(Reuters Health) - - The odds of smoking for U.S. adolescents are 50 percent higher in rural areas than in urban areas, even as rates of teen smoking in both settings have fallen, a recent study found.
Using data from more than 95,600 adolescents who participated in the National Survey of Drug Use and Health, researchers analyzed smoking rates over two periods: 2008-2010 and 2014-2016. Fifteen percent of the youth lived in rural counties.
Teenage smoking in urban areas fell by half from the first period to the second, after accounting for socioeconomic factors such as gender, race, ethnicity and family income. But it only went down by a third in rural places.
"(This could mean) we're going to have larger differences down the road with more people smoking in rural areas than urban areas, and it's going to create a new public health problem that we haven't really had before," Noel Brewer of the University of North Carolina at Chapel Hill, who was not involved in the study, told Reuters Health by phone.
It's not clear from the study why more rural teens smoke. But earlier research has shown that rural youths have easier access to tobacco products, start smoking at younger ages and more often have family members who smoke at home.
"We can't expect that the things we are doing in urban places (will) translate and work in rural communities," lead study author Erika Ziller of the University of Southern Maine in Portland told Reuters Health by phone.
Efforts to reduce smoking "need to pay attention to the rural places as well and really understand how these policies or programs may work or not work as well in rural places," she added.
Prevention efforts such as tobacco-free schools and workplaces, which have been implemented in many urban areas, are less common in rural places, Ziller and colleagues note in the American Journal of Public Health.
Rural attitudes on tobacco consumption may also affect prevention efforts, according to the study. For instance, the authors say, smoking among rural youth is often accepted and supported by adults, some of whom consider the habit a marker of social success.
From 2007 to 2014, cigarette smoking by U.S. adults also declined more rapidly in urban areas, possibly due to greater success of tobacco prevention and cessation programs in those regions, the researchers wrote.
This suggests that rural areas may require tailored anti-smoking interventions that reflect rural norms, the researchers say. They cite, for example, the Down and Dirty anti-smoking campaigns in Virginia and Vermont that are targeted to teens who love the outdoors.
Ziller noted that resources and public health infrastructure in rural areas are modest compared to urban areas, making it harder to implement evidence-based prevention programs.
One limitation of the study is that it does not account for vaping by teens. The study may have to be repeated, said Ziller, noting the surge in teenage use of e-cigarettes.
Ziller and Brewer believe policy changes, such as boosting prices of tobacco products by increasing taxes, could be the most effective way to lower smoking rates.
Restricting sale of cigarettes at rural outlets could also help, said Brewer, adding that it is easier to find stores that sell cigarettes in rural areas than in urban areas.
"Many of the most effective interventions have to do with changing the environment people are in, as opposed to trying to convince them that smoking is bad," said Brewer.
SOURCE: https://bit.ly/2TYIMmt American Journal of Public Health, online March 21, 2019.