Does Tobacco Use Differ by Metropolitan Status in Young Adults Ages 18-24?

Purpose: Prior research shows conflicting findings for the relationship between tobacco use and metropolitan status. The purpose of this study is to determine whether tobacco use, including smoking and chewing tobacco, differs by metropolitan status among young adults ages 18-34 years old. Methods: This is a cross sectional analysis using 2016 BRFSS data for Florida (N=752), Michigan (N=182), New York (N=1112), and Washington (N=285). Ordered logistic regression was performed for combined state data to assess patterns in relationships between tobacco use and metropolitan status while controlling for demographic and socioeconomic factors, health status, and alcohol use. Results: Across states, most people reported no tobacco use (77%), about one-fifth reported only smoking tobacco (19%), and very few people reported only chewing tobacco (3%) or both chewing and smoking tobacco (2%). For metropolitan status, about one-quarter reported living in a urban area (26%) and about one-third reported living in a suburban area (39%) or rural area (34%). The results of the adjusted analysis indicated that each successive level of tobacco use was moderately related to living in a rural or suburban area and highly related to alcohol use. Conclusion: The results of this study indicate that each successive level of tobacco use is moderately related to living in a suburban and rural area, compared to living in an urban area, and to alcohol use in young adults ages 18-34 years old. For primary care providers, it is recommended to screen for tobacco and alcohol use in all young adults, especially those living in rural and suburban communities. Clinicians should provide education for substance use and resources for substance abuse programs as needed.