Cigarette smoking rates among veterans: Association with rurality and psychiatric disorders

Abstract

Aims: Compared to the general U.S. population, military veterans and those living in rural areas disproportionately smoke cigarettes at higher rates, leading to increased health consequences. In the current study, prevalence and severity of cigarette smoking in Iraq and Afghanistan era veterans was assessed across rural and urban areas and comorbid mental health disorders. Method: Iraq/Afghanistan era veterans who participated in the Post-Deployment Mental Health study from 2005-2017 (N = 3229) were cross-sectionally assessed for the probability of being a current cigarette smoker based on locality status and psychiatric comorbidity. Multivariate logistic and linear regressions, adjusted for demographic characteristics, were used to model the odds of being a current smoker and the severity of nicotine dependence, respectively. Results: Veterans residing in rural regions, veterans with psychiatric comorbidities, and the interaction of locality and psychiatric disorders were significantly associated with smoking rates. Those veterans living in extremely rural areas and, independently, those living with psychiatric comorbidities were also more severely dependent on nicotine compared to urban veterans and veterans without psychiatric conditions. Conclusions: Rural veterans and veterans with psychiatric comorbidities are at increased risk of smoking and are more severely dependent on nicotine than urban veterans. These findings underscore the need to reduce barriers for treatment both for smoking cessation and mental healthcare for veterans residing in the most rural areas.

Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

“…People in rural and remote areas might experience more problems in accessing and following advice that is relevant to prevention [17], and often have lower educational attainment, poorer health literacy, experience more food insecurity, and have poorer or a higher cost to access healthy foods [18][19][20]. The rates of smoking are higher in rural areas and in people experiencing stress or mental illness [21,22], and the use of services that support quitting smoking has been found to be lower in rural residents [23]. There is a known higher prevalence of risk factors, such as rates of alcohol consumption and obesity in rural Australia [24].…”

Assessing Smoking Status and Risk of SARS-CoV-2 Infection: A Machine Learning Approach among Veterans

“…Recent critiques have argued that studies reporting an inverse correlation between smoking and testing positive have several methodological flaws, such as not having smoking as the primary exposure, low prevalence of smokers in cohorts, lacking explicit data on smoking status, not adjusting for confounders associated with smoking, and unexpectedly low percentages of chronic obstructive pulmonary disease and cardiovascular disease particularly among smokers, indicating potential selection bias [ 45 , 46 ]. Veterans are known to use tobacco products at a higher rate than non-veterans [ 47 , 48 , 49 ]. According to a 2016 report, 32.5% of veterans who served after 2001 are Current Smokers, 24.8% are Former Smokers, and 42.7% are Never Smokers [ 47 ].…”

Associations of tobacco use and consumption with rurality among patients with psychiatric disorders: Does smoke‐free policy matter?

“…Moreover, in a study on tobacco users derived from psychiatric and primary care units in São Paulo, Brazil, it was found that those of male sex and those with PDs were more likely to have greater tobacco dependence 35 . In addition, a study among US veterans demonstrated that those with PDs living in extremely rural areas were more tobacco dependent compared to their urban counterparts without PDs 13 . The scant information on the relationship between different demographic factors and tobacco consumption among rural and urban psychiatric patients necessitates that more studies be conducted to better understand and help this at‐risk population.…”

“…35 In addition, a study among US veterans demonstrated that those with PDs living in extremely rural areas were more tobacco dependent compared to their urban counterparts without PDs. 13 The scant information on the relationship between different demographic factors and tobacco consumption among rural and urban psychiatric patients necessitates that more studies be conducted to better understand and help this at-risk population.…”

“…Little is known as to whether these disproportionate rates are also observed within rural populations with PDs. A recent study among veterans found a significantly increased likelihood of cigarette smoking among rural as compared to urban dwellers, and this relationship was increased for those who had a PD as compared to those without 13 . Thus, more studies are needed to determine if rurality is an important risk factor for tobacco use among those with PDs.…”