Substance Use
Parsing the Prairie: Rurality Metrics and Their Association with Smoking in Nebraska James Buckley* James Buckley Buckley University of Nebraska Medical Center
Objective: To evaluate the effect of different rural-urban classification schemes on the association between rurality and increased smoking prevalence at the census-tract level.
Background: Smoking prevalence is well established by literature as linked to rurality. However, there is no one accepted measure of rurality in the United States. Government agencies currently utilize several different methods of determining rurality and urbanicity at varying levels of geography. Common classification schemes include Rural-Urban Commuting Areas (RUCA / Census Tract), Rural Urban Continuum Codes (RUCC / County), Urban Influence Codes (UIC / County), and Core-Based Statistical Areas (CBSA / County). All these metrics broadly categorize geographical units into metropolitan, small metro/micropolitan, and rural areas and many build from similar core assumptions, usually the Office of Management and Budget’s (OMB) Metropolitan/Micropolitan system.
Methods: Smoking prevalence was obtained from the CDC Places dataset. RUCA, RUCC, and UIC were obtained from the USDA’s Economic Research Service. County-level metrics were disaggregated down to constituent census tracts. CBSAs were obtained from the OMB. ANOVA was used to compare mean cigarette smoking prevalence with post-hoc pairwise comparisons using Tukey’s adjustment.
Results: All assessed rurality metrics reported mean smoking prevalence for the most rural areas as between 14.59 and 14.77 percent. All assessed rurality metrics reported mean smoking prevalence for the most urban classification ranged from 13.45 to 13.71 percent. The mean difference in cigarette smoking prevalence between the most urban classification and most rural classification ranged from 0.96 to 1.31 percentage points. All mean differences were significant at 0.05 significance level.
Conclusions: Smoking prevalence was consistently higher in rural areas than in urban areas, regardless of the rural-urban classification scheme used.