Tobacco Use in Rural Areas
Tobacco use is the leading
cause of preventable mortality and morbidity in the United States and is responsible for over
deaths each year. Smoking causes about 90%
of all lung cancer deaths in the United States. Those who smoke regularly are
likely than nonsmokers to develop heart disease, stroke, and lung cancer. About
smokers develop chronic obstructive pulmonary disease. On average, there is a 6.5
year loss in life expectancy for smokers as compared to non-smokers.
As of 2015, tobacco has cost the nation approximately $289
billion in medical costs and productivity loss. Rural residency is associated with higher rates of
smoking and smokeless tobacco use nationwide. Rural residency has also been linked to an earlier
age of onset for smoking and a disproportionately high rate of smoking among pregnant women.
Overall, the prevalence of cigarette smoking is in decline among adults in the United States.
However, adults in rural areas continue to smoke cigarettes more frequently than other individuals.
Data from the National Survey on Drug Use and Health in 2010 indicate that rural smokers are
likely to smoke more than 15 cigarettes a day compared to urban smokers. In 2012, cigarette use was
among the general adult population and 27.4%
among rural adults.
While the rate of smoking among Americans has declined
from 20.9% of adults in 2005 to 14% of adults in 2017, smokeless tobacco use among rural adults has increased
and remains higher in rural populations than in non-rural populations. Smokeless
tobacco is any type of tobacco that is not burned. Common terms for this form of tobacco are chewing
tobacco, spitting tobacco, dip, chew, and snuff.
In 2012, the prevalence of smokeless tobacco use
among American adults and 7.1%
among rural adults (an increase from 5.9% in 2004). Rural youth in nonmetropolitan areas also use smokeless tobacco at higher rates
(4.4%) than youth in metropolitan (1.2%) and small metropolitan (2.4%) areas.
Also known as electronic nicotine delivery systems (ENDS), e-cigarettes are a relatively new method for nicotine
delivery. Data from the HealthStyles Survey
found that between 2010 and 2013, the percentage of adults who had used an e-cigarette at least once rose from
3.3% to 8.5% and the percentage of adults aware of e-cigarettes almost doubled from 40.9% to 79.7%.
E-cigarettes have been promoted as safer
alternatives to traditional cigarettes or as smoking cessation aids. However, while these products do
not produce smoke, they do expose others to secondhand emissions. ENDS also contain nicotine, a highly addictive drug that
can lead to negative birth outcomes and is shown to increase adolescents' risk of developing
mental and behavioral disorders later in life. There has also been recent evidence of increased poisonings in both users and non-users
resulting from the ingestion of the liquid nicotine, absorption through the skin, and inhalation.
The Centers for Disease Control and Prevention (CDC) defines secondhand
smoke as smoke from burning tobacco products. Common sources of secondhand smoke are cigarettes and
cigars. Tobacco smoke contains several toxic chemicals that are linked to cancer.
Among children, exposure
to secondhand smoke may
lead to sudden infant death syndrome (SIDS), ear infections, asthma attacks, and other respiratory
symptoms and infections. Secondhand smoke exposure also has profound impacts on adults. For nonsmokers,
breathing secondhand smoke can
increase the likelihood of developing
heart disease and lung cancer, as well as having a heart attack or
Children who live in rural communities are more likely to live in a house with a smoker, and may
consequently have a higher risk of secondhand smoke exposure than children who live in other areas. The
National Survey of Children's
Health reports that while 24.4% of children in urban areas lives with a smoker, 33.1% of children
in large rural areas and 35% of children in small rural areas live with a smoker. The survey also found that
rural residents are more likely to allow smoking in the presence of their children in comparison to urban areas.
Resources to Learn More
2014 Update of the Rural-Urban Chartbook
This chartbook includes demographics and statistics on various health-related topics, including rates
of cigarette use in rural and urban areas and risk factors.
Author(s): Meit, M., Knudson, A., Gilbert, T., Tzy-Chi Yu, A., Tanenbaum, E., Ormson,
E., TenBroeck, S., Bayne, A., & Popat, S.
Organization(s): Rural Health Reform Policy Research Center
Combustible and Smokeless Tobacco Use Among
High School Athletes – United States, 2001-2013
Reports recent YRBSS findings related to increased smokeless tobacco use among high school athletes
and discusses possible reasons for the increased rates.
Author(s): Agaku, I.K., Singh, T., Everett Jones, S., King, B.A., Jamal, A., Neff, L.,
& Caraballo, R.S.
