Current Use of E-Cigarettes and Conventional Cigarettes Among US High School Students in Urban and Rural Locations: 2014 National Youth Tobacco Survey

Purpose: Adolescent tobacco use is higher in rural than in urban areas. While e-cigarette use is increasing rapidly among this age group, differences in prevalence between rural versus urban populations for this relatively novel product have not been explored. The purpose is to investigate whether location of school (rural–urban) is associated with e-cigarette use and dual use (defined as the use of both e-cigarettes and conventional cigarettes) among high school students. Design: Cross-sectional survey obtained using a stratified, 3-stage cluster sample design. Setting: United States. Participants: A nationally representative sample of US high school students (N = 11 053) who completed the 2014 National Youth Tobacco Survey (NYTS); slightly more than half were urban (54%). Measures: The NYTS measures tobacco-related knowledge, attitudes, and use behavior and demographics of students in the United States. Analysis: Weighted logistic regression assessed the relationships of urban–rural location with current e-cigarette use and dual use, adjusting for demographic factors, perceived risk, and social norms. Results: There were clear differences in patterns of adolescent e-cigarette and cigarette use in rural versus urban areas. Social norms and perceptions may play a role in understanding these differences. Conclusion: Urban youth current cigarette smokers were nearly twice as likely as rural cigarette smokers to also use e-cigarettes. Reasons for urban–rural differences need to be taken into account when designing prevention programs and policy changes.