Rural Americans — including those living in rural Minnesota — are more likely to use tobacco than their urban counterparts, especially smokeless tobacco, according to a report released Wednesday by the American Lung Association.
They’re also more likely to start using tobacco products at an earlier age, to use those products more heavily, to smoke throughout pregnancy, and to be exposed in their homes and workplaces to secondhand smoke. But they are less likely to have access to information and programs to help them stop their addiction to nicotine.
“It’s depressing considering all the progress we’ve had over the years bringing down the adult smoking rate,” said Robert Moffitt, communications director for the American Lung Association in Minnesota, in a phone interview Wednesday.
Tobacco is the leading cause of preventable illness and death in the United States, killing 440,000 Americans each year. Tobacco also asserts a huge financial burden on the country, costing $200 billion annually in direct medical expenses and lost productivity.
What the report found
Specifically, the report found that 27.8 percent of rural Americans use tobacco products, compared to 22.7 percent of the residents of urban areas. That may not seem like a huge difference — until you poke deeper into the numbers and look at the statistics for particular demographics, like pregnant women, Native Americans, young adults, teens and children.
Here are some of the more disturbing statistics from the report:
- Pregnant women: 27.4 percent of pregnant women in rural areas smoke throughout pregnancy, compared to 11.2 percent of expectant moms living in urban areas. In fact, rural women who are pregnant smoke at almost the same rate as non-pregnant urban women.
- Teenagers: Teens living in rural areas are three times more likely to smoke than their urban or suburban counterparts.
- Young adults: Young adults aged 18 to 34 are 27 percent more likely to smoke if they live in a rural area than if they live in an urban one.
- Native Americans: More than 45 percent of Native Americans living in rural areas use tobacco regularly — more than any other demographic group.
- Children and secondhand smoke: 33.2 percent of children in large rural areas and 35 percent of children in small rural areas live in a household with someone who smokes. That compares with 24.4 percent of urban kids. Adults living in rural areas are also more likely to permit people to smoke in the presence of children.
- Adults and secondhand smoke: 20.5 percent of adults living in rural areas reported that someone had smoked in their presence at home, compared to 14.1 percent of urban respondents. Rural respondents were also more likely to experience someone smoking in their presence at their workplace than the urban respondents (16.2 percent compared to 11 percent).
Cultural and economic factors
The American Lung Association cites several cultural and economic reasons for why tobacco use is greater in rural areas. To begin with, tobacco use is associated with lower education and income levels, and rural areas often have fewer opportunities for educational and economic advancement. Rural areas also tend to have fewer smoke-free air laws in place, and they offer fewer resources to help people overcome their nicotine addiction. As the report points out, rural Americans are also slightly less likely to have health insurance that would cover the costs of such programs.
In addition, the tobacco industry has traditionally used rugged rural imagery, such as “the Marlboro Man,” to sell its products.
In Minnesota, the tobacco industry likes to target people at rural events, including county fairs, rodeos and stock car races, said Moffitt. The companies advertise heavily at these events and hand out T-shirts or cheap samples of their products, such a one-dollar tins of chewing tobacco. (State law forbids the companies from giving it away free.)
“They are spending millions and millions of dollars here in Minnesota, trying to hook a new generation,” said Moffitt.
The tobacco industry also likes to target younger people at such rural events with “moist tobacco” products, candy-flavored chewable products that are designed to look and taste like fruit leather, mints or gum. (As MinnPost’s Beth Hawkins has reported, three Minnesota Republicans introduced legislation in 2011 that would have lowered the taxes on such products, which would have made them even more appealing to young people. The bill failed.)
‘A beacon in the Midwest’
Still, Minnesota “stands out like a beacon in the Midwest” in terms of its smoking rate, said Moffitt. Some 14.9 percent of Minnesota’s adults smoke, a rate that is significantly below the national average of 17.2 percent. That lower rate, Moffitt said, can be attributed to our higher educational levels, our leadership role in implementing policies that ensure smoke-free indoor workplaces, and the “grassroot efforts” of Minnesotans who “just got fed up with working in smoke-filled places.”
In fact, he pointed out, it was people in Greater Minnesota who led those efforts. The town of Moose Lake and Olmsted County passed smokefree workplace ordinances before any community or county in the Twin Cities, he said.
One of those outstate smoking-ban pioneers, Romelle Jones, a former café owner in Moose Lake, is featured in the American Lung Association report. Jones, whose parents both died of lung cancer, actively advocated for Moose Lake’s 2000 smoke-free ordinance, which was the first ordinance of its kind in Minnesota.
Not giving up
Although Minnesota is doing better than most states in terms of getting and keeping its tobacco-use rates down, much more needs to be done, said Moffitt, especially in rural areas.
“We’re not about to give up on helping that community kick the habit,” he said.
In its report, the American Lung Association “calls upon government agencies, the research and funding communities, health systems and insurers, community leaders, schools and families to take action now to cut tobacco’s rural roots”:
State and local tobacco control programs should be adequately funded, and should focus resources on disparities in rural communities. Adults and children should be protected from exposure to secondhand smoke in workplaces, schools and homes. People who are ready to quit should be aware of and have access to cessation services by qualified providers, fully covered by their insurance. And most important, parents and other community members should refuse to accept the culture of tobacco use as part of life in their communities, and to expect that their children will have healthy, tobacco-free lives.
You can download the report from the American Lung Association’s website. The report primarily used 2009 data from the National Survey on Drug Use and Health. A rural area was defined as one without a metropolitan community of 10,000 or more residents, with less than 25 percent of its residents working in a neighboring metropolitan area, and with less than 25 percent of its job being filled by residents from a neighboring metropolitan area.