Tobacco Use Among Rural and Urban US Middle and High School Students: National Youth Tobacco Survey, 2011-2016.

PURPOSE: Rural adolescents engage in higher smoking and smokeless tobacco use rates than those from urban communities; urban adolescents are more likely to use e-cigarettes. The study investigated whether place of residence (rural vs urban) is associated with tobacco use prevalence and change in prevalence among middle and high school students over time. METHODS: We analyzed data from the National Youth Tobacco Survey (2011-2016). Multiple logistic regression methods for weighted survey data assessed the relationship of place of residence with current tobacco product use over time, adjusting for demographics. FINDINGS: There was no difference in rate of change in use of any tobacco product between rural and urban middle or high school students. Adjusting for age, sex, race/ethnicity, and survey year, both middle and high school rural students were more likely to use cigarettes and smokeless tobacco, whereas urban high school students were more likely to use hookah. Significant polynomial trends were observed for e-cigarette and hookah use patterns, whereas linear changes in use patterns were detected for cigarette and smokeless tobacco use over time. CONCLUSIONS: Rural high school students are more likely to smoke cigarettes and use smokeless tobacco than their urban counterparts, although prevalence rates have decreased over time. However, use of hookah and e-cigarettes among middle and high school students has increased over time regardless of place of residence. To stem the rapid increase in use of hookah and e-cigarettes, comprehensive tobacco control policies are needed regardless of rural or urban location.

Current Use of E-Cigarettes and Conventional Cigarettes Among US High School Students in Urban and Rural Locations: 2014 National Youth Tobacco Survey.

PURPOSE: Adolescent tobacco use is higher in rural than in urban areas. While e-cigarette use is increasing rapidly among this age group, differences in prevalence between rural versus urban populations for this relatively novel product have not been explored. The purpose is to investigate whether location of school (rural-urban) is associated with e-cigarette use and dual use (defined as the use of both e-cigarettes and conventional cigarettes) among high school students. DESIGN: Cross-sectional survey obtained using a stratified, 3-stage cluster sample design. SETTING: United States. PARTICIPANTS: A nationally representative sample of US high school students (N = 11 053) who completed the 2014 National Youth Tobacco Survey (NYTS); slightly more than half were urban (54%). MEASURES: The NYTS measures tobacco-related knowledge, attitudes, and use behavior and demographics of students in the United States. ANALYSIS: Weighted logistic regression assessed the relationships of urban-rural location with current e-cigarette use and dual use, adjusting for demographic factors, perceived risk, and social norms. RESULTS: There were clear differences in patterns of adolescent e-cigarette and cigarette use in rural versus urban areas. Social norms and perceptions may play a role in understanding these differences. CONCLUSION: Urban youth current cigarette smokers were nearly twice as likely as rural cigarette smokers to also use e-cigarettes. Reasons for urban-rural differences need to be taken into account when designing prevention programs and policy changes.