More rural Americans smoke cigarettes versus urban residents, have harder time quitting too

NEW BRUNSWICK, N.J. — Cigarettes aren’t nearly as popular as they once were, but new research finds smoking is still much more common in rural U.S. regions today in comparison to urban areas. Additionally, rural-living Americans find it more difficult to stop smoking cigarettes than their urban counterparts.

The findings are the result of a study conducted by scientists from Rutgers University, Indiana University, and Yeshiva University.

Study authors report that overall, 19.2% of rural residents smoke cigarettes, versus just 14.4% of those in urban areas. While a similar number of smokers living in both rural and urban areas quit cigarettes in 2020 (52.9% versus 53.9%), quitting odds between 2010-2020 were a full 75 percent lower for rural residents.

“Higher cigarette smoking prevalence and lower cessation in rural populations have led to higher rates of smoking-attributable cancer incidence and death in rural, compared with urban residents,” says study co-author Andrea Villanti, associate professor in the Department of Health Behavior, Society and Policy at the Rutgers School of Public Health and deputy director of the Rutgers Center for Tobacco Studies, in a statement. “Tobacco cessation, therefore, is a high-impact target for cancer prevention efforts in rural populations.”

Study authors analyzed data provided by the U.S. Department of Health and Human Services’ 2010–2020 National Survey on Drug Use to reach these conclusions. Only American adults who had smoked at least 100 cigarettes over the course of their life, defined as lifetime cigarette smoking, were included in the analysis. Individuals were deemed “current smokers” if they had smoked one or more cigarettes over the prior month, or labeled a “former smoker” if they hadn’t smoked a cigarette over the past year. Finally, both annual and overall quit ratios were estimated as proportions of former smokers among lifetime smokers.

All in all, the study found that among a total of 161,348 lifetime cigarette smokers, 33.5 percent were former smokers.

Study authors believe their findings support the theorized existence of a persistent rural/urban smoking disparity. This may be due to most rural residents not having as robust access to smoking cessation services in comparison to urban residents. In conclusion, they suggest tobacco cessation resources, such as telephone quit lines and telehealth counseling, be made more readily available across rural areas in the United States.

The study is published in JAMA Network Open.

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