Transitions from cigarette smoking by geolocation among US adults: Results from waves 1-6 of the Population Assessment of Tobacco and Health (PATH) study 2013–2021
9 affiliations
- 1Public Health Westat Bethesda United States
- 2Pacific Institute for Research and Evaluation Louisville United States
- 3Department of Psychology Rosalind Franklin University of Medicine and Science North Chicago United States
- 4National Institute on Drug Abuse, National Institutes of Health Bethesda United States
- 5Kelly Government Solutions Bethesda United States
- 6Center for Tobacco Research, The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center Columbus United States
- 7Lee Kong Chian School of Medicine, Nanyang Technological University Singapore Singapore
- 8School of Global Public Health New York University New York United States
- 9College of Nursing University of Kentucky Lexington United States
Abstract
Introduction: Adults in rural US areas experience higher rates of tobacco use and related disease. They also have lower cigarette cessation success than those in non-rural areas, but it is unknown how transitions from exclusive cigarette use to other product use differ by geolocation. This study examined longitudinal associations between geolocation (urban, suburban, town, rural) and transitions from exclusive cigarette smoking.
Methods: We conducted a secondary analysis of pooled wave-pair observations from US adults participating in Waves (W) 1–6 of the Population Assessment for Tobacco and Health Study (2013–2021) who had exclusive past 30-day cigarette smoking at the wave-pair baseline and one of the following at the wave-pair follow-up: 1) continued exclusive cigarette smoking, 2) continued smoking with other added tobacco products, 3) switched to exclusive e-cigarette use, or 4) quit tobacco completely (reference group). Survey-weighted random-intercept multinomial logistic regressions were conducted, adjusting for sociodemographics, smoking-related factors, and survey wave.
Results: Of 13634 wave-pairs (32.3% suburban, 28.3% urban, 27.3% rural, 12.1% town), 90.8% continued smoking (73.7% exclusively smoking cigarettes, 17.1% with other added tobacco products), 1.2% switched to e-cigarettes, and 8.0% quit tobacco completely. Town (adjusted relative risk ratio, ARRR=1.52; 95% CI: 1.10–2.10) or rural (ARRR=1.34; 95% CI: 1.05–1.69) adults were significantly more likely to continue exclusive smoking than urban adults, with no significant associations between geolocation and other tobacco transitions.
Conclusions: Living in town or rural (vs urban) US areas was associated with an increased likelihood of continued exclusive cigarette smoking compared to quitting tobacco, suggesting that targeted interventions and policies are needed to support these populations.
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BibTeX
@article{ozga2026transitions,
title = {{Transitions from cigarette smoking by geolocation among US adults: Results from waves 1-6 of the Population Assessment of Tobacco and Health (PATH) study 2013–2021}},
author = {Jenny E. Ozga and Melissa H. Abadi and Nancy C. Jao and John H. Kingsbury and Michael J. Parks and Alayna P. Tackett and Wubin Xie and Shu Xu and Jing Zhang and Cassandra A. Stanton},
journal = {Tobacco Induced Diseases},
year = {2026},
month = oct,
doi = {10.18332/tid/226559},
url = {https://doi.org/10.18332/tid/226559},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Transitions from cigarette smoking by geolocation among US adults: Results from waves 1-6 of the Population Assessment of Tobacco and Health (PATH) study 2013–2021
AU - Jenny E. Ozga
AU - Melissa H. Abadi
AU - Nancy C. Jao
AU - John H. Kingsbury
AU - Michael J. Parks
AU - Alayna P. Tackett
AU - Wubin Xie
AU - Shu Xu
AU - Jing Zhang
AU - Cassandra A. Stanton
PY - 2026
DA - 2026/10/28
JO - Tobacco Induced Diseases
DO - 10.18332/tid/226559
UR - https://doi.org/10.18332/tid/226559
AB - Introduction: Adults in rural US areas experience higher rates of tobacco use and related disease. They also have lower cigarette cessation success than those in non-rural areas, but it is unknown how transitions from exclusive cigarette use to other product use differ by geolocation. This study examined longitudinal associations between geolocation (urban, suburban, town, rural) and transitions from exclusive cigarette smoking. Methods: We conducted a secondary analysis of pooled wave-pair observations from US adults participating in Waves (W) 1–6 of the Population Assessment for Tobacco and Health Study (2013–2021) who had exclusive past 30-day cigarette smoking at the wave-pair baseline and one of the following at the wave-pair follow-up: 1) continued exclusive cigarette smoking, 2) continued smoking with other added tobacco products, 3) switched to exclusive e-cigarette use, or 4) quit tobacco completely (reference group). Survey-weighted random-intercept multinomial logistic regressions were conducted, adjusting for sociodemographics, smoking-related factors, and survey wave. Results: Of 13634 wave-pairs (32.3% suburban, 28.3% urban, 27.3% rural, 12.1% town), 90.8% continued smoking (73.7% exclusively smoking cigarettes, 17.1% with other added tobacco products), 1.2% switched to e-cigarettes, and 8.0% quit tobacco completely. Town (adjusted relative risk ratio, ARRR=1.52; 95% CI: 1.10–2.10) or rural (ARRR=1.34; 95% CI: 1.05–1.69) adults were significantly more likely to continue exclusive smoking than urban adults, with no significant associations between geolocation and other tobacco transitions. Conclusions: Living in town or rural (vs urban) US areas was associated with an increased likelihood of continued exclusive cigarette smoking compared to quitting tobacco, suggesting that targeted interventions and policies are needed to support these populations.
SN - 2070-7266
SN - 1617-9625
ER -