Uneven Access to Smoke-Free Laws and Policies and Its Effect on Health Equity in the United States: 2000-2019.

Tobacco control measures have played an important role in the reduction of the cigarette smoking prevalence among US adults.However, although overall smoking prevalence has declined, it remains high among many subpopulations that are disproportionately burdened by tobacco use, resulting in tobacco-related health disparities. Slow diffusion of smoke-free laws to rural regions, particularly in the South and Southeast, and uneven adoption of voluntary policies in single-family homes and multiunit housing are key policy variables associated with the disproportionate burden of tobacco-related health disparities in these subpopulations.Developing policies that expand the reach of comprehensive smoke-free laws not only will facilitate the decline in smoking prevalence among subpopulations disproportionately burdened by tobacco use but will also decrease exposure to secondhand smoke and further reduce tobacco-caused health disparities in the United States.

Ozone pollution and asthma emergency department visits in the Central Valley, California, USA, during June to September of 2015: a time-stratified case-crossover analysis.

Objective: The San Joaquin Valley (SJV) exceeds the state and national standards for ozone (O3). This study investigates whether short-term exposure to O3 is associated with asthma emergency department (ED) visits. Methods: We identified 1,101 ED visits in June-September of 2015 in SJV, California, who lived within 15 km of active air monitors. Conditional logistic regression models were used to obtain the odds ratio (OR) and 95% confidence interval (CI) associated with an interquartile (IQR) increase in ozone. We explored the potential effect modification by sex (female and male), race (White, Black and Hispanic), age (2-5, 6-18, 19-40, 41-64 and > = 65) and county (Merced, Madera, Kings, Fresno and Kern). Results: An IQR range (18.1 ppb) increase in O3 exposure three days before an asthma attack (lag 3) was associated with a 6.6% [OR: 1.066 (95% CI: 1.032, 1.082)] increase in the odds of having an asthma ED visit. The overall ORs differed across age groups and races/ethnicities, with strongest for children aged 6-18 years [OR: 1.219 (95% CI: 1.159, 1.280)], adults 19-40 years [OR: 1.102 (95% CI: 1.053, 1.154)] and Blacks [OR: 1.159 (95% CI: 1.088, 1.236)], respectively. O3 exposure was not positively associated with asthma ED visits for Whites, while it was for other underrepresented groups. Fresno had the highest number of asthma ED visits and positive association among all five counties. Conclusion: We found that O3 exposure is associated with asthma ED visits in the SJV.

Web-Based Health Information Technology: Access Among Latinos Varies by Subgroup Affiliation.

BACKGROUND: There are significant health technology gaps between Latinos and non-Hispanic whites and between first- and second-generation Latinos. OBJECTIVE: This study aimed to examine disparities in Web-based health information-seeking behavior (HISB) and patient portal use among Latinos, taking into account nativity and subethnic affiliation. METHODS: We analyzed US-born, non-Hispanic whites and Latinos adults (N=49,259) and adult internet users (N=36,214) in the 2015 to 2016 National Health Interview Survey using a binary logistic regression controlling for individual difference level variables. Outcomes were internet use, HISB (health information-seeking online and using a chat group for health information), and patient portal use (using a computer to schedule an appointment, filling a prescription, and communicating with a provider). RESULTS: We found that US-born Mexicans (odds ratio [OR] 0.81, 95% CI 0.66-0.99), foreign-born Mexicans (OR 0.35, 95% CI 0.29-0.42), foreign-born Puerto Ricans (OR 0.62, 95% CI 0.44-0.87), foreign-born Central and South Americans (OR 0.42, 95% CI 0.33-0.53), and foreign-born other Latinos (OR 0.34, 95% CI 0.24-0.49) had lower odds of using the internet than US-born non-Hispanic whites. The relationship between subgroup affiliation and Web-based HISB varied by type of technology. US-born Mexicans (OR 0.77, 95% CI 0.66-0.9), foreign-born Mexicans (OR 0.51, 95% CI 0.43-0.61), foreign-born Central and South Americans (OR 0.53, 95% CI 0.43-0.64), and foreign-born other Latinos (OR 0.56, 95% CI 0.4-0.79) had lower odds of looking up health information online than US-born non-Hispanic whites. Controlling for age, sex, education, income to federal poverty level, and region, foreign-born Central and South Americans (OR 0.61, 95% CI 0.41-0.92) and foreign-born other Latinos (OR 0.26, 95% CI 0.1-0.68) had lower odds of filling a prescription using a computer than US-born non-Hispanic whites. Foreign-born Mexicans (OR 0.51, 95% CI 0.36-0.72) and foreign-born Central and South Americans (OR 0.7, 95% CI 0.5-0.99) have lower odds of emailing a health care provider than US-born non-Hispanic whites. Posthoc analyses were conducted among Mexican-Americans to see if age was significant in predicting Web-based HISB or other patient portal use. We found individuals aged 18 to 30 years had higher odds of using the internet (OR 3.46, 95% CI 2.61-4.59) and lower odds of looking up health information online (OR 0.75, 95% CI 0.58-0.96). A posthoc analysis was conducted among Mexican-Americans to see if nativity predicted Web-based HISB and patient portal use. We found that US-born individuals had higher odds (OR 52.9, 95% CI 1.2-1.93) of looking up health information online compared with foreign-born individuals. CONCLUSIONS: We found Latino subgroups do not use health information channels equally, and attempts to target Latinos should take ethnicity and nativity into account.

