424:Tobacco Use / Q000453:epidemiology*; D014505:Urban Population / Q000706:statistics & numerical data
keywords: epidemiology; geography; health disparities; social determinants of health; tobacco use