Rural-Urban Patterns in Household Rules Limiting Combustible Tobacco, Noncombustible Tobacco, and E-Cigarette Use

Area of Science:

• Public Health
• Epidemiology
• Tobacco Control

Background:

• Rural Americans face higher rates of smoking and related diseases than urban populations.
• Household smoking restrictions reduce secondhand smoke exposure and aid smoking cessation.
• Limited research indicates rural residents are less likely to implement household smoking bans.

Purpose of the Study:

• To investigate the association between rurality and household rules governing tobacco product use.
• To examine rules for combustible tobacco, non-combustible tobacco, and electronic cigarettes (e-cigarettes) in homes.

Main Methods:

• Utilized cross-sectional data from 10,126 US adults aged ≥40 from the 2018-2019 Population Assessment of Tobacco and Health Study.
• Assessed the relationship between residence rurality (rural, small-town, suburban, urban) and household smoking rules.
• Employed multivariable Poisson regression, adjusting for age, sex, race, education, income, and product use.

Main Results:

• Rural respondents were more likely than urban respondents to permit combustible tobacco (17.6% vs 13.6%), non-combustible tobacco (26.4% vs 16.4%), and e-cigarette use (20.8% vs 15.1%) in homes.
• Adjusted risk ratios indicated higher likelihood of allowing combustible tobacco (ARR=1.27), non-combustible tobacco (ARR=1.36), and e-cigarettes (ARR=1.34) in rural homes versus urban homes.
• Small-town residents showed similar increased risks, while suburban residents did not differ from urban residents.

Conclusions:

• Rural and small-town Americans are more likely to permit household use of all tobacco product types compared to urban dwellers.
• This pattern remains consistent even after adjusting for socioeconomic factors and individual tobacco product usage.
• Findings highlight potential targets for interventions to reduce tobacco-related health disparities in rural areas.