The Effects of Workplace Clean Indoor Air Law Coverage on Workers' Smoking-Related Outcomes.

This study investigated the effects of workplace clean indoor air law (CIAL) coverage on worksite compliance with CIALs, smoking participation among indoor workers, and secondhand smoke (SHS) exposure among nonsmoker indoor workers. This study improved on previous research by using the probability of a resident in a county covered by workplace CIALs, taking into account the state, county, and city legislation. The county-level probability of being covered by a CIAL is merged into two large nationally representative US surveys on smoking behaviors: Tobacco Use Supplement of the Current Population Survey (2001-2010) and Behavioral Risk Factor Surveillance System (2000-2006) based on the year of the survey and respondent's geographic location to identify respondents' CIAL coverage. This study estimated several model specifications of including and not including state or county fixed effects, and the effects of workplace CIALs are consistent across models. Increased coverage by workplace CIALs significantly increased likelihood of reporting a complete smoking restriction by 8% and 10% for the two different datasets, decreased smoking participation among indoor workers by 12%, and decreased SHS exposure among nonsmokers by 28%. Copyright © 2015 John Wiley & Sons, Ltd.

Soda consumption and hospital admissions among Californian adults with asthma.

INTRODUCTION: Asthma prevalence has been increasing consistently since 1995 in California. Recent studies have found that consuming soda and sugar-containing drinks may pose a risk for asthma. Research that examines the relationship between soda intake and asthma among adult asthmatics is limited. OBJECTIVE: This study investigated the relationship between sugar-sweetened soda consumption and asthma hospitalization among adult asthmatics in California. METHODS: This cross-sectional study was based on the 2011-2012 California Health Interview Survey (CHIS) data and included 3,784 adults who were diagnosed with asthma by a doctor and who currently reported either that they still had asthma, or that they had suffered from an asthma attack in the last 12 months. The analysis was survey weighted. The exposure variable was soda intake measured as the number of times soda was consumed in the last week. The health outcome measure was overnight hospital admission due to asthma. Logistic regression was used to examine the association between soda consumption and overnight hospital admission after adjusting for age, education, sex, race/ethnicity, weight status, smoking status, and self-rated health. RESULTS: Adults with asthma who drank soda three or more times per week reported higher odds of overnight hospitalization (adjusted odds ratio = 2.77, 95% CI: 1.51-5.10, p = 0.001). CONCLUSIONS: Our findings suggest that efforts designed to limit soda consumption would benefit asthma suffers by reducing hospital admissions. This, however, needs further research to confirm a direct causal association.

Online Health Information-Seeking Behavior and Confidence in Filling Out Online Forms Among Latinos: A Cross-Sectional Analysis of the California Health Interview Survey, 2011-2012.

