Rurality, tobacco use, and COPD: an analysis of two national datasets

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Project Abstract Individuals with chronic obstructive pulmonary disease (COPD) who live in rural areas of the United States have worse health outcomes compared with their non-rural counterparts. Although it is known that rural areas have higher rates of cigarette smoking, and that cigarette smoking is associated with worse outcomes in COPD, less is known about geographic variations in the motivations and beliefs that influence tobacco product appeal and use, especially among newer tobacco products including e-cigarettes. Further, it is largely unknown how much variability in tobacco use accounts for the geographic differences seen in COPD outcomes. Our long-term goal is to identify potentially modifiable determinants of tobacco product use that contribute to worse COPD in rural US, leading to future geographically tailored interventions designed to improve outcomes. Our overall objective for this application, which is the next step toward attainment of our long-term goal, is to quantify the perceptions of risk and benefit on the pattern of tobacco use in rural and urban populations in the United States, and to determine the impact of such patterns on COPD outcomes. Our central hypothesis is that perceptions of risk and benefit of tobacco products differ by geographic location in the US, and that tobacco exposure contributes significantly to the increased COPD risks associated with rural location. The rationale for this project is that identifying factors that influence tobacco product appeal and use will provide detailed insight into potentially modifiable contributors to geographic disparities in health outcomes and inform regulatory strategy. Using existing datasets, we will test our hypothesis in two specific aims: 1) To quantify and compare patterns of tobacco product use by geographic location, and to determine how perceptions of risk and benefit of tobacco products differ by geographic location; 2) To determine the relationship between geographic location and COPD prevalence, incidence, and respiratory symptoms, and to quantify the contribution of tobacco product exposure to these relationships. To address our aims, will use data from the Population Assessment of Tobacco and Health (PATH) Study and the National Health Interview Survey (NHIS).The PATH Study is a longitudinal, nationally representative study that includes detailed questions on the motivations, beliefs, and perceptions influencing tobacco product use, allowing us to analyze the longitudinal association of these trends with COPD risk and respiratory symptoms within a broad definition of urbanicity. In a separate, focused analysis, we will determine the cross-sectional association between tobacco products and COPD prevalence across urban/rural continuum using nationally representative data from the NHIS study. Our research team has extensive experience working with these datasets, each providing complimentary longitudinal and cross sectional perspectives to allow for comprehensive assessment of the contribution of tobacco use to observed disparities in COPD outcomes in rural populations.