Project Abstract
Individuals with chronic obstructive pulmonary disease (COPD) who live in rural areas of the United States
have worse health outcomes compared with their non-rural counterparts. Although it is known that rural areas
have higher rates of cigarette smoking, and that cigarette smoking is associated with worse outcomes in
COPD, less is known about geographic variations in the motivations and beliefs that influence tobacco product
appeal and use, especially among newer tobacco products including e-cigarettes. Further, it is largely
unknown how much variability in tobacco use accounts for the geographic differences seen in COPD
outcomes. Our long-term goal is to identify potentially modifiable determinants of tobacco product use that
contribute to worse COPD in rural US, leading to future geographically tailored interventions designed to
improve outcomes. Our overall objective for this application, which is the next step toward attainment of our
long-term goal, is to quantify the perceptions of risk and benefit on the pattern of tobacco use in rural and
urban populations in the United States, and to determine the impact of such patterns on COPD outcomes.
Our central hypothesis is that perceptions of risk and benefit of tobacco products differ by geographic location
in the US, and that tobacco exposure contributes significantly to the increased COPD risks associated with
rural location. The rationale for this project is that identifying factors that influence tobacco product appeal
and use will provide detailed insight into potentially modifiable contributors to geographic disparities in health
outcomes and inform regulatory strategy. Using existing datasets, we will test our hypothesis in two specific
aims: 1) To quantify and compare patterns of tobacco product use by geographic location, and to determine
how perceptions of risk and benefit of tobacco products differ by geographic location; 2) To determine the
relationship between geographic location and COPD prevalence, incidence, and respiratory symptoms, and
to quantify the contribution of tobacco product exposure to these relationships. To address our aims, will use
data from the Population Assessment of Tobacco and Health (PATH) Study and the National Health Interview
Survey (NHIS).The PATH Study is a longitudinal, nationally representative study that includes detailed
questions on the motivations, beliefs, and perceptions influencing tobacco product use, allowing us to analyze
the longitudinal association of these trends with COPD risk and respiratory symptoms within a broad definition
of urbanicity. In a separate, focused analysis, we will determine the cross-sectional association between
tobacco products and COPD prevalence across urban/rural continuum using nationally representative data
from the NHIS study. Our research team has extensive experience working with these datasets, each
providing complimentary longitudinal and cross sectional perspectives to allow for comprehensive
assessment of the contribution of tobacco use to observed disparities in COPD outcomes in rural populations.