Purpose: Determine associations of strength of local smoke-free laws and urban/rural location with cigarette and smokeless tobacco use among high school students in grades 10 and 12. Design: Secondary data analysis from the 2004–2018 biennial Kentucky Incentives for Prevention Survey Setting: Public high schools in Kentucky Sample: N = 353502 10th/12th graders Measures: County-level smoke-free law status from the Kentucky Center for Smoke-free Policy; Rural Urban Continuum Codes; self-reported last 30-day alcohol, marijuana, cigarette, and smokeless tobacco use Analysis: Generalized estimating equations modeling assessed the association of law status and urban/rural location with tobacco use across cohorts, controlling for demographics and other substance use. Results: Students in counties with a comprehensive smoke-free law were 23% less likely to smoke cigarettes and 16% less likely to use smokeless, compared to those in counties without a law. Students in counties with moderate/weak laws did not differ in likelihood of use for either product, compared to those in counties without a law. Students in urban counties were 14% less likely to smoke, but there was no difference in likelihood of smokeless use by urban/rural location. Conclusion: Comprehensive smoke-free laws are associated with a lower likelihood of youth cigarette and smokeless use. Rural youth may be at increased risk of cigarette smoking relative to youth in urban areas.

Original languageEnglish
Pages (from-to)673-677
Number of pages5
JournalAmerican Journal of Health Promotion
Issue number4
StatePublished - May 2022

Bibliographical note

Publisher Copyright:
© The Author(s) 2022.


  • adolescent
  • cigarettes
  • outcome assessment
  • smoke-free policy
  • smokeless tobacco
  • tobacco use

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health


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