Rural residents smoke at higher rates than city dwellers

Smoking is at its lowest level ever, but rural residents smoke far more than their city cousins do, according to a federal report released Tuesday.

About 13.9 percent of U.S. adults were cigarette smokers in 2017, down from 15.8 percent the year before, according to the National Center for Health Statistics.

But 21.5 percent of adults in areas with a population of fewer than 50,000 people were smokers, compared to 11.4 percent of people in metropolitan areas with a population of 1 million or more.

The latest report from one of the Centers for Disease Control and Prevention doesn’t examine reasons behind the overall decline in smoking. But public health researchers credit federal and state laws on cigarettes that have banned flavors, increased taxes and reduced the number of places where people can smoke — shifting cultural attitudes from cigarettes.

Less credit is given to e-cigarettes, which have been marketed as a means to curb tobacco smoking but pose unknown health risks and attract more nonsmoking youths than adult smokers.

“E-cigarettes probably did play a role in the decline in smoking, particularly among kids and young adults, but we can’t really say definitively based on the studies that we’ve seen so far,” said Jidong Huang, a Georgia State University researcher who wasn’t involved in the CDC study. “I think the most important factors are still those tobacco-control policies and hard-hitting media campaigns.”

Healthy People 2020, the U.S. government’s timeline to achieve specific public health measures, seeks to lower the adult smoking figure to 12 percent.

“On the surface, I would say this is, of course, excellent news,” said Robin Koval, CEO of the nonprofit anti-smoking Truth Initiative. “It does continue to support what we have said that the tools that we know absolutely work, making cigarettes more expensive, clean air laws, strong public education programs — like ones we run at Truth are all highly effective.”

However, Ms. Koval found troubling the CDC’s data on more smoking occurring in rural areas.

“In order to reach those goals, we need to be making sure that these policies are in place for everyone,” she said.

In October, the Truth Initiative released a report titled “Tobacco Nation” about how variations in state laws on cigarettes affect smoking.

While federal regulations ban all flavors in cigarettes (except menthol) and imposed a $1.01 tax on cigarette packs, states vary widely on their additional prevention measures.

For example, New York has the highest state tax on cigarettes, $4.35 per pack. In 2015, about 15.2 percent of its residents were smokers.

Meanwhile, Missouri has the lowest cigarette tax, 17 cents per pack, and one of the nation’s highest smoking rates — 22.3 percent.

“There’s a very notable correlation between low cigarette taxes and rate of smoking by adults by state,” said Dr. Robert K. Jackler, the principal investigator for Stanford Research into the Impact of Tobacco Advertising, who wasn’t involved in the latest CDC study. “If you correlate the high tax states, there tends to be lower adult smoking.”

The CDC data also show a decline in smoking among younger adults. In 2017, 14.6 percent of 18- to 44-year-olds were current smokers, compared to 16.8 percent the year before.

Public health researchers fear these trends will be reversed with less regulation of e-cigarettes, which can offer flavors that are banned for conventional cigarettes and can be used in places where cigarettes aren’t allowed.

“Paradoxically in the adult smoker, vapor products are sometimes used to plug the gaps when they can’t smoke those actually discourage quitting,” said Dr. Jackler, a professor of the study of ear, nose and throat diseases at Stanford University.

The CDC report marks the first quarterly analysis of separate results for metropolitan and rural areas, more vigorously tracking trends in health disparities. The latest statistics are published alongside a number of measures of physical and mental health to better understand concerns in different environments.

In general, people in rural areas had a much lower quality of overall health, with higher rates of obesity, diabetes, lack of physical activity and psychological stress. They also were more likely to cite cost as a barrier to obtaining medical care.