{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T19:00:59Z","timestamp":1784660459243,"version":"3.55.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Rural communities in the United States experience higher tobacco use and worse tobacco-related health outcomes than urban areas, with disparities increasingly extending to electronic nicotine delivery systems (ENDS). Little is known about rural\u2013urban differences in ENDS use across detailed age groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from the 2022\u20132023 Tobacco Use Supplement to the Current Population Survey, a nationally representative survey of US adults (\u226518\u00a0years). Respondents were categorized into 4 age groups (18\u201324, 25\u201344, 45\u201364, \u226565). Rural\u2013urban residence was defined using metropolitan status. Weighted prevalence estimate of lifetime, former, and current ENDS use were calculated by age group and rural\u2013urban residence, and gender-adjusted contrasts were estimated using survey-weighted marginal standardization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Lifetime, former, and current ENDS use were 9.6%, 6.6%, and 3.0%, respectively. Lifetime and current ENDS use were higher in rural than urban areas across most age groups, with the largest differences observed among adults aged 25\u201344 and 45\u201364 (current use PRs of 1.29 and 1.44, respectively). Young adults (18\u201324) in rural areas had the highest prevalence (lifetime: 19.5%; current: 10.5%). Among lifetime users, adults aged 18\u201324 and 25\u201344 in rural areas were more likely to report current use than their counterparts in urban areas (18\u201324: 53.8% vs. 44.6%; 25\u201344: 35.2% vs. 29.5%). Former use was significantly higher in rural areas overall and among adults aged 25\u201344 and 45\u201364, but not among adults aged 18\u201324 or \u226565.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These patterns of ENDS use underscore the need for age-targeted ENDS prevention and cessation interventions in rural populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>Findings identify young adults (YAs) in rural areas as a priority population for tobacco control efforts and provide updated evidence that current ENDS use among adults aged 18\u201324 is significantly higher in rural than urban settings. Their high prevalence of ENDS use underscore the need for age-specific prevention and cessation strategies tailored to rural contexts. Public health programs should address barriers affecting YAs in rural areas, including limited cessation resources and pro-ENDS social environments. Disaggregating age groups reveals important differences that should guide future surveillance, interventions, and policies to reduce rural\u2013urban tobacco disparities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ntr\/ntag153","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T13:32:43Z","timestamp":1782826363000},"source":"Crossref","is-referenced-by-count":0,"title":["Rural e-cigarette use higher than urban across age groups"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7578-1986","authenticated-orcid":false,"given":"Jovan","family":"Gwon","sequence":"first","affiliation":[{"name":"School of Nursing, University of Minnesota, Minneapolis , MN 55455 ,","place":["United States"]},{"name":"Masonic Cancer Center, University of Minnesota, Minneapolis , MN 55455 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young","family":"Cho","sequence":"additional","affiliation":[{"name":"Joseph. J. Zilber College of Public Health, University of Wisconsin-Milwaukee , Milwaukee, WI 53211 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4334-9515","authenticated-orcid":false,"given":"Dana M","family":"Carroll","sequence":"additional","affiliation":[{"name":"Masonic Cancer Center, University of Minnesota, Minneapolis , MN 55455 ,","place":["United States"]},{"name":"Department of Family Medicine and Community Health, University of Minnesota, Minneapolis , MN 55455 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M","family":"Busch","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hennepin Healthcare & University of Minnesota , Minneapolis, MN 55455 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6675-8736","authenticated-orcid":false,"given":"Devon","family":"Noonan","sequence":"additional","affiliation":[{"name":"School of Nursing, Duke Cancer Institute, Duke University , Durham, NC 27710 \u00a0","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"2026072114015059700_ref1","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.ypmed.2017.03.011","article-title":"A growing geographic disparity: rural and urban cigarette smoking trends in the United States","volume":"104","author":"Doogan","year":"2017","journal-title":"Prev Med"},{"key":"2026072114015059700_ref2","doi-asserted-by":"publisher","first-page":"e70004","DOI":"10.1002\/cncr.70004","article-title":"Urban\u2013rural disparities in lung cancer incidence and mortality patterns in Black and White populations","volume":"131","author":"Howlader","year":"2025","journal-title":"Cancer."},{"key":"2026072114015059700_ref3","doi-asserted-by":"publisher","first-page":"102763","DOI":"10.1016\/j.canep.2025.102763","article-title":"Differences in lung cancer death rates by rural vs urban status in comparison to all-cancer death rates\u2014United States, 1999\u20132020","volume":"95","author":"Kava","year":"2025","journal-title":"Cancer Epidemiol"},{"key":"2026072114015059700_ref4","volume-title":"Current Electronic Cigarette Use Among Adults Aged 18 and Over: United States, 2021","author":"Kramarow","year":"2023"},{"key":"2026072114015059700_ref5","doi-asserted-by":"publisher","first-page":"e2020019153","DOI":"10.1542\/peds.2020-020651","article-title":"Rural\u2013urban differences in changes and effects of tobacco 21 in youth e-cigarette use","volume":"147","author":"Dai","year":"2021","journal-title":"Pediatrics."},{"key":"2026072114015059700_ref6","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1177\/0890117117719621","article-title":"Current use of e-cigarettes and conventional cigarettes among US high school students in urban and rural locations: 2014 National Youth Tobacco Survey","volume":"32","author":"Noland","year":"2018","journal-title":"Am J Health Promot"},{"key":"2026072114015059700_ref7","doi-asserted-by":"publisher","first-page":"1554","DOI":"10.2105\/AJPH.2017.303967","article-title":"Rural versus urban use of traditional and emerging tobacco products in the United States, 2013\u20132014","volume":"107","author":"Roberts","year":"2017","journal-title":"Am J Public Health"},{"key":"2026072114015059700_ref8","doi-asserted-by":"publisher","first-page":"105898","DOI":"10.1016\/j.ypmed.2019.105898","article-title":"Rural\u2013urban differences in e-cigarette ever use, perception of harm, and information-seeking behaviors among US adults in a nationally representative study","volume":"130","author":"Lewis-Thames","year":"2020","journal-title":"Prev Med"},{"key":"2026072114015059700_ref9","doi-asserted-by":"publisher","first-page":"1736","DOI":"10.15585\/mmwr.mm6946a4","article-title":"Tobacco product use among adults\u2014United States, 2019","volume":"69","author":"Cornelius","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026072114015059700_ref10","doi-asserted-by":"publisher","first-page":"1394","DOI":"10.1001\/jamainternmed.2020.2817","article-title":"Trends in e-cigarette use in adults in the United States, 2016\u20132018","volume":"180","author":"Obisesan","year":"2020","journal-title":"JAMA Intern Med"},{"key":"2026072114015059700_ref11","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1111\/jrh.12333","article-title":"Regional rural\u2013urban differences in e-cigarette use and reasons for use in the United States","volume":"35","author":"Mumford","year":"2019","journal-title":"J Rural Health"},{"key":"2026072114015059700_ref12","author":"US Department of Commerce, Census Bureau; 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