BACKGROUND: Health information is increasingly being disseminated online, but there is a knowledge gap between Latinos and non-Hispanic whites, particularly those whose English language proficiency is poor, in terms both of online health information-seeking behavior and computer literacy skills. This knowledge gap may also exist between US- and foreign-born Latinos. OBJECTIVE: The specific aim of this study was to examine Internet use, online health information-seeking behavior, and confidence in filling out online forms among Latinos, particularly as it relates to health-risk behaviors. We then stratified our sample by nativity. METHODS: We used the adult population file of the 2011-2012 California Health Interview Survey, analyzing Internet use, online health information-seeking behavior, and confidence in filling out online forms using binary logistic regression among Latinos and whites (N=27,289), Latinos (n=9506), and Latinos who use the Internet (n=6037). RESULTS: Foreign-born Latinos (OR 0.71, 95% CI 0.58-0.88, P=.002) have lower odds of engaging in online health information-seeking behavior, and higher odds (OR 2.90, 95% CI 2.07-4.06, P<.001) of reporting a lack of confidence in filling out online forms compared to US-born Latinos. Correlates of online health information-seeking behavior and form confidence varied by nativity. CONCLUSIONS: Latinos, particularly foreign-born individuals, are at an increased risk of being left behind as the move to increase online content delivery and care expands. As online health information dissemination and online health portals become more popular, the impact of these sites on Latino gaps in coverage and care should be considered.

Cost of chronic disease in California: estimates at the county level.

CONTEXT: An estimated 39% of people in California suffer from at least one chronic condition or disease. While the increased coverage provided by the Affordable Care Act will result in greater access to primary health care, coordinated strategies are needed to prevent chronic conditions. To identify cost-effective strategies, local health departments and other agencies need accurate information on the costs of chronic conditions in their region. OBJECTIVE: To present a methodology for estimating the cost of chronic conditions for counties. METHODS: Estimates of the attributable cost of 6 chronic conditions-arthritis, asthma, cancer, cardiovascular disease, diabetes, and depression-from the Centers for Disease Control and Prevention's Chronic Disease Cost Calculator were combined with prevalence rates from the various sources and census data for California counties to estimate the number of cases and costs of each condition. The estimates were adjusted for differences in prices using Medicare geographical adjusters. RESULTS: An estimated $98 billion is currently spent on treating chronic conditions in California. There is significant variation between counties in the percentage of total health care expenditure due to chronic conditions and county size, ranging from a low 32% to a high of 63%. The variations between counties result from differing rates of chronic conditions across age, ethnicity, and gender. CONCLUSIONS: Information on the cost of chronic conditions is important for planning prevention and control efforts. This study demonstrates a method for providing local health departments with estimates of the scope of the problems in their region. Combining the cost estimates with information on current prevention strategies can identify gaps in prevention activities and the prevention measures that promise the greatest return on investment for each county.

Association of strong smoke-free laws with dentists' advice to quit smoking, 2006-2007.

OBJECTIVES: We examined the association of smoke-free laws with dentists' advice to quit smoking and referral to a quit line, among smokers who reported visiting the dentist in the past 12 months. METHODS: We used the 2006 to 2007 Tobacco Use Supplement of the Current Population Survey merged with the American Nonsmokers' Rights Foundation Local Ordinance Database of smoke-free laws. The dependent variables were advice from a dentist to quit smoking and referral to a quit line, and the independent variable of interest was 100% smoke-free law coverage. We controlled for respondent demographics and an index of state-level smoking ban attitudes (included to ensure that the effect detected was not the result of social attitudes). RESULTS: Smoke-free law coverage was associated with dental advice to quit smoking (odds ratio [OR] = 1.27; 95% confidence interval [CI] = 1.01, 1.59; P = .041), but not with referral to a quit line (OR = 1.33; 95% CI = 0.79, 2.25; P = .283). CONCLUSIONS: Interventions with dentists are needed to increase referrals to quit lines and other smoking cessation efforts.

Health preemption behind closed doors: trade agreements and fast-track authority.

Noncommunicable diseases result from consuming unhealthy products, including tobacco, which are promoted by transnational corporations. The tobacco industry uses preemption to block or reverse tobacco control policies. Preemption removes authority from jurisdictions where tobacco companies' influence is weak and transfers it to jurisdictions where they have an advantage. International trade agreements relocate decisions about tobacco control policy to venues where there is little opportunity for public scrutiny, participation, and debate. Tobacco companies are using these agreements to preempt domestic authority over tobacco policy. Other transnational corporations that profit by promoting unhealthy foods could do the same. "Fast-track authority," in which Congress cedes ongoing oversight authority to the President, further distances the public from the debate. With international agreements binding governments to prioritize trade over health, transparency and public oversight of the trade negotiation process is necessary to safeguard public health interests.

Strong smoke-free law coverage in the United States by race/ethnicity: 2000-2009.

