Teens living in disadvantaged areas are more likely to smoke, but it depends on whether they live in rural or urban areas.
A new study from the University of Michigan highlights stark rural-urban disparities in the health of young people. It reports that the association between neighborhood disadvantage and tobacco use appears only in rural areas. Teens in poor rural areas are more likely to smoke cigarettes than their peers in disadvantaged rural areas.
These results suggest that urban areas may have different social impacts.
In rural areas, adult smoking rates are high and quit rates are low. Such environments may reduce the risk of smoking among adolescents. ”
Joy Jang, Assistant Researcher, UM Institute for Social Research
Published in Alcohol and Drug Research Journal The study was funded by the National Institute on Drug Abuse and analyzed data from the Prospective Monitoring Study.
Chan and colleague Megan Patrick, a research professor at ISR and principal investigator at MTF, also investigated how neighborhood socio-economic environments relate to binge drinking and marijuana use among U.S. teens.
“We found that neighborhood context plays an important role in adolescent substance use, but their associations vary by substance type and broader context of urbanity,” Zhang said. “Neighborhood disadvantage increased tobacco use, but the pattern was not the same everywhere.”
The researchers said that although the study did not directly test the mechanism, this pattern is consistent with weak tobacco control policies and permissive smoking norms in rural areas.
For binge drinking, the likelihood decreased as neighborhood disadvantage increased, independent of urbanicity, but this association was driven by family socioeconomic status, measured as a proxy for parental education.
“Our findings suggest that both neighborhood context and family resources are important,” Chan said. “Prevention efforts need to address both.”
Urban cannabis disparity
Cannabis use showed a different pattern. Urban teens were more likely to use cannabis regardless of neighborhood disadvantage. The findings are consistent with today’s cannabis laws and access.
“Due to the changing regulatory landscape and increased presence of cannabis retailers in their neighborhoods, urban youth may be at particular risk when it comes to cannabis use,” Patrick said.
Patrick and Chan said their findings have long-term implications for public health. Increased tobacco use among teenagers in disadvantaged rural areas and cannabis use in urban areas could further widen health disparities into adulthood. Targeted, place-based prevention strategies are needed, they said.
“This study shows that neighborhood context is associated with drug use in a variety of ways, and we need to pay attention to where youth live and what they are experiencing,” Patrick said. “Understanding these patterns can help policy makers and communities design more effective interventions and focus prevention resources where they are needed most.”
The authors say further research is needed to identify the mechanisms linking neighborhood context and drug use and to understand how the environment of adolescence influences drug use into adulthood.
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Reference magazines:
Jiang, J.B., and Patrick, Mayne (2026). Neighborhood disadvantage and adolescent substance use: Differences by urbanity and substance type. Alcohol and Drug Research Journal. DOI: 10.15288/jsad.25-00368. https://www.jsad.com/doi/10.15288/jsad.25-00368
