Tobacco use remains the leading cause of death and disease in the United States, accounting for more than 440,000 deaths each year. In spite of years of effort by federal, state and local public health agencies and advocates, residents of rural communities are more likely to use tobacco products, to start at a younger age, to use more heavily and to be exposed to secondhand smoke at work and at home than their counterparts in cities and suburbs. Tobacco use is deeply rooted in the social environment in many rural communities, not only harming the health and well-being of the current generation, but also perpetuating a cycle that threatens future generations. Many of the factors that are known to promote tobacco use among children and adults are at work in rural counties and small towns. The tobacco industry has targeted young rural men, especially smokeless tobacco users, with appealing imagery of rugged individualism. State and local governments serving large segments of the rural population have been less likely to enact the kinds of policies that have reduced tobacco use elsewhere, such as increasing excise taxes and eliminating exposure to secondhand smoke in workplaces and other public venues. Rural youth are more likely to be surrounded by role models who are tobacco users, and are less likely to hear anti-tobacco messages in the media. And people living in rural areas who are ready to quit often find they have few resources available to help them.
The United States has made great progress in reducing overall tobacco use over the past several decades, but some parts of our society bear a disproportionate burden of tobacco use and tobacco-related illness. People living in rural communities are more likely to use tobacco and have especially high rates of smokeless 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.
The American Lung Association’s latest health disparity report, “Cutting Tobacco’s Rural Roots: Tobacco Use in Rural Communities,” examines the prevalence of tobacco addiction and exposure to secondhand smoke in rural America, particularly among rural youth.
Tobacco use is higher in rural communities than in suburban and urban communities, and smokeless tobacco use is shockingly twice as common. Rural youth are more likely to use tobacco and to start earlier than urban youth, perpetuating the cycle of tobacco addiction and death and disease.
“Tobacco use is often accepted as a social norm in rural areas, making it more likely that rural youth will view it as acceptable and more likely that they will become tobacco users themselves,” said Ross P. Lanzafame, Chair of the Board of the American Lung Association. “Community leaders and residents need to take a stand against the culture of tobacco use as part of life and empower their future generations to have healthy, tobacco-free lives.”
There are a number of environmental and social factors that contribute to this generational cycle of tobacco use among youth and adults in rural America.
Increased tobacco use is associated with lower education levels and lower income, which are both common in rural areas where there may be fewer opportunities for educational and economic advancement. Exposure to secondhand smoke is also higher as rural communities are less likely to have smokefree air laws in place and less likely to have voluntary restrictions on smoking indoors.
For decades, the tobacco industry has used rural imagery, such as the Marlboro Man, to promote its products and appeal to rural audiences. Over the past several years, the tobacco industry’s marketing of smokeless tobacco products has skyrocketed. Sadly as the tobacco industry spends millions of dollars targeting rural youth, these youth are less likely to be exposed to tobacco counter-marketing campaigns. Rural tobacco users are also less likely to have access to tobacco cessation programs and services to get the help they need to quit.
Many rural states have low tobacco taxes. Raising tobacco prices is a proven strategy to reduce tobacco use. Promotion of the availability of state counseling services by phone and online resources also lags.
The American Lung Association is calling on government agencies, the research and funding community, health systems and insurers, community leaders, schools and families to take steps now to cut tobacco’s rural roots. “The rural community clearly requires special attention if we hope to end the epidemic of tobacco use in this country. We must all work together as neighbors to overcome this health disparity,” said Kimberly Horn, Ed. D., Associate Dean of Research, The George Washington University School of Public Health and Health Services.
In addition to expanding the Lung Association’s capability to provide its programs and services to the rural community, there are also several other action steps to reduce rural tobacco use. These steps are detailed in the full report, and include that state and federal tobacco control programs must make a concerted effort and dedicate funding to reach rural communities; the research community should focus attention and resources on identifying effective cessation treatments for smokeless tobacco use; and school, health and employment systems in rural areas must all implement effective tobacco control strategies including smokefree air policies and access to cessation services.