Abstract

Purpose: Tobacco retailer density is a key correlate of tobacco use prevalence in the United States, but this relationship has typically been examined in urban areas. We examined the relationship between retailer density and tobacco use across Kentucky counties, a state with high smoking rates and a substantial rural population.

Methods: We obtained a list of tobacco retailers from the 2021 Kentucky Synar program, used for minor’s access inspections. We merged these data with county-level prevalence estimates for cigarette and smokeless tobacco use for each county in Kentucky, calculated using pooled 3-year estimates (2017-2019) of Kentucky Behavioral Risk Factor Surveillance System data. We modeled county-level frequency of each outcome among adults as a function of tobacco retailer density and the Index of Relative Rurality, and interactions using ANCOVA, controlling for county percent of adult population and percent with an advanced degree.

Findings: We observed significant interactions between retailer density and rurality for both cigarette and smokeless tobacco use. Post-hoc protected pairwise comparisons demonstrated that within the 40 most urban counties, cigarette and smokeless tobacco use were significantly higher among counties with the highest retailer density, compared to low-density counties. Retailer density was not associated with the prevalence of cigarette and smokeless tobacco use within the 2 more rural tertiles of counties.

Conclusions: Consistent with prior research, policies limiting tobacco retailer density could be most beneficial in urban and urban-adjacent areas, while other policies may need to be considered for rural areas, even within a relatively rural state such as Kentucky.

Document Type

Article

Publication Date

2026

Notes/Citation Information

© 2025 National Rural Health Association.

Digital Object Identifier (DOI)

https://doi.org/10.1111/jrh.70106

Funding Information

Research reported in this publication was supported by grant R01CA251478 from the National Cancer Institute and U54DA05825601 from the National Institute of Health (NIH) and the Food and Drug Administration (FDA) Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the U.S. Food and Drug Administration.

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