Title : Rural-urban disparity in the use of tobacco products and marijuana, the belief of emerging tobacco to quit smoking, and the technology use
Abstract:
Background: Emerging tobacco products, particularly e-cigarettes and nicotine pouches, witness a rapid rise in the United States and globally. While rural residents were reported to have disproportionately higher risk for traditional tobacco and marijuana use separately, no research has been done to examine the rural and urban difference in the co-use of the emerging tobacco products and marijuana. Also, population level data was lacking in examining the rural-urban difference in the belief of emerging tobacco products as cigarette quitting method, telehealth utilization, and digital literacy skills.
Objective: we used the nationally representative sample of the Health Information National Trends Survey (HINTS7) to examine the rural urban difference in emerging tobacco and marijuana concurrent use, belief of emerging tobacco to quit smoking, telehealth use, and digital literacy skills.
Methods: Weighted Rao-Scott Chi-square test was used to compare the co-use status of emerging tobacco and marijuana use, belief of emerging tobacco to quit smoking, telehealth use, and health-related technology use between rural and urban areas. The emerging tobaccos included e-cigarettes, nicotine pouches, and modified risk tobacco. Rural-urban classification was done using RUCC 2023.
Results: Of the 7,278 US adult sample, 92% reported ever use of tobacco, including 5.1% ever used e-cigarettes, 0.8% used nicotine pouches, and 0.3% used modified risk tobacco products only. As compared to urban residents, higher percentage of rural residents ever used single emerging tobacco products (4.9% vs. 3.5%), while lower percentage of rural residents ever co-used marijuana and single (2.1% vs. 2.5%) or multiple tobacco products (5.9% vs. 7.2%). Similar results are shown for current use of those products and/or marijuana. Rural were less likely to believe that using multiple emerging tobacco could help quit cigarettes (5.1% vs. 9.2%, p = 0.004) or to receive care using telehealth (26.2% vs. 36.9%, p<0.001). Contrastingly, rural residents tended not to use social media (19.4% vs. 16.7%, p=0.013) and to believe the information from social media is false or misleading (33.1% vs. 29.7%).
Conclusions: Rural-urban differences were presented in single and co-use of emerging tobacco and marijuana, the perception of emerging tobacco products for quitting cigarettes, and use of technology in healthcare and health information in the US adult population, indicating that appropriate health policies should be tailored to specific rural and urban populations to reduce health disparities related to emerging tobacco products.
