Cumulative disadvantage as a framework for understanding rural tobacco use disparities.

Abstract

Traditional tobacco product (cigarettes and smokeless tobacco) and polytobacco use rates are significantly higher among rural adolescents and adults compared to their nonrural counterparts. Such disparities are due to several factors that promote tobacco use initiation and continuation, including individual-level psychopharmacological factors and structural-level factors such as fewer tobacco control efforts (e.g., fewer smoke-free policies and lower tobacco excise taxes), targeted tobacco marketing, less access to healthrelevant resources, and more positive cultural norms surrounding tobacco use in rural communities. In this review, we use cumulative disadvantage theory as a framework for understanding how psychopharmacological and structural-level factors serve as drivers of tobacco use in rural areas. We start by describing how structural-level differences between rural-nonrural communities impact psychopharmacological influences and, when available, how these factors influence tobacco use. We conclude by discussing the interplay between factors, providing suggestions for ways to assess our application of cumulative disadvantage theory empirically and making recommendations for research and policy implementation in rural areas. Public Health SignificanceDespite public health efforts, rural-nonrural disparities for traditional tobacco products (cigarettes and smokeless tobacco) have only widened in recent years. We use cumulative disadvantage theory as a framework for describing the interplay between psychopharmacological and structural-level drivers of tobacco use in rural areas. Based on this framework, we suggest ways to assess our proposed model empirically and make research and policy recommendations for reducing tobacco use in rural areas.

Resilience is an Adverse Event: A Critical Discussion of Resilience Theory in Health Services Research and Public Health

“…We approach this topic as a biracial Black cisgender woman in social work and a Black transgender woman in medicine and epidemiology, writing through our shared lens of Black womanhood and our distinct experiences as both researchers and practitioners. Building upon foundational interventions in health equity such as the social determinants of health, 8 , 9 we apply theories of cumulative disadvantage 10 , 11 to current understandings of resilience. We ultimately advocate for a broadened perspective on resilience that foregrounds collectivist and peer-centered models of survival and healing, rather than an individualized approach to promote coping.…”

Tobacco Use and Cessation among a Nationally Representative Sample of Men in India, 2019–2021

“…The prevalence of tobacco is the highest in the age category 50-64 years across rural and urban areas. For instance, rural-urban differentials in tobacco use have been documented well in the pieces of literature [ 7 , 10 , 27 ].…”

Safety Net Provider Attitudes Toward Smoking Cessation Treatment

“…In addition, a second set of analyses were conducted using Chi-square Test of Independence, which is a non-parametric test appropriate for nominal data (20), to compare the proportion of providers from DHS vs. DMH clinics who responded in agreement to each attitude and belief item. Specifically, for attitude items, responses were coded and dichotomized into "disagree" (0) and "agree" (1), such that raw responses ranging from "strongly disagree" (1) to "neutral" (4) were coded as "disagree, " and raw responses ranging from "slightly agree" (5) to "strongly agree" (7) were coded as "agree." For belief items, responses were coded and dichotomized into "not effective" (0) and "effective" (1), such that raw responses ranging from "not at all effective" (1) to "neutral" (3) were coded as "not effective, " and raw responses ranging from "moderately effective" (4) to "very effective" (5) were coded as "effective."…”

“…While California's regulations and efforts to decrease tobacco use have been successful in the general population, cigarette smoking remains elevated among certain groups. For instance, rural residents of California are more likely to smoke tobacco and have lower cessation rates than those residing in urban areas (4,5). Moreover, individuals at the greatest risk for developing a TUD in California are among those experiencing high levels of stress and racial discrimination, males, certain racial and ethnic groups, and those with lower education, income, employment, and rates of health insurance (4).…”