Unveiling rural and Appalachian disparities in cigarette smoking through the social vulnerability index and other county-level characteristics

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2024-06-20 DOI:10.1111/jrh.12860

Asal Pilehvari PhD, Rebecca A. Krukowski PhD, Wen You PhD, Kara P. Wiseman PhD, Abigail G. Wester MPH, Wendy F. Cohn PhD, Roger T. Anderson PhD, Melissa A. Little PhD

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Abstract

Purpose

Mitigating tobacco-related disparities in the Appalachian region and rural areas is crucial. This study seeks to gauge cigarette smoking prevalence in Virginia counties, uncover rurality and Appalachian-linked disparities, and explore local drivers of these gaps.

Method

A 2011-2019 Virginia BRFSS data were used to estimate county-level cigarette smoking rates in adults aged 18 or older. Counties were categorized as urban/rural and Appalachian/non-Appalachian, with a focus on rural-Appalachian. Disparities in cigarette smoking rates and associated factors were analyzed via the Blinder-Oaxaca decomposition method. The study assessed 4 dimensions of the Centers for Disease Control and Prevention's social vulnerability index (SVI): socioeconomic, minority status, household composition, and housing. Additionally, county-specific factors such as tobacco agriculture, physician availability, coal mining, and tobacco retailer density were examined.

Findings

Rural areas exhibited a 6.18% higher cigarette smoking prevalence compared to urban areas (P<.001). SVI dimensions accounted for 53.2% of the disparity, county features explained 16.4%, and 30.4% remained unexplained. Appalachian areas had a 6.79% higher cigarette smoking prevalence than non-Appalachian areas (P<.001). SVI dimensions explained 51.4% of the disparity, county features accounted for 21.8%, leaving 26.8% unexplained. Rural-Appalachian areas showed a 7.8% higher cigarette smoking prevalence (P<.001). SVI dimensions contributed to 51.7% of the disparity, county features explained 9.6%, and 38.7% remained unexplained.

Conclusions

Substantial disparities in cigarette smoking prevalence exist in underserved areas of Virginia, including rural, Appalachian, and rural-Appalachian regions. While SVI dimensions, physician availability, tobacco agriculture, and coal mining contribute, yet notable gaps remain unexplained. Targeted interventions must tackle unique challenges in disadvantaged areas to reduce smoking and promote health equity.

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通过社会脆弱性指数和其他县级特征揭示农村和阿巴拉契亚地区在吸烟方面的差异

目的缩小阿巴拉契亚地区和农村地区与烟草相关的差距至关重要。本研究旨在估测弗吉尼亚州各县的卷烟吸烟率，揭示与农村和阿巴拉契亚地区相关的差异，并探讨造成这些差距的当地驱动因素。方法使用2011-2019年弗吉尼亚州BRFSS数据估算18岁及以上成年人的县级卷烟吸烟率。县被分为城市/农村和阿巴拉契亚/非阿巴拉契亚两类，重点是阿巴拉契亚农村地区。通过布林德-瓦哈卡分解法分析了吸烟率的差异及相关因素。研究评估了美国疾病控制和预防中心的社会脆弱性指数（SVI）的四个方面：社会经济、少数民族地位、家庭组成和住房。此外，还考察了烟草农业、医生可用性、煤矿开采和烟草零售商密度等县域特定因素。研究结果与城市地区相比，农村地区的吸烟率高出 6.18%（P< .001）。53.2% 的差异是由 SVI 维度造成的，16.4% 是由县域特征造成的，还有 30.4% 的差异无法解释。阿巴拉契亚地区的吸烟率比非阿巴拉契亚地区高 6.79%（P< .001）。SVI维度解释了51.4%的差异，县域特征占21.8%，还有26.8%无法解释。阿巴拉契亚农村地区的吸烟率高出 7.8%（P< .001）。结论在弗吉尼亚州服务不足的地区，包括农村、阿巴拉契亚和阿巴拉契亚农村地区，吸烟率存在巨大差异。虽然SVI因素、医生的可用性、烟草农业和煤矿开采都有影响，但明显的差距仍未得到解释。有针对性的干预措施必须解决贫困地区面临的独特挑战，以减少吸烟和促进健康公平。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.