Cigarette Smoking More Prevalent – and Harder to Quit – Among Rural vs. Urban Americans

Cigarette smoking is more prevalent among Americans residing in rural areas and they also have a more difficult time quitting smoking than urban residents, according to a study involving Rutgers researchers.

The study, published in JAMA Network Open, found smoking prevalence was higher in rural than urban areas – 19.2 percent versus 14.4 percent. While the number of smokers quitting in 2020 was similar in both rural and urban areas – 52.9 percent compared with 53.9 percent – the odds of quitting between 2010 and 2020 were 75 percent lower in rural areas compared with urban areas.

“Higher cigarette smoking prevalence and lower cessation in rural populations have led to higher rates of smoking-attributable cancer incidence and death in rural, compared with urban residents,” said Andrea Villanti, coauthor of the study, associate professor in the Department of Health Behavior, Society and Policy at the Rutgers School of Public Health and deputy director of the Rutgers Center for Tobacco Studies. “Tobacco cessation, therefore, is a high-impact target for cancer prevention efforts in rural populations.”

The study used data from the U.S. Department of Health and Human Services’ 2010–2020 National Survey on Drug Use to analyze adults who had smoked at least 100 cigarettes in a lifetime, which they defined as lifetime cigarette smoking. Current smoking was defined as smoking one or more cigarettes in the past month and former smoking as no cigarettes in the past year. Overall and annual quit ratios were estimated as proportions of former smokers among lifetime smokers.

The researchers found that of the 161,348 lifetime cigarette smokers analyzed, 33.5 percent were former smokers.

According to the researchers, the findings support the existence of a persistent rural/urban disparity, possibly attributed to the fact that rural residents may face more barriers to using smoking cessation services than urban residents or may be in an earlier stage of motivation to quit.

They suggest smoking intervention at the clinical setting, health system or population level might improve reach and sustainability of cessation services for rural residents. Tobacco cessation resources, including telephone quit lines and telehealth counseling could also reduce barriers to accessing tobacco treatment in rural residents.

The study team was led by Indiana University and included researchers at Yeshiva University.