Agunwamba Amenah A, Kawachi Ichiro, Williams David R, Finney Rutten Lila J, Wilson Patrick M, Viswanath Kasisomayajula
Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota.
Social Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
J Rural Health. 2017 Apr;33(2):180-189. doi: 10.1111/jrh.12182. Epub 2016 Apr 14.
Disparities in tobacco use persist despite successful policies reducing use within the United States. In particular, the prevalence of tobacco use in rural and certain minority communities is significantly higher compared to that of their counterparts. In this work, we examine the impact of rurality, mental health, and racial discrimination on tobacco use.
Data come from the 2003 California Health Interview Survey (n = 42,044). Modified Poisson regression models were adjusted for age, sex, race/ethnicity, birth origin, education, income, insurance, and marital status.
Compared to urban residents, rural residents had a significantly higher risk for smoking after adjustment (RR = 1.10, 95% CI: 1.01-1.19). Those who reported having experienced racial discrimination also had a significantly greater risk for smoking compared to those who did not (RR = 1.17, 95% CI: 1.07-1.27). Additionally, those who reported higher stress had a significantly greater risk for smoking (RR = 1.61, 95% CI: 1.07-1.67). There was evidence of interaction between rurality and race/ethnicity, and rurality and gender (P < .05).
Residing in rural areas was associated with an increased risk for smoking, above and beyond sociodemographics. There were no significant differences across rural-urban environments for the relationship between stress and tobacco use-an indication that the impact of stress and discrimination is not buffered or exacerbated by environmental characteristics potentially found in either location. Mechanisms that explain rural-urban tobacco use disparities need to be explored, and smoking cessation programs and policies should be tailored to target these factors within rural communities.
尽管美国已成功实施减少烟草使用的政策，但烟草使用方面的差异依然存在。特别是，农村地区和某些少数族裔社区的烟草使用率显著高于其他地区。在本研究中，我们探讨了农村地区、心理健康和种族歧视对烟草使用的影响。
数据来自2003年加利福尼亚健康访谈调查（n = 42,044）。修正泊松回归模型针对年龄、性别、种族/族裔、出生地、教育程度、收入、保险和婚姻状况进行了调整。
与城市居民相比，农村居民在调整后吸烟风险显著更高（相对风险 = 1.10，95%置信区间：1.01 - 1.19）。报告曾经历种族歧视的人比未经历过的人吸烟风险也显著更高（相对风险 = 1.17，95%置信区间：1.07 - 1.27）。此外，报告压力较大的人吸烟风险显著更高（相对风险 = 1.61，95%置信区间：1.07 - 1.67）。有证据表明农村地区与种族/族裔以及农村地区与性别之间存在交互作用（P < 0.05）。
居住在农村地区与吸烟风险增加相关，这一关联独立于社会人口统计学因素。压力与烟草使用之间的关系在城乡环境中没有显著差异，这表明压力和歧视的影响不会因任何一个地区可能存在的环境特征而得到缓冲或加剧。需要探索解释城乡烟草使用差异的机制，戒烟项目和政策应针对农村社区的这些因素进行调整。
