title: Adolescent Tobacco Use in Urban Versus Rural Areas of the United States: The Influence of Tobacco Control Policy Environments.
abstract: OBJECTIVE
  Adults and adolescents who reside in rural areas of the United States are traditionally more likely to be tobacco users. This urban-rural disparity remains largely unexplained and, more recently, it is unclear what impact the emergence of electronic cigarettes (e-cigarettes) has had on adolescent tobacco use in urban and rural areas. Our objective is to evaluate the influence of sociodemographics and tobacco control policy environments on adolescent tobacco use in urban versus rural areas, as well as to identify the effect of e-cigarettes on traditional patterns of urban-rural tobacco use.
  
  
  METHODS
  This study analyzes repeated cross-sectional data from the National Youth Tobacco Survey for the years 2011-2014. We estimate the associations between rural residence, cigarette taxes, tobacco advertisement exposure, and ease of access to tobacco with six tobacco use outcomes: current (past 30-day) use of cigarettes, e-cigarettes, cigars, smokeless tobacco, multiple tobacco products, and any tobacco.
  
  
  RESULTS
  E-cigarette use among urban youths aged 11-17 years in the United States increased from .82% in 2011 to 8.62% in 2014 (p < .001). Tobacco advertisement exposure was significantly positively associated with all current tobacco use outcomes (p < .001) except for e-cigarettes. Our predictors account for approximately 40% of the difference in urban-rural cigarette use.
  
  
  CONCLUSIONS
  Sociodemographics, cigarette taxes, and tobacco advertisement exposure are significant predictors of adolescent tobacco use in the United States but do not entirely explain urban-rural disparities. In addition, e-cigarettes appear to be rapidly changing traditional patterns of tobacco use, particularly in urban areas.
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York. Electronic address: mip2037@med.cornell.edu.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Pesko
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York.
authors.forename: Adam M T
authors.initials: AMT
authors.lastname: Robarts
mesh_terms: D000293:Adolescent; D000329:Advertising; D002648:Child; D003430:Cross-Sectional Studies; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D012424:Rural Population; D012959:Socioeconomic Factors; D013660:Taxes; D062789:Tobacco Products / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D064424:Tobacco Use / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014505:Urban Population
keywords: E-cigarettes; Rural health; Tobacco control; Youth tobacco use