OBJECTIVES: We determined whether racial/ethnic disparities existed in coverage by type of 100% smoke-free private workplace, restaurant, and bar laws from 2000 to 2009. METHODS: We combined US census population data and the American Nonsmokers' Rights Foundation US Tobacco Control Database to calculate the percentage of individuals in counties covered by each type of law by race/ethnicity from 2000 to 2009. RESULTS: More of the US Hispanic and Asian populations were covered by 100% smoke-free restaurant and bar laws than non-Hispanic White and non-Hispanic Black populations. Asian coverage by smoke-free bars laws increased from 36% to 75%, and Hispanic coverage increased from 31% to 62%, compared with 6% to 41% for non-Hispanic Blacks and 8% to 49% for non-Hispanic Whites. CONCLUSIONS: Hispanics and Asians benefited more from the rapid spread of smoke-free law coverage, whereas non-Hispanic Blacks benefited less. These ethnic disparities suggest a likely effect of geographic region and may provide a basis for more effective, community-based, and tailored policy-related interventions, particularly regarding areas with high concentrations of non-Hispanic Blacks.

The pattern of indoor smoking restriction law transitions, 1970-2009: laws are sticky.

OBJECTIVES: We examined the pattern of the passage of smoking laws across venues (government and private workplaces, restaurants, bars) and by strength (no law to 100% smoke-free). METHODS: We conducted transition analyses of local and state smoking restrictions passed between 1970 and 2009, with data from the Americans for Nonsmokers' Rights Ordinance Database. RESULTS: Each decade, more laws were enacted, from 18 passed in the 1970s to 3172 in the first decade of this century, when 91% of existing state laws were passed. Most laws passed took states and localities from no law to some level of smoking restriction, and most new local (77%; 5148/6648) and state (73%; 115/158) laws passed in the study period did not change strength. CONCLUSIONS: Because these laws are "sticky"-once a law has passed, strength of the law and venues covered do not change often-policymakers and advocates should focus on passing strong laws the first time, rather than settling for less comprehensive laws with the hope of improving them in the future.

Failure of policy regarding smoke-free bars in the Netherlands.

BACKGROUND: Tobacco companies consistently work to prevent and undermine smoke-free laws. The tobacco industry and its allies have funded hospitality associations and other third parties to oppose smoke-free laws, argue that smoke-free laws will economically damage hospitality venues, promote ventilation and voluntary smoker 'accommodation' as an alternative to smoke-free laws, and to challenge smoke-free laws in court. In 2008, the Netherlands extended its smoke-free law to hospitality venues. METHODS: We triangulated news articles, government documents, scientific papers, statistical reports and interviews to construct this case study. RESULTS: Despite widespread public support for smoke-free hospitality venues, opponents successfully represented these laws as unpopular and damaging to small bars. These challenges and related smokers' rights activities resulted in non-compliance among all bars and reinstating an exemption for small, owner-run venues. This policy reversal was the result of a weak implementing media campaign (which failed to present the law as protecting nonsmokers), smoking room exemptions and reactive (vs. proactive) measures by the Ministry of Health and civil society. CONCLUSION: The policy failure in the Netherlands is the result of poor implementation efforts and the failure to anticipate and deal with opposition to the law. When implementing smoke-free laws it is important to anticipate opposition, used the media to target non-smokers to reinforce public support, and actively enforce the law.

Post-Resettlement Food Insecurity: Afghan Refugees and Challenges of the New Environment.

BACKGROUND: Lack of access to adequate, safe, and nutritious food is a major concern for the Afghan population due to ongoing war and humanitarian crises. Recently resettled Afghan refugees in the US continue to face challenges securing adequate, nutritious food resources in new environments. This study examined Afghan refugees' food access and insecurity in the San Joaquin Valley, California. METHODS: Semi-structured, in-depth interviews were conducted to collect the perspectives and experiences of key informants and newly arrived Afghan refugees. RESULTS: This study highlights environmental and structural factors (availability and accessibility of grocery stores; availability of religious-appropriate items in the stores; the public benefit received by a family; and public transportation) and individual factors (religious and cultural practices; financial and language barriers) as major determinants of post-resettlement food insecurity. CONCLUSION: Increasing the accessibility and affordability of culturally and religiously appropriate food items within the US food system, enhancing the collaboration of community volunteers and resettlement organizations in the direct assistance of new families, and providing continuous access to public benefits are possible steps to mitigate the risk of food insecurity among Afghan refugees. This study suggests a continuous examination of the degree of food insecurity in this population and its attendant health impacts.

Perceptions of COVID-related risks among people who smoke: A mediation model.

