Smoking and Tobacco Use in Rural Populations

Rural communities account for about 90 percent of the land area in the United States and about 19.3 percent of the total population (U.S. Census Bureau, 2010opens in new window). Compared to their urban counterparts, rural communities have higher rates of preventable diseases, such as obesity, diabetes and cancer, and higher rates of risky health behaviors, such as smoking, physical inactivity, poor diet and inadequate use of seat belts (Eberhardt & Pamuk, 2004opens in new window; Hartley, 2004opens in new window). America’s rural population is more likely to use tobacco especially smokeless tobacco and is more heavily impacted by tobacco use. Rural Americans are also more likely to be exposed to secondhand smoke and less likely to have access to programs that help them quit smoking (American Lung Association, 2012opens in new window).

• Rural populations are more likely to be uninsured, have limited access to care, have fewer available health care providers,and have limited transportation options which pose barriers for rural residents to see their health provider on a regular basis (Eberhardt & Pamuk, 2004opens in new window).  
• The use of remote monitoring and reinforcement of smoking abstinence may enhance the accessibility and acceptability of cigarette smoking abstinence reinforcement programs, particularly in rural areas where transportation can be unreliable and treatment providers are distant (Stoops WW, Dallery J, Fields NM, Nuzzo PA, et al, 2003).
• Among rural medically underserved worksite participants, educational interventions can increase knowledge regarding the dangers of tobacco use and secondhand smoke exposure. Among current tobacco users, these interventions also increase family rules regarding secondhand smoke exposure in their homes and vehicles (Scott, Las Sala, Lyndaker, Neil-Urban, 2016opens in new window).
• For rural providers, consistent, strong curricula education at all health provider levels and continuing education for new and more effective strategies is essential to empower health care providers to address smoking cessation interventions consistently and effectively (Scott,  Las Sala, Lyndaker, Neil-Urban, 2013).
• Rural, low-income women attempting to stop smoking benefit from social support systems that exist within the smoker's social networks in lieu of social support interventions that offer support through more distant resources (telephone, internet, professional visits, etc.) (Mitchell, Kneipp, & Giscombe, 2015).
• Smoking in rural low-income women carries social stigma, which increases their social isolation. Social isolation connected to the stigma of smoking may decrease their opportunity to engage with community members and resources that facilitate the desire and ability to stop smoking (Mitchell, 2016).
  

Acknowledgments: This fact sheet has been made available through funding from the Agency for Healthcare Research and Quality (AHRQ).