Smoking risk among adolescents varies between disadvantaged rural and urban communities

Teenagers in deprived areas are more likely to smoke, but this depends on whether they live in rural or urban areas.

A new study from the University of Michigan highlights a stark rural-urban gap in teen health. It reports that the association between neighborhood disadvantage and cigarette use appears only in rural areas. Adolescents in poor rural areas are more likely to smoke cigarettes than their peers in less deprived rural areas.

These results suggest that urban areas may present different social impacts.

In rural areas, adults smoke at higher rates and quit at lower rates. That environment may reduce the perceived risk of smoking for teens.”

Joy Jang, assistant research scientist at the U-M Institute for Social Research

published in Journal of Studies on Alcohol and Drugs And funded by the National Institute on Drug Abuse, the study analyzed data from the Monitoring the Future study.

Jang and colleague Megan Patrick, ISR research professor and MTF principal investigator, also examined how neighborhood socioeconomic environment relates to binge drinking and cannabis use among American adolescents.

“We found that neighborhood context plays an important role in adolescent substance use, although their relationships vary by substance type and the broader context of urbanicity,” Jung said. “Cigarette use increased with neighborhood disadvantage, but the pattern was not the same everywhere.”

The researchers said the study did not directly test the mechanisms, but the pattern is consistent with weaker tobacco control policies and more permissive smoking norms in rural communities.

With regard to binge drinking, the likelihood decreased as neighborhood disadvantage increased, regardless of urbanization, but this link was driven by family socioeconomic status, measured through parental education as a proxy.

“The findings suggest that both neighborhood context and family resources matter,” Jung said. “Prevention efforts must address both.”

urban cannabis difference

Cannabis use showed a different pattern. Adolescents in urban areas were more likely to use cannabis, regardless of neighborhood disadvantage. The findings match today’s cannabis laws and access.

“Urban teens may be at particular risk for cannabis use due to changes in the regulatory landscape and the increasing presence of cannabis retailers in their neighborhoods,” Patrick said.

Patrick and Jang said their findings have long-term implications for public health. Greater cigarette use by adolescents in deprived rural areas and greater cannabis use in urban areas may reinforce health disparities in adulthood. He said targeted, location-based prevention strategies are needed.

“This study shows that neighborhood conditions are associated with substance use in different ways and we need to pay attention to where teens live and what they are experiencing,” Patrick said. “Understanding these patterns can help policymakers and communities design more effective interventions and target prevention resources where they are most needed.”

According to the authors, more research is needed to identify mechanisms linking neighborhood contexts to substance use and to understand how the adolescent environment influences substance use in adulthood.