Does Tobacco Use Differ by Metropolitan Status Among Young Adults Males Ages 18-34?

Purpose: With conflicting findings for the relationship between tobacco use and metropolitan status, the purpose of this study is to assess whether smoking cigarettes and chewing tobacco differs by metropolitan status for young adult males in the general population.

Methods: This cross-sectional analysis uses 2016 Behavioral Risk Factor Surveillance System (BRFSS) data for N=935 males ages 18 to 34 in Florida, Michigan, New York, and Washington. Ordered logistic regression was performed for combined state data to assess patterns in relationships between tobacco use (none vs chewing tobacco only vs smoking cigarettes only vs both) and metropolitan status while controlling health-related, demographic, and socioeconomic factors and state.

Results: Across states, about one-fourth of young adult males reported tobacco use (26%), with about one-fifth for smoking cigarettes only (18%), and very few for chewing tobacco only (6%) or both chewing and smoking cigarettes (3%). In this study, roughly one-third lived in urban (27%), suburban (41%) or rural (32%) areas. The results of adjusted analysis indicated that each successive level of tobacco use was moderately related to living in a suburban or rural area and moderately- to highly-related to moderate and excessive alcohol use.

Conclusion: The results of this study indicate that successive use of chewing tobacco and smoking cigarettes in young adult males in the general population is related to living in suburban or rural areas and to moderate and excessive alcohol use. In primary care, providers may expect up to one-fourth of young adult males to smoke cigarettes or chew and half to use alcohol. Because these are moderately to high-related, providers should continue to screen for tobacco and alcohol use in all young adult males, especially those living in suburban or rural communities. Clinicians should provide education and resources for tobacco cessation and substance abuse programs as necessary.


Mankus KE, McMahon MN, Morgan ME, O’Rourke VL and Hartos JL

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