September 9, 2022 - Podcast

Episode 303 — Cigarette smoking among rural and urban Americans

A new study by Indiana University researchers found that from 2010 to 2020, a larger proportion of rural Americans smoked cigarettes compared to those living in urban areas. Additionally, rural Americans' odds of quitting smoking were lower than urban Americans. The study team was led by IU Epidemiology and Biostatistics Professor Maria Parker and included colleagues at IU, Rutgers University and Yeshiva University. Their findings were recently published in JAMA Network Open. Parker says cigarette smoking prevalence is higher in rural than urban U.S. communities, and that disparity has only increased over time. She says the researchers sought so understand if quit ratios might account for some of rural vs. urban area smoking disparity too. Using deidentified data from the U.S. Department of Health and Human Services' National Survey on Drug Use, the researchers analyzed adults who had smoked at least 100 cigarettes in a lifetime, which they defined as lifetime cigarette smoking. Current smoking was defined as smoking one or more cigarettes in the past month. And former smoking was defined as no cigarettes in the past year. Overall and annual quit ratios were estimated as proportions of former smokers among lifetime smokers. The researchers found that of the over 160,000 lifetime cigarette smokers analyzed, 33.5% were former smokers. From 2010 to 2020, the odds of quitting smoking were 75% lower in rural areas compared to urban ones. Over time, smoking quit ratios among both rural and urban populations increased. In 2020, quit ratios were similar in rural and urban areas, at 52.9% and 53.9%, respectively. However, current smoking prevalence was nearly 5 percentage points higher in rural than urban areas. Parker says the researchers' findings support that a persistent rural/urban disparity exists. She says rural residents may face more barriers to using smoking cessation services than urban residents, or they may be in an earlier stage of motivation to quit smoking. Parker says that smoking intervention at the clinical setting, health system or population level might improve reach and sustainability of cessation services for rural residents. Leveraging existing smoking quit lines and telehealth solutions may also help rural residents by minimizing barriers to access.