Examining U.S. disparities in smoking among rural versus urban women of reproductive age: 2002–2019

Objective

This study is part of a programmatic investigation of rural disparities in cigarette smoking examining disparities in smoking prevalence and for the first-time quit ratios among adult women of reproductive age (18–44 years), a highly vulnerable population due to risk for multigenerational adverse effects.

Methods

Data came from 18 years (2002–2019) of the U.S. National Survey on Drug Use and Health (NSDUH) among women (n = 280,626) categorized by rural-urban residence, pregnancy status, using weighted logistic regression models testing time trends and controlling for well-established sociodemographic predictors of smoking (race/ethnicity, education, income). Concerns regarding changes in survey methods used before 2002 and after 2019 precluded inclusion of earlier and more recent survey years in the present study.

Results

Overall smoking prevalence across years was greater in rural than urban residents (adjusted odds ratio [AOR] = 1.11; 95%CI, 1.07–1.15; P < .001) including those not-pregnant (AOR = 1.10; 1.07–1.14; P < .001) and pregnant (AOR = 1.29; 1.09–1.52; P < .001). Overall quit ratios across years were lower in rural than urban residents (AOR = 0.93; 0.87–0.99; P < .001) including those not-pregnant (AOR = 0.93; 0.88–1.00, P = .035) and pregnant (AOR = 0.78; 0.62–0.99; P = .039). Interactions of rural versus urban residence with study years for prevalence and quit ratios overall and by pregnancy status are detailed in the main text.

Conclusions

These results support a longstanding and robust rural disparity in smoking prevalence among women of reproductive age including those currently pregnant and provides novel evidence that differences in smoking cessation contribute to this disparity further underscoring a need for greater access to evidence-based tobacco control and regulatory interventions in rural regions.