A comparison of classifications for geographic location and their associations with tobacco use among US adults

Purpose This study compared two classifications of rurality and their associations with cigarette, e‐cigarette, and smokeless tobacco (SLT) use among a nationally representative sample of 31,196 US adults. Methods Data from Wave 1 of the Population Assessment of Tobacco and Health Study. Weighted descriptive statistics and multivariable logistic regressions assessed whether two classifications of rurality were differentially associated with past 30‐day (P30D) cigarette, e‐cigarette, or SLT use in separate models. Classifications were (1) the US Census Bureau's classification as urban/non‐urban; and (2) the National Center for Education Statistic (NCES)’s classification as urban/suburban/town/rural. This study is reported in accordance with STROBE guidelines. Findings With the Census Bureau classification, 79.3% were in urban areas. With the NCES classification, 34.3% were in urban, 35.1% in suburban, 9.4% in town, and 21.1% in rural areas. With the Census Bureau classification, non‐urban (vs. urban) residence was associated with reduced odds of e‐cigarette use (AOR = 0.79; 95% CI = 0.70–0.88) and increased odds of SLT use (AOR = 2.32; 95% CI = 1.97–2.72). With the NCES classification with urban as reference, rural residence was associated with reduced odds of e‐cigarette use (AOR = 0.77; 95% CI = 0.75–0.98); both town (AOR = 2.16; 95% CI = 1.69–2.78) and rural (AOR = 2.75; 95% CI = 2.16, 3.48) were associated with increased odds of SLT use. Location was not associated with cigarette use for either classification. Conclusions Location was similarly associated with P30D e‐cigarette and SLT use across both classifications in adjusted models. The use of classifications with more categories may be beneficial to understand nuanced location differences in tobacco use.