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Am J Public Health. 2019 May;109(5):771-773. doi: 10.2105/AJPH.2019.304995. Epub 2019 Mar 21.

Rural-Urban Differences in the Decline of Adolescent Cigarette Smoking.

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Erika C. Ziller, Jennifer Dunbar Lenardson, Nathan C. Paluso, and Jean A. Talbot are with the Maine Rural Health Research Center, University of Southern Maine, Portland. Angela Daley is with the School of Economics, University of Maine, Orono.



To examine change over time in cigarette smoking among rural and urban adolescents and to test whether rates of change differ by rural versus urban residence.


We used the 2008 through 2010 and 2014 through 2016 US National Survey of Drug Use and Health to estimate prevalence and adjusted odds of current cigarette smoking among rural and urban adolescents aged 12 to 17 years in each period. To test for rural-urban differences in the change between periods, we included an interaction between residence and time.


Between 2008 to 2010 and 2014 to 2016, cigarette smoking rates declined for rural and urban adolescents; however, rural reductions lagged behind urban reductions. Controlling for socioeconomic characteristics, rural versus urban odds of cigarette smoking did not differ in 2008 through 2010; however, in 2014 through 2016, rural youths had 50% higher odds of smoking than did their urban peers.


Differential reductions in rural youth cigarette smoking have widened the rural-urban gap in current smoking rates for adolescents. Public Health Implications. To continue gains in adolescent cigarette abstinence and reduce rural-urban disparities, prevention efforts should target rural adolescents.


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