Rural E-Cigarette Use Higher than Urban Across Age Groups

Rural communities in the United States experience higher tobacco use and worse tobacco-related health outcomes than urban areas, with disparities increasingly extending to electronic nicotine delivery systems (ENDS). Little is known about rural-urban differences in ENDS use across detailed age groups.

We analyzed data from the 2022-2023 Tobacco Use Supplement to the Current Population Survey (TUS-CPS), a nationally representative survey of U.S. adults (≥18 years). Respondents were categorized into four age groups (18-24, 25-44, 45-64, ≥65). Rural-urban residence was defined using metropolitan status. Weighted prevalence estimate of lifetime, former, and current ENDS use were calculated by age group and rural-urban residence, and gender-adjusted contrasts were estimated using survey-weighted marginal standardization.

Lifetime, former, and current ENDS use were 9.6%, 6.6%, and 3.0%, respectively. Lifetime and current ENDS use were higher in rural than urban areas across most age groups, with the largest differences observed among adults aged 25-44 and 45-64 (current use PRs of 1.29 and 1.44, respectively). YAs (18-24) in rural areas had the highest prevalence (lifetime: 19.5%; current: 10.5%). Among lifetime users, adults aged 18-24 and 25-44 in rural areas were more likely to report current use than their counterparts in urban areas (18-24: 53.8% vs. 44.6%; 25-44: 35.2% vs. 29.5%). Former use was significantly higher in rural areas overall and among adults aged 25-44 and 45-64, but not among adults aged 18-24 or ≥65.

These patterns of ENDS use underscore the need for age-targeted ENDS prevention and cessation interventions in rural populations.