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Am J Public Health. 2017 Oct;107(10):1554-1559. doi: 10.2105/AJPH.2017.303967. Epub 2017 Aug 17.

Rural Versus Urban Use of Traditional and Emerging Tobacco Products in the United States, 2013-2014.

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Megan E. Roberts, Nathan J. Doogan, and Amanda J. Quisenberry are with the Center of Excellence in Regulatory Tobacco Science, Ohio State University, Columbus. Cassandra A. Stanton is with Westat, Center for Evaluation and Coordination of Training and Research in Tobacco Regulatory Science, Rockville, MD. Andrea C. Villanti, Diann E. Gaalema, Diana R. Keith, Allison N. Kurti, Alexa A. Lopez, Antonio Cepeda-Benito, and Stephen T. Higgins are with the Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington. Ryan Redner is with the Rehabilitation Institute, Southern Illinois University, Carbondale.



To examine urban-rural differences in US prevalences of traditional and emerging tobacco product use as well as dual or polytobacco use of these products.


Our data were derived from wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. We estimated weighted prevalences of adult tobacco use across urban-rural geographies and examined prevalences classified by gender, poverty level, and region of the country.


Nationally, cigarette use and smokeless tobacco use, as well as dual or polytobacco use of traditional products, were more prevalent in rural than in urban areas. Conversely, cigarillo and hookah use and dual or polytobacco use of emerging products were higher in urban areas. There was no significant urban-rural difference in use of e-cigarettes. Gender, poverty, and region of the country did not seem to be driving most urban-rural differences, although differences related to cigarillo use and dual or polytobacco use of emerging products became nonsignificant after control for covariates.


Our findings highlight important urban-rural differences in tobacco use. Whether the changing tobacco product landscape will contribute to a continuation of rural health disparities remains to be seen.

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