Even Fifth Graders Smoke: Examining Tobacco Use in Rural Communities

I would like to tell a story of a student I met many years ago in Southeast Missouri. This story is about a boy named Jason, a fifth grade student and a cancer survivor.

Jason grew up in rural farming community and had used smokeless tobacco, “chew” as he called it, since age 6. Tobacco use at a young age was not only modeled but acceptable in his family. Jason looked like your normal fifth grader; he loved sports and music. He tolerated school, for his passion was working on the family farm. Jason’s story isn’t like that of a “normal” fifth grader though, he was fighting cancer. At the start of his fifth grade year, cancerous sores began to appear in his mouth. After multiple surgeries and aggressive treatments Jason was cancer free, but he would have physical and emotional scars for life.

Jason’s story is unfortunately just one of many in rural areas. Our new disparity report, “Cutting Tobacco’s Rural Roots: Tobacco Use in Rural Communities,” takes a close look at tobacco use in rural communities. The report highlights that, “Rural youth are more likely to be surrounded by role models who are tobacco users, and are less likely to hear anti-tobacco messages in the media.”

According to a recent study, youth who live in rural areas were three times as likely as both urban and suburban youth to smoke. Among children living in rural areas, those who smoked a full cigarette before the age of 12 were twice as likely to become regular smokers as those who started experimenting at a later age. Overall, 37.4 percent of rural adolescents were considered regular, daily smokers, which was significantly higher than both suburban and urban adolescents. (Lutfiyya MN et al. Adolescent daily cigarette smoking: is rural residency a risk factor? Rural and RemoteHealth, January-March 2008;8:875.)

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Such high percentages of tobacco use aren’t simply just because of living in a rural community. One must understand the populations in rural communities are diverse and the reasons for increased tobacco rates are just as complex and diverse. Poverty, lack of education, and increased stress levels all contribute to tobacco use. Others include lack of funding for education and services while the tobacco industry pours millions into rural communities to recruit new young smokers. Best practices tell us increased tobacco tax and smoke-free public policies are the most effective measures to discourage youth from starting. However, Missouri has the lowest tobacco tax in the nation, and in Jason’s case, there are no smoke-free policies in Southeast Missouri, thus making it a societal norm.

Although the challenges ahead seem daunting, we must remain vigilant and ensure a brighter future for our youth. Collaborative efforts of The American Lung Association and many other health organizations across the nation are working together to implement successful initiatives. The American Lung Association in Missouri continues to be a part of health organizations and coalitions advocating for tobacco control throughout the state of Missouri. Rural communities have a long road ahead, but together we can make a difference in the lives of our youth.


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