{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T15:42:32Z","timestamp":1784907752024,"version":"3.55.0"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2010level prevalence estimates for cigarette and smokeless tobacco use for each county in Kentucky, calculated using pooled 3\u2010year estimates (2017\u20102019) of Kentucky Behavioral Risk Factor Surveillance System data. We modeled county\u2010level 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>We observed significant interactions between retailer density and rurality for both cigarette and smokeless tobacco use. Post\u2010hoc 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\u2010density counties. Retailer density was not associated with the prevalence of cigarette and smokeless tobacco use within the 2 more rural tertiles of counties.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Consistent with prior research, policies limiting tobacco retailer density could be most beneficial in urban and urban\u2010adjacent areas, while other policies may need to be considered for rural areas, even within a relatively rural state such as Kentucky.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70106","type":"journal-article","created":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T06:00:15Z","timestamp":1766815215000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The interaction of tobacco retailer density and rurality with tobacco use prevalence in Kentucky"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4200-1197","authenticated-orcid":false,"given":"Shyanika W.","family":"Rose","sequence":"first","affiliation":[{"name":"Department of Behavioral Science College of Medicine University of Kentucky  Lexington Kentucky USA"},{"name":"Markey Cancer Center University of Kentucky  Lexington Kentucky USA"},{"name":"Center for Health Engagement and Transformation College of Medicine University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Jay","family":"Christian","sequence":"additional","affiliation":[{"name":"Department of Epidemiology &amp; Environmental Health College of Public Health University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy van de","family":"Venne","sequence":"additional","affiliation":[{"name":"Center for Health Engagement and Transformation College of Medicine University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delvon","family":"Mattingly","sequence":"additional","affiliation":[{"name":"Department of Behavioral Science College of Medicine University of Kentucky  Lexington Kentucky USA"},{"name":"Center for Health Engagement and Transformation College of Medicine University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany Shorey","family":"Fennell","sequence":"additional","affiliation":[{"name":"Markey Cancer Center University of Kentucky  Lexington Kentucky USA"},{"name":"Department of Family &amp; Community Medicine College of Medicine University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5084-1965","authenticated-orcid":false,"given":"Saber","family":"Feizy","sequence":"additional","affiliation":[{"name":"Department of Behavioral Science College of Medicine University of Kentucky  Lexington Kentucky USA"},{"name":"Center for Health Engagement and Transformation College of Medicine University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Kay","family":"Rayens","sequence":"additional","affiliation":[{"name":"College of Nursing University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,26]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"U.S. Department of Health and Human Services.The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General.Atlanta GA:U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Office on Smoking and Health;2014."},{"key":"e_1_2_8_3_1","unstructured":"National Cancer Institute.The Role of the Media in Promoting and Reducing Tobacco Use.Bethesda MD:Department of Health and Human Services National Institutes of Health National Cancer Institute;2008."},{"key":"e_1_2_8_4_1","unstructured":"U.S. Department of Health and Human Services.Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.Atlanta GA:U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Office on Smoking and Health;2012."},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2011-050416"},{"key":"e_1_2_8_6_1","unstructured":"Federal Trade Commission.Cigarette Report for 2022.Washington DC:2023."},{"key":"e_1_2_8_7_1","unstructured":"Federal Trade Commission.Smokeless Tobacco Report for 2022.Washington DC;2023."},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2019.102275"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2021-056717"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2017.303685"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/1524839919888652"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2018.08.035"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2019.101005"},{"key":"e_1_2_8_14_1","unstructured":"American Lung Association.Adult Cigarette Smoking Rates by State.2022.https:\/\/www.lung.org\/research\/trends\u2010in\u2010lung\u2010disease\/tobacco\u2010trends\u2010brief\/rates\u2010by\u2010state"},{"key":"e_1_2_8_15_1","unstructured":"Kentucky State Data Center.Annual Estimates of the Total Population (2020\u20102023).2024."},{"key":"e_1_2_8_16_1","unstructured":"Centers for Disease Control and Prevention.Behavioral Risk Factor Surveillance System Survey Questionnaire.Atlanta GA;2017\u20132019."},{"key":"e_1_2_8_17_1","unstructured":"Centers for Disease Control and Prevention (CDC).Behavioral Risk Factor Surveillance System (BRFSS): Complex Sampling Weights and Preparing 2019 BRFSS Module Data for Analysis.Atlanta GA;2020."},{"key":"e_1_2_8_18_1","unstructured":"WaldorfBS.A Continuous Multi\u2010Dimensional Measure of Rurality: Moving Beyond Threshold Measures.2006."},{"key":"e_1_2_8_19_1","unstructured":"WaldorfBS KimA.Defining and Measuring Rurality in the US: From Typologies to Continuous Indices.2015."},{"key":"e_1_2_8_20_1","unstructured":"KimA WaldorfB.The Index of Relative Rurality (IRR): US County Data for 2020 (1.0.0) Data Set.Zenodo;2023. doi:10.5281\/zenodo.7675745"},{"key":"e_1_2_8_21_1","unstructured":"Kentucky Department of Public Health.Kentucky Behavioral Risk Factor Survey (KyBRFS) 2021 Annual Report. Data Source: Kentucky Behavior Risk Factor Survey 2019.Frankfort KY:Kentucky Department for Public Health Division of Prevention and Quality Improvement Chronic Disease Prevention & Control Branch;2021."},{"key":"e_1_2_8_22_1","unstructured":"University of Kentucky College of Nursing (BREATHE).Kentucky Smoke\u2010Free Ordinance Database.2024."},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/tc-2024-058739"}],"container-title":["The Journal of Rural Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.70106","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jrh.70106","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.70106","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T06:12:24Z","timestamp":1778047944000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jrh.70106"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,26]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/jrh.70106"],"URL":"https:\/\/doi.org\/10.1111\/jrh.70106","archive":["Portico"],"relation":{},"ISSN":["0890-765X","1748-0361"],"issn-type":[{"value":"0890-765X","type":"print"},{"value":"1748-0361","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,26]]},"assertion":[{"value":"2025-02-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70106"}}