Examining rural disparities in cigarette smoking among U.S. women by chronological age: 2002-2022.

Objective: This study investigated rural disparities in cigarette smoking among U.S. women by age (18-65+ years) across survey years (2002-2022).

Methods, data source: Data came from the National Survey on Drug Use and Health. Women were categorized by rural-urban residence and age. We examined associations between residence, age, and time on current-smoking prevalence and quit ratios in two-year bins using weighted logistic-regression adjusting for race/ethnicity, education, annual income.

Results: Effects of residence on current-smoking prevalence interacted with time (t[df = 430,180] = 4.51, P < .001), with reductions over time among urban (AOR = 0.95, 95 %CI: 0.94-0.96, P < .001) but not rural residents (AOR = 0.99, 95 %CI: 0.98-1.01, P = .66). Residence interacted with age (t[df = 430,180] = -4.90, P < .001), with greater smoking among rural women in younger (AORs≥1.23, 95 %CI: 1.01-1.44, Ps ≤ 0.008), but not older age brackets (AORs ≤1.04, 95 %CI: 0.74-1.35, Ps ≥ 0.688). Rural residence predicted lower odds of quitting smoking (AOR = 0.80, 95 %CI: 0.71-0.91, P < .001).

Conclusions: There is a growing disparity in smoking prevalence that disproportionately impacts rural women ages 18-49 years raising concerns about multigenerational adverse effects as this demographic is most likely to be pregnant or parenting young children. There is also a rural disparity in quitting smoking across age groups underscoring a need for greater access to smoking-cessation services among rural women.