Smoking prevalence and trends among a U.S. national sample of women of reproductive age in rural versus urban settings

Abstract

U.S. smoking prevalence is declining at a slower rate in rural than urban settings and contributing to regional health disparities. Cigarette smoking among women of reproductive age is particularly concerning due to the potential for serious maternal and infant adverse health effects should a smoker become pregnant. The aim of the present study was to examine whether this rural-urban disparity impacts women of reproductive age (ages 15–44) including pregnant women. Data came from the ten most recent years of the U.S. National Survey on Drug Use and Health (2007–2016). We estimated prevalence of current smoking and nicotine dependence among women categorized by rural-urban residence, pregnancy status, and trends using chi-square testing and multivariable modeling while adjusting for common risk factors for smoking. Despite overall decreasing trends in smoking prevalence, prevalence was higher among rural than urban women of reproductive age overall (χ2(1) = 579.33, p < .0001) and among non-pregnant (χ2(1) = 578.0, p < .0001) and pregnant (χ2(1) = 79.69, p < .0001) women examined separately. An interaction between residence and pregnancy status showed adjusted odds of smoking among urban pregnant compared to non-pregnant women (AOR = .58, [.53 –.63]) were lower than those among rural pregnant compared to non-pregnant women (AOR = 0.75, [.62 –.92]), consistent with greater pregnancy-related smoking cessation among urban pregnant women. Prevalence of nicotine dependence was also higher in rural than urban smokers overall (χ2(2) = 790.42, p < .0001) and among non-pregnant (χ2(2) = 790.58, p < .0001) and pregnant women examined separately (χ2(2) = 63.69, p < .0001), with no significant changes over time. Associations involving residence and pregnancy status remained significant in models adjusting for covariates (ps < 0.05). Results document greater prevalence of smoking and nicotine dependence and suggest less pregnancy-related quitting among rural compared to urban women, disparities that have potential for direct, multi-generational adverse health impacts.

Trends in smoking during pregnancy by socioeconomic characteristics in the United States, 2010–2017

“…A Canadian study showed that trends in maternal smoking during pregnancy were not consistent across groups with different educational backgrounds [5]. In addition, a 2007-2016 US study found higher smoking prevalence among rural women of reproductive age compared to their urban counterparts [6]. The results of another US study suggest that women who were aged 20-24, American Indian/Alaska Natives, high school educated or less, and had Medicaid coverage had the highest prevalences of smoking before, during, and after pregnancy [7].…”

“…There is evidence that smoking cessation after becoming pregnant is associated with a reduced risk of preterm birth [8]. In past research, women who were younger than 20, Asian/Pacific Islander, had more than 12 years of education, had private insurance, and lived in urban areas were most likely to quit smoking during pregnancy [6,7]. However, despite a recent increase in prenatal quitting rates, only half of women quit smoking during pregnancy [4].…”

Low Burden Strategies Are Needed to Reduce Smoking in Rural Healthcare Settings: A Lesson from Cancer Clinics

“…Public health surveillance has identified geographical differences in smoking prevalence as well as smoking-related morbidity of 11 and mortality between urban and rural populations [4][5][6][7][8]. Rural populations have significantly higher prevalence of smoking compared to their urban counterparts [4,5] and consume a higher number of cigarettes per day [6]. Additionally, despite an overall reduction in cancer diagnoses [7], rural populations experience a higher likelihood of lung cancer diagnosis and death than urban populations-a pattern likely tied to the elevated prevalence of smoking in rural settings [3].…”

Smoke-Free Moms: Financial Rewards for Smoking Cessation by Low-Income Rural Pregnant Women

“…4 Women's smoking rates overall, and in pregnancy, have slowly declined and rural and lower-income women continue to have higher rates of smoking and lower quit rates in pregnancy. [5][6][7] In addition national birth certificate data from 2014 shows 10.1% women smoked just prior to pregnancy and 8.4% reporting smoking in pregnancy. Of these smokers in pregnancy about one in five women had quit between the first and third trimester.…”

“…Of these smokers in pregnancy about one in five women had quit between the first and third trimester. 6 Pregnancy can serve as a catalyst for mothers to change health behaviors to benefit their child. 8 Mothers alter diet, alcohol, and tobacco use in response to being pregnant.…”