The COVID-19 pandemic provides both reasons to quit smoking as well as stress that may promote increased cigarette consumption. Perceptions of COVID-19 risk related to smoking may motivate cessation among smokers. At the same time, other evidence shows that affective perceptions (i.e., worry) could lead to increased smoking as a coping mechanism. Using a sample drawn from a rural region of California (N = 295), we examined the relationship between perceptions about health risks for smokers during the pandemic and both reported increases in smoking frequency and intentions to quit smoking. We also examined whether worry about health risks mediated these relationships. High perceived risk was associated both with reported increases in smoking frequency as well as greater intentions to quit smoking. Worry partially mediated both these relationships, with worry accounting for 29.11% of the variance in the relationship between high risk perceptions and increased smoking as well as 20.17% of the relationship between risk perceptions and intentions to quit smoking. These findings suggest that while smokers' awareness about their increased risk of COVID-19 can motivate intent to quit smoking in the future, smokers may require greater support to act on these intentions.

Through tobacco industry eyes: civil society and the FCTC process from Philip Morris and British American Tobacco's perspectives.

OBJECTIVE: To analyse the models Philip Morris (PM) and British American Tobacco (BAT) used internally to understand tobacco control non-governmental organizations (NGOs) and their relationship to the global tobacco control policy-making process that resulted in the Framework Convention for Tobacco Control (FCTC). METHODS: Analysis of internal tobacco industry documents in the Legacy Tobacco Document Library. RESULTS: PM contracted with Mongoven, Biscoe, and Duchin, Inc. (MBD, a consulting firm specialising in NGO surveillance) as advisors. MBD argued that because NGOs are increasingly linked to epistemic communities, NGOs could insert themselves into the global policy-making process and influence the discourse surrounding the treaty-making process. MBD advised PM to insert itself into the policy-making process, mimicking NGO behaviour. BAT's Consumer and Regulatory Affairs (CORA) department argued that global regulation emerged from the perception (by NGOs and governments) that the industry could not regulate itself, leading to BAT advocating social alignment and self-regulation to minimise the impact of the FCTC. Most efforts to block or redirect the FCTC failed. CONCLUSIONS: PM and BAT articulated a global policy-making environment in which NGOs are key, non-state stakeholders, and as a result, internationalised some of their previous national-level strategies. After both companies failed to prevent the FCTC, their strategies began to align. Multinational corporations have continued to successfully employ some of the strategies outlined in this paper at the local and national level while being formally excluded from ongoing FCTC negotiations at the global level.

Challenging Assumptions About Race/Ethnicity, Socioeconomic Status, and Cigarette Smoking Among Adolescents.

BACKGROUND: Previous research indicates that differences in cigarette smoking exist among those of different race/ethnicity and varying levels of socioeconomic status. However, most research has examined the influence of these factors separately on cigarette smoking despite their observed covariation. To examine the interaction of race/ethnicity and socioeconomic status on adolescent tobacco use and behaviors, this study tests whether or not the social gradient holds for smoking patterns and perceptions of smoking among African American, American Indian/Alaska Native (AIAN), Asian, Hispanic, and White adolescents. METHODS: Using data from the 2018 National Survey on Drug Use and Health, the sample included African American/Black (Black), American Indian/Alaska Native (AIAN), Asian, Hispanic, and White adolescents (N = 12,474), ages 12-17 years old. Measures included race/ethnicity, annual household income, age, gender, cigarette smoking, perceptions of peer use, parental attitudes, and health risks of smoking; logistic regression analyses were conducted. RESULTS: Findings indicated significant interactions between high income and Black and Hispanic race/ethnicity for having ever smoked a cigarette indicating a difference in comparison to high-income White adolescents (p's < 0.05). We also found that the interaction between high income and AIAN race/ethnicity for disapproval of peers smoking was significant compared to White adolescents at the same income levels (p < 0.05). No differences were found for smoking health risk perceptions. CONCLUSIONS: The relationship between race/ethnicity, income, and smoking may be more complex than previously thought with these results having important preventative implications for identification of adolescents who may be most at risk for tobacco use.

Why do smokers use e-cigarettes? A study on reasons among dual users.

