Associations of tobacco use and consumption with rurality among patients with psychiatric disorders: Does smoke-free policy matter?

Purpose: People with psychiatric disorders (PDs) have high risks for tobacco use and associated health effects; however, little is known about differences in tobacco use status and consumption by urban or rural residence. Among patients with PDs, we examined the association of smoke-free policy on tobacco use by rural/urban residence. Method: A cross-sectional retrospective study (N = 2060) among patients in a psychiatric facility was conducted. Multi-logistic and multilinear regression analyses assessed differences in outcomes stratified by rural/urban status. Results: Among rural residents, a substance use history (odds ratios [ORs[= 2.82, 95% CI: 2.01–3.96), high school education (OR = 0.71, 95% CI: 0.51–0.98), older age (OR = 0.99, 95% CI: 0.98–1.00), and longer length of hospital stay (OR = 0.99, 95% CI: 0.98–1.00) were associated with tobacco use. Among urban residents, male sex (OR = 1.38, 95% CI: 1.02–1.86), a substance use history (OR = 2.61, 95% CI: 1.86–3.66), and externalizing disorder diagnosis (OR = 2.72, 95% CI: 1.35–5.48) correlated with tobacco use. Increased tobacco consumption among rural residents was associated with being male (β = 0.12, p = 0.007) and having less than a high school education (β = 0.14, P = 0.001). Whereas, White ethnicity (β = 0.14, p = 0.006), having less than a high school education (β = 0.11, p = 0.022), and a psychotic disorder diagnosis (β = 0.25, p = 0.038) were associated with greater tobacco consumption in urban residents. Smoke-free policy was not associated with tobacco use (OR = 1.08, 95% CI: 0.87–1.34) and consumption (β = 0.05, p = 0.134). Conclusions: Despite higher rates of tobacco use among rural patients with PDs, they have similar risk factors as their urban counterparts. However, residing in a location with a smoke-free policy may not contribute to tobacco use behaviors among those with PDs.