Tobacco Use by Urbanization Level Among U.S. Adults, 2024

The aim of this study was to examine rural-urban differences in the current use of tobacco products among U.S. adults using 2024 National Health Interview Survey data and the updated 2023 National Center for Health Statistics urban-rural classification scheme.

This study analyzed data from U.S. adults aged ≥18 years in the 2024 National Health Interview Survey (N=32,629). Weighted logistic regression models estimated the associations between rurality and the current use of any tobacco, cigarettes, E-cigarettes, cigars, and smokeless tobacco. A Poisson regression model assessed the number of tobacco products used, with a sensitivity analysis among adults with any tobacco use. The models adjusted for age; sex; race and ethnicity; sexual identity; region; family income-to-poverty ratio; past-year alcohol use; and, in sensitivity analyses, chronic and psychiatric conditions.

Rural residents had higher adjusted odds of current use of any tobacco (AOR=1.42; 95% CI=1.29, 1.56), cigarettes (AOR=1.31; 95% CI=1.17, 1.48), and smokeless tobacco (AOR=2.28; 95% CI=1.85, 2.80) than urban residents. Cigar use did not differ by urbanization level, and the association for E-cigarette use did not meet the multiple-comparison threshold. Rural residence was associated with a higher number of tobacco products used overall (adjusted prevalence rate=1.28; 95% CI=1.19, 1.39), but among adults who used any tobacco product, urbanization level was not associated with the number of products used. Among adults who used smokeless tobacco, rural residents had higher odds of daily use than urban residents (AOR=1.82; 95% CI= 1.26, 2.64).

In 2024, rural-urban disparities in tobacco use among U.S. adults remained concentrated in cigarettes and smokeless tobacco, supporting a focus on these products in rural surveillance, prevention, and cessation efforts.