Objective: There is minimal research that has measured motivations behind e-cigarette use and the relationship to cigarette and e-cigarette use. The aim of this study was to (1) examine extent to which motivations to use e-cigarettes varies among dual users and (2) examine whether e-cigarette motivations are related to e-cigarette and cigarette consumption among dual users. Methods: Adults residing in California were recruited through social media (n = 1762, 68.9 % males, 62.9 % White) to complete an online survey. Participants self-identified as using combustible cigarettes and e-cigarettes (dual users) and reported their motivations for using an e-cigarette device, nicotine consumption, and nicotine dependence with both combustible cigarettes and e-cigarettes. Results: A greater proportion of people reported using e-cigarettes for enjoyment purposes than other motivations (34.2 %). Motivations to use e-cigarettes to quit were positively related to monthly cigarette consumption (IRR = 1.17, 95 % CI [1.08, 1.26]). Motivations to use e-cigarettes to quit smoking were also related to smoking the first cigarette within 30 min (IRR = 1.46, 95 % CI [1.05, 2.02]) and first e-cigarette within 30 min (b = 0.28, 95 % CI [0.19, 0.37]). Conclusions: Compared to those who use e-cigarettes for enjoyment, smokers who are motivated to use e-cigarettes for cessation purposes are more likely to have greater nicotine dependence, cigarette consumption, and e-cigarette consumption. Future research needs to acknowledge that not all e-cigarette users are the same; motivations and use differ and are related to both consumption and dependence.

The nature, scope, and development of the global tobacco control epistemic community.

Over the past 50 years, tobacco control has been transformed from a national to a global issue, becoming institutionalized in the World Health Organization (WHO) Framework Convention on Tobacco Control, the first international public health treaty negotiated under the auspices of the WHO. The global tobacco control epistemic community, a worldwide network of professionals with a common interpretation of the science in tobacco use and control, has contributed to this transformation. We investigated the development, structure, and function of this community through interviews and archival documents. Professionals in the community are bound by values and consensual knowledge developed after years of contentious debates undergirded their activities. Although these professionals play multiple roles, they recognize that scientific evidence should inform advocacy and policy activities. Public health professionals should continue to strengthen the links between science and advocacy for policy while being vigilant against industry efforts to undermine the scientific evidence on tobacco use and control.

Professional liability in oral surgery: legal and medical study of 63 court sentences.

OBJECTIVES: Dentistry, like all other health care professions, has in recent years been subjected to an increase in legal pressure by patients. Nevertheless, there are areas of activity in dentistry in which, whether because of their frequency or due to the importance of the damage and sequelae claimed, this legal pressure is greater. Amongst these areas of activity is that of oral surgery. STUDY DESIGN: To be meticulously analyzed in this report are 63 sentences issued by courts of second instance or higher levels regarding lawsuits involving oral surgery. The data collection file includes 13 variables. The descriptive and comparative statistical study by cross-referencing certain variables provides us with a clear and accurate picture of the lawsuit profile. RESULTS AND CONCLUSIONS: Implantological surgery was the practice subject to the most claims due to surgery (55.6 percent: 35 sentences), and it drew our attention that in 71.4% of all cases (45 sentences) there was a ruling against the professional. The most frequent range of damage payments was between €18,001 and €60,000 (40.9%: 18 sentences), the highest amount having been €24,000, an important factor to take into account when contracting professional civil liability insurance.

Traditional Cigarette and Poly-Tobacco Use Are Associated with Medical Opioid Use in Rural Areas of the US.

INTRODUCTION: Medical prescriptions for opioids are higher in rural areas of the US as compared to urban areas. Tobacco use may also play a role in this process. This analysis examines the association between differing types of tobacco use and medical opioid use. METHODS: We analyze the relationship between tobacco product use and medical opioid use among the US general population living in rural (non-metropolitan) areas using the publicly available sample adult file 2019 National Health Interview Survey (NHIS) (n = 5028). Tobacco use was classified into the following categories: only using cigarettes, only using e-cigarettes/vapes, only using cigars, only using smokeless tobacco, or using two or more of the following products. We used a binary logistic regression, controlling for individual differences. RESULTS: Individuals who reported using only traditional cigarettes (and no other tobacco product, OR = 1.62, 95% CI: 1.31, 2.01), or who reported being a poly-tobacco users (OR = 2.13, 95% CI: 1.40, 3.22) had higher odds of medical opioid use in the last twelve months. CONCLUSION: Results suggest a link between tobacco use, particularly cigarette use and poly-tobacco use, and medical opioid use in rural communities. Clinical and structural level interventions need to be implemented in rural communities to reduce comorbid tobacco and opioid use.