Tobacco use in rural populations is a pressing public health issue. Individuals living in rural areas suffer disproportionately from tobacco use, with cross-sectional surveys consistently showing higher prevalence rates of cigarette smoking and smokeless tobacco use in rural areas compared to metropolitan areas. While the scientific knowledge about adolescent tobacco use has grown significantly in the past several decades, most of this knowledge is based primarily on youth living in urban areas. The proposed work utilizes over a decade of existing longitudinal data from Minnesota to characterize important factors that may contribute to tobacco-related disparities in rural communities.
The aims of the current proposal are to: (1) examine differences in the progression of cigarette smoking and smokeless tobacco use among rural and metropolitan youth during adolescence and young adulthood and (2) assess how the social and tobacco control environments differ in rural and metropolitan areas, and how these account for differences in rates and patterns of smoking among rural and metropolitan youth. Youth in rural areas are hypothesized to show higher rates of initiation and at earlier ages, heavier use patterns, fewer quit attempts, and lower rates of cessation compared to metropolitan youth. Rural youth are further hypothesized to report higher levels of smoking among their social networks, greater social acceptability of smoking, greater access to tobacco, and exposure to fewer tobacco control policies than youth in metropolitan areas and that these factors will relate to heavier patterns of use among rural youth. We will also examine if factors associated with differences in rates of tobacco use among rural and metropolitan youth are comparable in a large diverse sample of youth from Florida. We hypothesize that the factors associated with differences in rates of smoking among rural and metropolitan youth in Minnesota will be comparable in Florida. The proposed approach is innovative because it includes a repeated measures design with a large sample of youth from rural and metropolitan areas, along with detailed and frequent data about tobacco use behaviors from adolescence to young adulthood, as well as links between behavior and a multitude of social factors that may affect tobacco use and cessation among rural youth. The proposed project is expected to advance our understanding of tobacco-related disparities among rural youth by providing a detailed understanding of factors associated with tobacco disparities in rural youth that have been observed in cross-sectional studies. Importantly, the proposed project will provide an evidence base for designing effective interventions aimed at reducing tobacco use in rural populations.

Public Health Relevance

The proposed research will characterize important differences in smoking between rural and metropolitan youth that contribute to tobacco-related disparities in rural communities. The results are expected to aid in the development of effective interventions for reducing tobacco use, and ultimately tobacco-related morbidity and mortality, in rural communities. The proposed research is relevant to NCI's mission to reduce health disparities in cancer.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Small Research Grants (R03)
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Special Emphasis Panel (ZCA1-SRLB-B (O1))
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Kaufman, Annette R
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University of Maryland College Park
Public Health & Prev Medicine
Schools of Public Health
College Park
United States
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Bernat, Debra H; Choi, Kelvin (2018) Differences in Cigarette Use and the Tobacco Environment Among Youth Living in Metropolitan and Nonmetropolitan Areas. J Rural Health 34:80-87
Choi, Kelvin; Grana, Rachel; Bernat, Debra (2017) Electronic Nicotine Delivery Systems and Acceptability of Adult Cigarette Smoking Among Florida Youth: Renormalization of Smoking? J Adolesc Health 60:592-598
Choi, Kelvin; Bernat, Debra (2016) E-Cigarette Use Among Florida Youth With and Without Asthma. Am J Prev Med 51:446-53
Bellatorre, Anna; Choi, Kelvin; Bernat, Debra (2015) The influence of the social environment on youth smoking status. Prev Med 81:309-13