Adolescent Tobacco Use in Urban Versus Rural Areas of the United States: The Influence of Tobacco Control Policy Environments

J Adolesc Health. 2017 Jul;61(1):70-76. doi: 10.1016/j.jadohealth.2017.01.019. Epub 2017 Mar 28.


Purpose: Adults and adolescents who reside in rural areas of the United States are traditionally more likely to be tobacco users. This urban-rural disparity remains largely unexplained and, more recently, it is unclear what impact the emergence of electronic cigarettes (e-cigarettes) has had on adolescent tobacco use in urban and rural areas. Our objective is to evaluate the influence of sociodemographics and tobacco control policy environments on adolescent tobacco use in urban versus rural areas, as well as to identify the effect of e-cigarettes on traditional patterns of urban-rural tobacco use.

Methods: This study analyzes repeated cross-sectional data from the National Youth Tobacco Survey for the years 2011-2014. We estimate the associations between rural residence, cigarette taxes, tobacco advertisement exposure, and ease of access to tobacco with six tobacco use outcomes: current (past 30-day) use of cigarettes, e-cigarettes, cigars, smokeless tobacco, multiple tobacco products, and any tobacco.

Results: E-cigarette use among urban youths aged 11-17 years in the United States increased from .82% in 2011 to 8.62% in 2014 (p < .001). Tobacco advertisement exposure was significantly positively associated with all current tobacco use outcomes (p < .001) except for e-cigarettes. Our predictors account for approximately 40% of the difference in urban-rural cigarette use.

Conclusions: Sociodemographics, cigarette taxes, and tobacco advertisement exposure are significant predictors of adolescent tobacco use in the United States but do not entirely explain urban-rural disparities. In addition, e-cigarettes appear to be rapidly changing traditional patterns of tobacco use, particularly in urban areas.

Keywords: E-cigarettes; Rural health; Tobacco control; Youth tobacco use.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Advertising
  • Child
  • Cross-Sectional Studies
  • Electronic Nicotine Delivery Systems / statistics & numerical data
  • Female
  • Health Surveys
  • Humans
  • Male
  • Rural Population
  • Socioeconomic Factors
  • Taxes
  • Tobacco Products / economics
  • Tobacco Products / legislation & jurisprudence
  • Tobacco Products / statistics & numerical data*
  • Tobacco Use / epidemiology*
  • United States / epidemiology
  • Urban Population