A growing geographic disparity: Rural and urban cigarette smoking trends in the United States.
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.
Center of Excellence in Tobacco Regulatory Science, The Ohio State University, College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA. Electronic address: Doogan.1@osu.edu.
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Doogan
Center of Excellence in Tobacco Regulatory Science, The Ohio State University, College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA.
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Roberts
Center of Excellence in Tobacco Regulatory Science, The Ohio State University, College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA.
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Wewers
Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Westat, 1600 Research Boulevard, Rockville, MD 20850, USA; Department of Oncology/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Research Building, Suite E501, 3970 Reservoir Road, N.W., Washington D.C. 20057, USA.
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Stanton
Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 446AR6, Burlington, VT 05401, USA.
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Keith
Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA.
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Gaalema
Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA.
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Kurti
Rehabilitation Institute, Southern Illinois University Carbondale, Rehn Hall, Mail Code 4609, Carbondale, IL 62901, USA.
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Redner
Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA; Department of Psychological Science, University of Vermont, John Dewey Hall, Rm 248, 2 Colchester Avenue, Burlington, VT 05405-0134, USA.
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Cepeda-Benito
Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA.
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Bunn
Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 446AR6, Burlington, VT 05401, USA.
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Lopez
Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA.
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Higgins
D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D040541:Marketing; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data* / Q000639:trends; D012907:Smoking / Q000453:epidemiology* / Q000639:trends*; D012959:Socioeconomic Factors; D062789:Tobacco Products; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data* / Q000639:trends
Health status disparities; Rural health; Tobacco products