The interaction of tobacco retailer density and rurality with tobacco use prevalence in Kentucky.

PURPOSE: Tobacco retailer density is a key correlate of tobacco use prevalence in the United States, but this relationship has typically been examined in urban areas. We examined the relationship between retailer density and tobacco use across Kentucky counties, a state with high smoking rates and a substantial rural population.

METHODS

We obtained a list of tobacco retailers from the 2021 Kentucky Synar program, used for minor's access inspections. We merged these data with county-level prevalence estimates for cigarette and smokeless tobacco use for each county in Kentucky, calculated using pooled 3-year estimates (2017-2019) of Kentucky Behavioral Risk Factor Surveillance System data. We modeled county-level frequency of each outcome among adults as a function of tobacco retailer density and the Index of Relative Rurality, and interactions using ANCOVA, controlling for county percent of adult population and percent with an advanced degree.

FINDINGS: We observed significant interactions between retailer density and rurality for both cigarette and smokeless tobacco use. Post-hoc protected pairwise comparisons demonstrated that within the 40 most urban counties, cigarette and smokeless tobacco use were significantly higher among counties with the highest retailer density, compared to low-density counties. Retailer density was not associated with the prevalence of cigarette and smokeless tobacco use within the 2 more rural tertiles of counties.

CONCLUSIONS

Consistent with prior research, policies limiting tobacco retailer density could be most beneficial in urban and urban-adjacent areas, while other policies may need to be considered for rural areas, even within a relatively rural state such as Kentucky.