Ozga Jenny E, Stanton Cassandra A, Sargent James D, Steinberg Alexander W, Tang Zhiqun, Paulin Laura M
Westat Behavioral Health and Health Policy Practice, Rockville, United States.
Department of Pediatrics, Geisel School of Medicine, Hanover, United States.
Tob Induc Dis. 2024 Sep 12;22. doi: 10.18332/tid/191827. eCollection 2024.
Cigarette smoking and smoking-related lung disease are more common in rural (vs urban) areas of the United States (US). This study examined relationships between geographical location, cigarette risk perceptions, and current smoking among older adults who are at greatest risk of developing smoking-related lung disease.
The study was a secondary data analysis of 12126 respondents aged ≥40 years from Wave 5 of the Population Assessment of Tobacco and Health Study. Weighted descriptive statistics and Poisson regressions assessed current smoking (vs never or former) as a function of geographical location in a stepwise fashion, first unadjusted, then adjusting for sociodemographic characteristics, and finally for both sociodemographic characteristics and cigarette risk perceptions (4-item scale), in three separate models. Sensitivity analyses examined whether individual risk perceptions items had a greater impact on the association between geographical location and current smoking.
Current smoking was more common among rural (20.6%) than urban (17.6%) residents. The risk ratio (RR) for rural (vs urban) residence on current smoking decreased from 1.17 (95% CI: 1.03-1.32) to 1.14 (95% CI: 1.01-1.29) to 1.08 (95% CI: 0.96-1.21) across the stepwise models. Lower cigarette risk perceptions confounded the rural-current smoking association and was an independent risk factor for smoking (adjusted RR, ARR=2.15; 95% CI: 1.94-2.18). In sensitivity analyses, believing that cigarettes are very or extremely (vs somewhat, slightly, or not at all) harmful to health and agreeing (vs not agreeing) that secondhand smoke causes lung disease in people who do not smoke, confounded the rural-current smoking association whereas beliefs about smoking causing lung cancer or lung disease in people who smoke did not.
Lower cigarette risk perceptions among rural residents confounded the positive association between rural residence and current smoking. Results from sensitivity analyses highlight potential targets for communication campaigns aimed at promoting more accurate perceptions of the harmful health consequences of cigarette smoking.
在美国，吸烟及与吸烟相关的肺部疾病在农村地区比城市地区更为常见。本研究调查了地理位置、对香烟风险的认知与当前吸烟行为之间的关系，这些研究对象为患吸烟相关肺部疾病风险最高的老年人。
该研究是对烟草与健康人口评估研究第5波中12126名年龄≥40岁的受访者进行的二次数据分析。加权描述性统计和泊松回归以逐步方式评估当前吸烟行为（相对于从不吸烟或曾经吸烟）作为地理位置的函数，首先是未调整的，然后调整社会人口学特征，最后在三个单独模型中同时调整社会人口学特征和香烟风险认知（4项量表）。敏感性分析检验了个体风险认知项目是否对地理位置与当前吸烟之间的关联有更大影响。
当前吸烟在农村居民（20.6%）中比城市居民（17.6%）中更为常见。在逐步模型中，农村（相对于城市）居民当前吸烟的风险比（RR）从1.17（95%置信区间：1.03 - 1.32）降至1.14（95%置信区间：1.01 - 1.29），再降至1.08（95%置信区间：0.96 - 1.21）。较低的香烟风险认知混淆了农村与当前吸烟的关联，并且是吸烟的一个独立风险因素（调整后的RR，归因风险率=2.15；95%置信区间：1.94 - 2.18）。在敏感性分析中，认为香烟对健康非常或极其（相对于有点、轻微或完全不）有害，以及同意（相对于不同意）二手烟会导致不吸烟者患肺病，混淆了农村与当前吸烟的关联，而关于吸烟会导致吸烟者患肺癌或肺病的信念则没有。
农村居民中较低的香烟风险认知混淆了农村居住与当前吸烟之间的正相关关系。敏感性分析结果突出了旨在促进对吸烟有害健康后果形成更准确认知的宣传活动的潜在目标。
