Urban-Rural Differences in Youth Nicotine Use, 2011-2022

To examine urban-rural differences in US youth nicotine use from 2011 to 2022.

To assess past 30-day frequency of nicotine product use and allow for quantitative comparisons across multiple products, we calculated nicotine product days (NPDs), i.e., days in which students used any nicotine product. We also calculated product-specific NPDs for combustible products, smokeless products, and electronic cigarettes.

Among our sample of 232,621 students, 107,652 were in middle school and 124,969 were in high school. Rural middle and high school students consistently reported greater NPDs than their urban peers. While combustible and smokeless NPDs were higher in rural students, electronic cigarette NPDs were similar between rural and urban students.

By using NPDs, our study provides a more refined assessment of youth urban-rural nicotine product use. Further research is needed to identify the factors underlying the remaining gaps in rural-urban youth nicotine use.