Adult tobacco product use patterns across the urban–rural continuum: The longitudinal Population Assessment of Tobacco and Health (PATH) study, 2016–2023

Authors

• Jing Zhang, University of Kentucky
• Shyanika W. Rose, University of KentuckyFollow
• Ellen J. Hahn, University of KentuckyFollow
• Megan E. Roberts, The Ohio State University
• Bethany Shorey Fennell, University of KentuckyFollow
• Jenny E. Ozga, Westat Behavioral Health and Health Policy Practice
• Seth Himelhoch, University of Chicago
• Saber Feizy, University of KentuckyFollow
• W. Jay Christian, University of KentuckyFollow
• Amanda Thaxton Wiggins, University of KentuckyFollow
• Melissa Abadi, Pacific Institute for Research & Evaluation
• Delvon T. Mattingly, University of KentuckyFollow
• Mary Kay Rayens, University of KentuckyFollow

Abstract

Purpose: To determine the association between adult tobacco/nicotine product use over time and residence location (urban, suburban, town, rural), controlling for demographics.

Methods: Data from Waves 4–7 (2016–2023) of the Population Assessment of Tobacco and Health (PATH) study (N = 18,590 adults) were analyzed using survey-weighted logistic regression to evaluate location and time differences in likelihoods of current, daily, and established use of combustible tobacco, electronic nicotine delivery systems (ENDS), smokeless products, and poly use (≥2 products).

Findings: Compared to those residing in urban locations, suburban residents were less likely to report current (adjusted odds ratio (aOR) = 0.88), daily (aOR = 0.73), and established combustible products use (aOR = 0.77); town residents were more likely to use these products currently (aOR = 1.20) and daily (aOR = 1.42), and rural residents were more likely to use daily (aOR = 1.25) and report established use (aOR = 1.33). Rural residents had a lower likelihood of current ENDS use (aOR = 0.90), compared with those in urban locations. Compared with urban residents, current smokeless products use was more likely among rural residents (aOR = 1.63) and less likely among those in suburban locations (aOR = 0.74). Participants living in suburban (vs. urban) locations were less likely to use ≥2 products currently (aOR = 0.89) or daily (aOR = 0.79), while rural residents were more likely to engage in daily poly use (aOR = 1.39). Time was a significant factor in all models, with fluctuating patterns across waves.

Conclusions: These findings highlight nuanced geographic differences in tobacco/nicotine product use patterns beyond simple urban–rural comparisons, informing efforts to eliminate tobacco/nicotine use disparities.

Document Type

Article

Publication Date

2026

Notes/Citation Information

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2026 The Author(s). The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association.

Digital Object Identifier (DOI)

https://doi.org/10.1111/jrh.70140

Funding Information

the National Institute of Health (NIH), Grant/Award Numbers: U54DA05825601, U54DA046060; Food and Drug Administration; Center for Tobacco Products; National Institutes of Health

Repository Citation

Zhang, Jing; Rose, Shyanika W.; Hahn, Ellen J.; Roberts, Megan E.; Fennell, Bethany Shorey; Ozga, Jenny E.; Himelhoch, Seth; Feizy, Saber; Christian, W. Jay; Wiggins, Amanda Thaxton; Abadi, Melissa; Mattingly, Delvon T.; and Rayens, Mary Kay, "Adult tobacco product use patterns across the urban–rural continuum: The longitudinal Population Assessment of Tobacco and Health (PATH) study, 2016–2023" (2026). Nursing Faculty Publications. 88.
https://uknowledge.uky.edu/nursing_facpub/88