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. 2018 Dec;117:69-75.
doi: 10.1016/j.ypmed.2018.04.008. Epub 2018 Apr 5.

Trend Differences in Men and Women in Rural and Urban U.S. Settings

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Trend Differences in Men and Women in Rural and Urban U.S. Settings

A Cepeda-Benito et al. Prev Med. .
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Background: Smoking prevalence is declining at a slower rate in rural than urban settings in the United States (U.S.), and known predictors of smoking do not readily account for this trend difference. Given that socioeconomic and psychosocial determinants of health disparities accumulate in rural settings and that life-course disadvantages are often greater in women than men, we examined whether smoking trends are different for rural and urban men and women.

Method: We used yearly cross-sectional data (n = 303,311) from the U.S. National Survey on Drug Use and Health (NSDUH) from 2007 through 2014 to compare cigarette smoking trends in men and women across rural and urban areas. Current smoking status was modelled using logistic regression controlling for confounding risk factors.

Results: Regression derived graphs predicting unadjusted prevalence estimates and 95% confidence bands revealed that whereas the smoking trends of rural men, urban men, and urban women significantly declined from 2007 to 2014, the trend for rural women was flat. Controlling for demographic, socioeconomic and psychosocial predictors of smoking did not explain rural women's significantly different trend from those of the other three groups.

Conclusion: Rural women lag behind rural men, urban men and urban women in decreasing smoking, a health disparity finding that supports the need for tobacco control and regulatory policies and interventions that are more effective in reducing smoking among rural women.

Keywords: Rural smoking; Smoking gender differences; Smoking trends; Tobacco control; Tobacco regulation.

Conflict of interest statement

Conflicts of interest

None to declare.


Fig. 1.
Fig. 1.
Covariate-unadjusted yearly current cigarette smoking prevalencetrends with 95% confidence bands for rural and urban men and women populations. Estimates are weight-adjusted to reflect the U.S. population.
Fig. 2.
Fig. 2.
Rural and urban men and women current cigarette smoking prevalence, trends, and 95% confidence bands adjusted to a common characteristic profile, visualizing the unique contribution of rural residence and gender across time given our adjusted model. Estimates are weight adjusted to reflect the U.S. population.

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