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Updated: Jul 3, 2026

Cigarette Smoke Exposure in Mice using a Whole-Body Inhalation System
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Published on: October 22, 2020

Rural E-Cigarette Use Higher than Urban Across Age Groups.

Jovan Gwon1, Young Cho2, Dana Carroll3

  • 1School of Nursing, University of Minnesota, Twin Cities, MN.

Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco
|July 1, 2026
PubMed
Summary

Electronic Nicotine Delivery Systems (ENDS) use is higher in rural U.S. areas across most age groups, particularly among young adults. Targeted prevention and cessation programs are crucial for rural populations.

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Area of Science:

  • Public Health
  • Epidemiology
  • Tobacco Control

Background:

  • Rural U.S. communities face higher rates of tobacco use and related health issues compared to urban areas.
  • Disparities in electronic nicotine delivery systems (ENDS) use are growing between rural and urban populations.
  • Limited data exists on rural-urban differences in ENDS use across specific age demographics.

Purpose of the Study:

  • To analyze and compare the prevalence of electronic nicotine delivery systems (ENDS) use between rural and urban adults in the U.S.
  • To examine ENDS use patterns across detailed age groups (18-24, 25-44, 45-64, ≥65) stratified by rural-urban residence.
  • To identify specific age demographics and geographic locations with the highest ENDS use prevalence.

Main Methods:

  • Utilized data from the 2022-2023 Tobacco Use Supplement to the Current Population Survey (TUS-CPS), a national representative sample of U.S. adults.
  • Categorized respondents into four age groups and defined rural-urban residence based on metropolitan status.
  • Calculated weighted prevalence estimates for lifetime, former, and current ENDS use, employing gender-adjusted contrasts via marginal standardization.

Main Results:

  • Overall prevalence: 9.6% lifetime, 6.6% former, and 3.0% current ENDS use.
  • Higher lifetime and current ENDS use observed in rural areas across most age groups, with notable differences in adults aged 25-44 (PR=1.29) and 45-64 (PR=1.44).
  • Young adults (18-24) in rural areas exhibited the highest prevalence (19.5% lifetime, 10.5% current). Rural young adults and those aged 25-44 were more likely to be current users among lifetime users compared to urban counterparts.

Conclusions:

  • Significant rural-urban disparities in ENDS use exist across various adult age groups.
  • Younger adults (18-24 and 25-44) in rural areas show higher likelihood of current ENDS use.
  • Age-targeted ENDS prevention and cessation interventions are critically needed for rural populations.