Rural-urban differences in the social climate surrounding environmental tobacco smoke: A report from the 2002 social climate survey of tobacco control

Context: Although previous research has found smoking rates to be higher among residents of rural areas, few studies have investigated rural-urban differences in exposure to environmental tobacco smoke (ETS). Objective: This study contrasted the social climate surrounding ETS among Americans who resided in 5 levels of county urbanization. Design: Data were collected via telephone interviews administered to a representative sample of 3,009 civilian, noninstitutionalized adults over age 18 in the United States. Households were selected using random digit dialing procedures. Findings: Compared to residents of urban counties, rural residents reported fewer restrictions on smoking in the presence of children and lower incidences of smoking bans in households, family automobiles, work areas, convenience stores, fast-food restaurants, and restaurants. Interestingly, when rural-urban variations in knowledge and attitudes about ETS were examined, the magnitude of rural-urban differences was smaller or nonexistent for these indicators. Moreover, logistic regression models indicated that none of these rural-urban differences in knowledge and attitudes persisted after statistically controlling for region, smoking status, gender, race, age, and education factors. This suggests that the observed rural-urban differences in ETS bans could not be explained adequately by rural-urban differences in knowledge and attitudes about the dangers of ETS. Conclusions: The policy implications of this research point to a greater need in rural America for programs focusing on the restriction and elimination of ETS. They also suggest that programs focusing only on influencing the levels of ETS knowledge and attitudes among the general population may not be adequate in producing the desired change.