U54 Pilot: Comparing Tobacco Product Susceptibility and Product Substitution by Relative Rurality and Alcohol Use

Approximately one in five Americans live in areas that may be considered rural.12 While this represents 20% of the population, this minority has substantially disproportionate tobacco use relative to Americans in urban areas, with higher rates of tobacco use in rural areas.4,13 This has, in no small part, increased the disease burden in rural areas as a function of increased and more persistent tobacco use.14 In rural areas, there are other factors that may contribute to higher rates of tobacco use. For example, alcohol use is generally higher in rural communities.7,8 Heavier alcohol use has also been related to increased cigarette use, as well as decreased likelihood to succeed in smoking cessation.9 Even in non-tobacco users, alcohol use increases public self-reported desire for use of tobacco products.15 Given that one of the Federal Drug Administration Center for Tobacco Products (FDA CTP) high priority research areas, behavior, is determining who is likely to initiate tobacco product use as well as determine how current users might switch products or cease tobacco use1 investigating how relative rurality and alcohol use could provide initial insight into how these factors might interact for tobacco initiation and substitution. Identification of how these factors interact on tobacco susceptibility and quit patterns could lead to better prediction of how different potential tobacco regulations (e.g., reduced flavor options, reduced nicotine content). A set of methodologies that have been particularly useful in predicting behavior and understanding switch patterns come from behavioral economics.