Prevalence of Tobacco Use Among Rural-Dwelling Individuals Who Inject Drugs

Discussion

Among this large sample of rural-dwelling individuals who were actively injecting opioids and/or stimulants, an extremely high proportion reported that they currently smoked cigarettes. The smoking rate of more than 90% is among the highest reported among any subpopulation and exceeds that of many other groups with a high prevalence of smoking, including adults with schizophrenia. In contrast, the overall adult smoking prevalence rate in the US in 2018 was 13.8%.

Although tobacco control interventions during the past several decades have led to overall declines in smoking, PWID in rural communities appear not to have been reached by these measures. The health risks associated with tobacco use among rural-dwelling PWID may be exacerbated by limited access to primary care, unstable housing, and other social determinants. Our findings suggest that novel approaches to eliminating tobacco use among this population are needed.

Limitations of this study include its focus on residents of a single US state and reliance on a non random sampling method. Respondent-driven sampling, a social network–based recruitment strategy, is a widely used tool for engaging difficult-to-reach populations in research, but it may underestimate the variability within populations because of the tendency of participants to recruit peers with similar characteristics. However, preliminary analysis suggests that there were no differences in smoking prevalence based on whether participants recruited their peers to the study. Network chains of participants recruited by their peers did show variability in terms of drug of choice, syringe sharing behavior, and alcohol use. Future research should examine regional and sociodemographic variability of tobacco use patterns among PWID and seek to inform smoking cessation interventions that are appropriately tailored to the health and social service needs of this population.