Teenage smoking declines more slowly in rural areas of the United States

(Reuters Health) – Smoking odds among US teens are 50% higher in rural than in urban areas, although teen smoking rates have declined in both settings, a recent study found .

Using data from more than 95,600 adolescents who participated in the National Survey on Drug Use and Health, researchers badyzed smoking rates over two periods: 2008-2010 and 2014-2016. Fifteen percent of the youth lived in rural counties.

Teenage smoking in urban areas declined by half from the first to the second period, taking into account socioeconomic factors such as gender, race, ethnicity and family income. But it has only decreased by a third in rural areas.

"(This could mean) we will have bigger differences on the road with more people smoking in rural areas than in urban areas, and this will create a new public health problem that we have not had. not really had it before, "Noel Brewer of the University of North Carolina at Chapel Hill, who did not participate in the study, told Reuters Health by phone.

The study does not explain why more teenagers in rural areas smoke. But previous research had shown that young people in rural areas had easier access to tobacco products, started to smoke at a younger age and more often had family members who smoked at home.

"We can not expect what we do in urban areas to translate and work in rural communities," Reuters Health reported on the phone, lead author of the study, Erika Ziller of the United States. University of Southern Maine in Portland.

Efforts to reduce smoking "also need to pay special attention to rural areas and to understand how these policies or programs may or may not work in rural areas," she added.

Prevention efforts such as schools and tobacco-free workplaces, which have been implemented in many urban areas, are less common in rural areas, notes Ziller and colleagues in the American Journal of Public Health.

Rural attitudes towards tobacco use may also affect prevention efforts, according to the study. For example, the authors say, smoking among rural youth is often accepted and supported by adults, some of whom view the habit as a marker of social success.

From 2007 to 2014, cigarette smoking among American adults also declined more rapidly in urban areas, likely because of the increased success of smoking prevention and smoking cessation programs in these areas, the researchers wrote.

This suggests that rural areas may require tobacco control interventions tailored to rural standards, according to the researchers. They cite, for example, the Down and Dirty anti-smoking campaigns in Virginia and Vermont that target teens who enjoy the outdoors.

Ziller noted that public health resources and infrastructure in rural areas are modest relative to urban areas, making it more difficult to implement evidence-based prevention programs.

One of the limitations of the study is that it does not take into account teenage vaping. The study may need to be repeated, Ziller said, highlighting the skyrocketing use of e-cigarettes by teens.

Ziller and Brewer believe that policy changes, such as increasing the prices of tobacco products by raising taxes, could be the most effective way to reduce smoking rates.

Restricting the sale of cigarettes in rural stores could also help, Brewer said, adding that it is easier to find shops selling cigarettes in rural areas than in urban areas.

"Many of the most effective interventions relate to changing the environment in which people find themselves, instead of trying to convince them that smoking is bad," Brewer said.

SOURCE: bit.ly/2TYIMmt American Journal of Public Health, posted on March 21, 2019.