Cigarette smoking prevalence, nicotine dependence, and quit ratios among U.S. adult females by residence and military-veteran status: 2002-2023.

Abstract

Examine nationally representative U.S. data to determine trends in cigarette smoking, nicotine dependence, and quit ratios among females by rurality and veteran status between 2002 and 2023. Data were obtained from the 2002-2023 files (N = 454,981) of the National Survey on Drug Use and Health. Adult female respondents were categorized by rural/urban residence and veteran/nonveteran status to examine smoking outcomes across 3-year intervals. To adjust for non-response, selection probability, and post-stratification, analyses were conducted using survey weighted logistic regression models controlling for socio-demographic covariates. Smoking prevalence was higher among rural versus urban residents (aOR = 1.55, 95 %CI = 1.43, 1.67) and veterans versus nonveterans (aOR = 1.72, 95 %CI = 1.36, 2.17). Nicotine dependence was higher among rural versus urban residents (aOR = 1.84, 95 %CI = 1.66, 2.03) and veterans versus nonveterans (aOR = 1.49, 95 %CI = 1.08, 2.06). Quit ratios were lower in rural versus urban residents (aOR = 0.70, 95 %CI = 0.63, 0.78), but not among veterans (aOR = 0.83, 95 % CI = 0.62, 1.10). Rates of decline over time in smoking prevalence and nicotine dependence, as well as increases in quit ratios, were lower among rural residents (p's < 0.001) whereas changes by veteran status did not interact with time. Results across 21 years from a nationally representative US survey substantiate a growing rural-urban disparity in smoking that disproportionately impacts rural females. We also identified a disparity that disproportionately impacts veteran compared to nonveteran females. Thus, rural and veteran female populations need targeted treatment interventions.