Citation: Morbidity and Mortality Weekly Report (MMWR), 64(34), 935-939
Culture in Evaluation #2: Rural -
Tobacco Control Evaluation with Rural Populations
This brief provides an overview of cultural competency when working with issues of tobacco control
among rural populations.
Author(s): Treiber, J. & Satterlund, T.
Organization(s): Tobacco Control Evaluation Center
Current Cigarette Smoking Among Adults – United
Summarizes findings from the 2014 National Health Interview Survey (NHIS) related to prevalence of cigarette
smoking among adults in the United States as well as prevalence by age, race, education, poverty status, health
insurance coverage, disability, and sexual orientation.
Author(s): Jamal, A., Homa, D., O'Connor, E., Babb, S.D., Caraballo, R.S., Singh, T.,
Hu, S.S., & King, B.A.
Citation: Morbidity and Mortality Weekly Report (MMWR), 64 (44), 1233-1240
Electronic Cigarettes (E-Cigarettes)
This fact sheet answers questions about how e-cigarettes work, their safety, and their effectiveness as a
smoking cessation aid.
Organization(s): National Institute on Drug Abuse
A Review of the Literature
This summary of peer-reviewed literature about e-cigarettes provides and overall introduction to cigarettes and
discusses secondhand aerosol, marketing, dual use with tobacco, tobacco cessation, harm reduction, and policy
Author(s): Bushore, C. & Pizacani, B.
Organization(s): Alaska Department of Health and Human Services
Consequences of Smoking – 50 Years of Progress. A Report of the Surgeon General
This comprehensive report provides a history of tobacco use in the United States for the past 50 years.
Organization(s): U.S. Department of Health and Human Services
Notes from the Field: Calls to Poison Centers
for Exposures to Electronic Cigarettes – United States, September 2010 – February 2014
Analyzes the number of calls involving e-cigarettes to poison centers with regard to age and exposure.
Author(s): Chatham-Stephens, K., Law, R., Taylor, E., Melstrom, P., Bunnell, R., Wang,
B., Apelberg, B., & Schier, J.G.
Citation: Morbidity and Mortality Weekly Report (MMWR), 63 (13), 292-293
the 2012 National Survey on Drug Use and Health: Summary of National Findings
This report presents a summary of findings from the 2012 National Survey on Drug Use and Health, an annual
survey sponsored by the Substance Abuse and Mental Health Services Administration.
Organization(s): Substance Abuse and Mental Health Services Administration
State-Specific Prevalence of Current Cigarette Smoking and
Smokeless Tobacco Use Among Adults Aged ≥18 Years – United States, 2011–2013
Summarizes findings from the Behavioral Risk Factor Surveillance System (BRFSS) related to adults tobacco use by
Author(s): Nguyen, K., Marshall, L., Hu, S., & Neff, L.
Citation: Morbidity and Mortality Weekly Report (MMWR), 64 (19), 532-536
Statement on E-Cigarettes
This position statement from the American Lung Association provides a brief overview of early research related
to the components of e-cigarettes and the effects of nicotine.
Organization(s): American Lung Association
Regulation of Electronic Cigarettes
This policy statement from the American Public Health Association discusses e-cigarettes in terms of secondhand
exposure, children and youth, cessation research, and advertising and marketing. The statement also lists action
steps for organizations to take in addressing the issue.
Organization(s): American Public Health Association
Tobacco Use in Rural America
This chapter of Rural Healthy People 2020, Volume 1 discusses the scope of tobacco use in rural areas
as it relates to the Health People 2020 objectives. The chapter discusses tobacco use differences by ethnicity,
barriers, and proposed interventions.
Author(s): Geletko, K. & Bellamy, G.
Organization(s): Texas A&M University Health Science Center, School of Public Health, Southwest Rural
Health Research Center
Trends in Awareness and Use of Electronic
Cigarettes among U.S. Adults, 2010-2013
This article reviews data from the 2010-2013 HealthStyles Survey, describing emerging trends in the
use of electronic cigarettes among adults in the U.S.
Author(s): King, B.A., Patel, R., Nguyen, K.H., & Dube, S.R.
Citation: Nicotine and Tobacco Research, 17 (2), 219-227
Urban and Rural Disparities in Tobacco
This presentation from the 2012 National Conference on Health Statistics explores significant predictors of
tobacco use among rural and urban areas and determines areas where programs and advocacy could be useful.
Author(s): Shan, M., Jump, Z., & Lancet, E.
Organization(s): American Lung Association