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. 2017 Nov:104:79-85.
doi: 10.1016/j.ypmed.2017.03.011. Epub 2017 Mar 16.

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

N J Doogan  1 , M E Roberts  2 , M E Wewers  2 , C A Stanton  3 , D R Keith  4 , D E Gaalema  5 , A N Kurti  5 , R Redner  6 , A Cepeda-Benito  7 , J Y Bunn  5 , A A Lopez  4 , S T Higgins  5
Affiliations

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

N J Doogan et al. Prev Med. 2017 Nov.

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.

Keywords: Health status disparities; Rural health; Tobacco products.

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Conflict of interest statement

Conflict of Interest

The authors declare there is no conflict of interest.

Figures

Figure 1
Figure 1
Rural versus urban current cigarette smoking prevalence by year with best-fit trendlines (not covariate-adjusted) and 95% confidence bands. Estimates are weight-adjusted to reflect the U.S. population during the years 2007-2014.
Figure 2
Figure 2
Rural versus urban cigarette smoking prevalence trends and 95% confidence bands adjusted to a common characteristic profile, visualizing the unique contribution of rural residence across time given our adjusted model. Estimates are also weight-adjusted to reflect the U.S. population across the 2007–2014 period.
See this image and copyright information in PMC

References

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