Study: Smoking rates have declined less among rural teens

Estimates of rural-urban difference in the prevalence of smoking
by high-school seniors, 1996-2021 (University of Minnesota chart)

Overall smoking rates continued to decline among teens from 1998 to 2018, but less so among rural teens, according to a newly published study in The Journal of Rural Health.

Smoking, the primary cause of preventable death, is more common in rural America. Since smokers typically begin the habit during adolescence, the researchers posited that higher smoking rates among rural teens contribute to significant long-term health disparities between rural and urban adults. They recommend that policymakers redouble their efforts to get rural teens to stop smoking or never start, since it could have big ramifications for rural morbidity and mortality rates down the line.

Researchers pulled data from 12th-grader surveys by the U.S. "Monitoring the Future" study from 1998 to 2018. Using the data, they estimated trends in the age of smoking initiation as well as how much the respondents smoke, both now and ever, and compared rural and urban estimates. 

Between 1998 and 2018, rural teens became far more likely than their urban peers to have ever smoked in their lifetimes. In 1998 rural teens were 6.9 percent more likely to have ever smoked, which rose to 13.5% in 2018—among the highest disparity in the past 20 years. 

However, over the past 20 years, the gap narrowed between rural and urban teens who had ever regularly smoked or currently smoke. The gap between rural and urban teens who had ever regularly smoked narrowed from 6.4% to 4.8% in the time period studied, while the gap between rural and urban teens who currently smoke narrowed from 5.5% to 3.0%.