Rural E-Cigarette Use Higher than Urban Across Age Groups

Abstract Introduction 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–urban differences in ENDS use across detailed age groups. Methods We analyzed data from the 2022–2023 Tobacco Use Supplement to the Current Population Survey (TUS-CPS), a nationally representative survey of U.S. adults (≥18 years). Respondents were categorized into four age groups (18–24, 25–44, 45–64, ≥65). Rural–urban residence was defined using metropolitan status. Weighted prevalence estimate of lifetime, former, and current ENDS use were calculated by age group and rural–urban residence, and gender-adjusted contrasts were estimated using survey-weighted marginal standardization. Results 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 25–44 and 45–64 (current use PRs of 1.29 and 1.44, respectively). YAs (18–24) in rural areas had the highest prevalence (lifetime: 19.5%; current: 10.5%). Among lifetime users, adults aged 18–24 and 25–44 in rural areas were more likely to report current use than their counterparts in urban areas (18–24: 53.8% vs. 44.6%; 25–44: 35.2% vs. 29.5%). Former use was significantly higher in rural areas overall and among adults aged 25–44 and 45–64, but not among adults aged 18–24 or ≥65. Conclusions These patterns of ENDS use underscore the need for age-targeted ENDS prevention and cessation interventions in rural populations.