Cigarette smoking prevalence, nicotine dependence, and quit ratios among U.S. adult females by residence and military-veteran status: 2002-2023.

Objective: Examine nationally representative U.S. data to determine trends in cigarette smoking, nicotine dependence, and quit ratios among females by rurality and veteran status between 2002 and 2023.

Methods: Data were obtained from the 2002-2023 files (N = 454,981) of the National Survey on Drug Use and Health. Adult female respondents were categorized by rural/urban residence and veteran/nonveteran status to examine smoking outcomes across 3-year intervals. To adjust for non-response, selection probability, and post-stratification, analyses were conducted using survey weighted logistic regression models controlling for socio-demographic covariates.

Results: Smoking prevalence was higher among rural versus urban residents (aOR = 1.55, 95 %CI = 1.43, 1.67) and veterans versus nonveterans (aOR = 1.72, 95 %CI = 1.36, 2.17). Nicotine dependence was higher among rural versus urban residents (aOR = 1.84, 95 %CI = 1.66, 2.03) and veterans versus nonveterans (aOR = 1.49, 95 %CI = 1.08, 2.06). Quit ratios were lower in rural versus urban residents (aOR = 0.70, 95 %CI = 0.63, 0.78), but not among veterans (aOR = 0.83, 95 % CI = 0.62, 1.10). Rates of decline over time in smoking prevalence and nicotine dependence, as well as increases in quit ratios, were lower among rural residents (p's < 0.001) whereas changes by veteran status did not interact with time.

Conclusions: Results across 21 years from a nationally representative US survey substantiate a growing rural-urban disparity in smoking that disproportionately impacts rural females. We also identified a disparity that disproportionately impacts veteran compared to nonveteran females. Thus, rural and veteran female populations need targeted treatment interventions.