Substantial health disparities exist between rural and urban regions of the US. Adults in rural areas have among the highest smoking rates in the country: consuming more cigarettes and using more smokeless/spit tobacco when compared to their urban counterparts. Rural populations have worse health outcomes and lower cancer survival rates and have been historically underserved by tobacco control programs, lack access to prevention and cessation services and are less likely to have implemented protective tobacco control policies. In addition, rural areas have been treated as homogenous and the differences among these divergent areas have not been adequately researched. A further complication for research is the lack of a consistent definition of what is meant as rural so there are multiple measures of the urban-rural continuum. To assure that limited resources are appropriately targeting subgroups most at risk of smoking-related morbidity and mortality, we propose to develop an innovative methodology to define and measure this urban-rural continuum and apply this as a proof of concept to improve tobacco epidemiology and tobacco control research. Developing better measures will allow for a more comprehensive investigation of cancer risk factors that exist in rural regions. To accomplish this, we propose first to use the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) at the individual level to develop and test an innovative methodology for urban-rural continuum measures. Second, we propose to use selected survey items from the TUS- CPS and link this data at the tract level to other Census data sets to investigate selected underlying factors that can identify specific rural differences. We will convene a panel of rural practitioners and academic experts to provide key stakeholder perspectives to validate and elucidate the findings. This innovative methodology will advance cancer research in an understudied topic and help explore differences in tobacco use across rural regions and populations.

Public Health Relevance

Rural residents face fewer tobacco control regulations than urban counterparts and rural tobacco use rates are significantly higher than urban rates, with direct linkages to poorer health outcomes. This project will examine government and methodological categorizations of rural isolation and apply the refined measures to improve the targeting of rural subgroups most at risk of smoking-related morbidity and mortality. Results will strengthen research methodology and inform public health campaigns and tobacco control policy and regulatory efforts, reducing the burden of tobacco-attributable diseases among rural populations.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZCA1-SRB-X (J1))
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Hartman, Anne
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National Opinion Research Center
Other Domestic Non-Profits
United States
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Doogan, Nathan J; Roberts, Megan E; Wewers, Mary Ellen et al. (2018) Validation of a new continuous geographic isolation scale: A tool for rural health disparities research. Soc Sci Med 215:123-132