Disparities in Rural Tobacco Use, Smoke-Free Policies, and Tobacco Taxes.
Kelly Buettner-Schmidt, Donald R Miller, Brody Maack
PMID 30774036WHAT IT FOUND
Rural US residents smoke more, face higher secondhand smoke exposure, and live under weaker smoke-free laws and lower tobacco taxes than urban residents.
A state-level analysis found higher ruralness correlates with lower cigarette tax rates.
Key findings
01Rural smoking rates are higher than urban rates, with one analysis finding 25.1% in rural counties versus 19% overall.
02State cigarette tax rates negatively correlate with ruralness, meaning more rural states tend to have lower taxes.
03Rural populations are exposed to more secondhand smoke than urban populations.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a narrative review, not a systematic review, so the selection of studies was not exhaustive or strictly protocolized. The original correlation analysis is ecological, comparing state-level tax rates to state-level rural percentages, so it cannot infer individual-level behavior. Definitions of 'rural' vary across the cited studies, which may affect comparability.
Declared interests
The authors declared no conflicts of interest and received no financial support.
The easy way to misread this
Do not interpret the negative correlation between ruralness and tobacco taxes as evidence that raising taxes in rural states will automatically reduce smoking without considering political and social barriers. The review notes that rural areas often have stronger resistance to such policies due to cultural and economic ties to tobacco.