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

Rationale: Rural Americans experience higher rates of smoking and smoking-associated disease than urban Americans. Household rules limiting smoking inside the home decrease secondhand smoke exposure and may facilitate quitting among those who smoke. Limited research suggests that rural Americans are less likely to report household smoking restrictions. Objective: To study the relationship between rurality and household rules limiting combustible tobacco, noncombustible tobacco, and electronic cigarette (e-cigarette) use. Methods: Cross-sectional data for 10,126 U.S. respondents aged ⩾40 years from the Population Assessment of Tobacco and Health Study Wave 5 (2018-2019) were used to assess the relationship between residence rurality (rural, small town, suburban, urban) and household rules limiting combustible tobacco, noncombustible tobacco, or e-cigarette use. Multivariable Poisson regression analyses were adjusted for respondent age, sex, race, education, family income, and product use. Results: Rural (vs. urban) respondents more commonly allowed combustible tobacco (17.6% vs. 13.6%), noncombustible tobacco (26.4% vs. 16.4%), and e-cigarette use (20.8% vs. 15.1%) in the home. The fully adjusted risk ratios (ARRs) for rural (vs. urban) homes were 1.27 (95% confidence interval [CI], 1.12, 1.44) for combustible tobacco, 1.36 (95% CI, 1.20, 1.54) for noncombustible tobacco, and 1.34 (95% CI, 1.17, 1.55) for e-cigarettes. Small-town respondents had similarly increased ARRs, whereas suburban respondents' ARRs were not different from the urban reference group's. Conclusions: Rural and small-town Americans were more likely than urban respondents to allow household use of all tobacco product types. This pattern persisted when adjusted for socioeconomic factors and respondent product use. These findings may help address tobacco-related diseases that disproportionately affect rural Americans.