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Brianna Tranby, M.A., senior research program coordinator at Mayo Clinic recently presented findings on rural and urban differences in tobacco use, differences in tobacco use, support for quitting, and lung cancer screening at the American Association for Cancer Research Conference held in San Diego, California April 17-22, 2026. Her poster, titled Patterns of Tobacco Use, Cessation Interventions, and Lung Cancer Screening in Rural vs. Urban Areas Over Time: A 10-Year Retrospective Cohort Study, highlighted important trends that can help inform efforts to improve lung cancer prevention and early detection in rural communities.
What it is
The Rochester Epidemiology Project (REP) has collected clinical data in a 27-county area in Minnesota and Wisconsin for 60 years. A National Cancer Institute-funded R01 project with investigators from Mayo Clinic, Ohio State University, and Vanderbilt University, supported by the Rural Health Research Core, used REP data to understand patterns of tobacco use, cessation interventions and lung cancer screening in rural vs urban adults over time.
How it works
A retrospective cohort study from 2014-2023 used REP clinical data from healthcare encounters in a 27-county region of the midwestern United States. Patients aged 40-80 were included. Rural-Urban Commuting Area codes were used to assign residence as urban, rural, or highly rural. This study examined yearly smoking prevalence, cessation interventions including pharmacotherapy and counseling, and low-dose computed tomography (LDCT) lung cancer screening patterns across the rural-urban continuum in a geographically defined area over 10 years.
Key Findings
- Over the 10-year study period, the sample size ranged from 305,530 to 340,411 people annually with 36-38% urban, 56-57% rural, and 6-7% highly rural.
- Current smoking prevalence declined from 14 to 12% over the 10-year period and was consistently lower in urban areas than rural and highly rural areas.
- Among individuals who currently smoked with no history of lung cancer, yearly smoking cessation intervention ranged from 16% to 23%, increasing over the 10-year period.
- Cessation medication (varenicline, bupropion, or nicotine replacement) prescription consistently increased overall over time but remained higher in urban than rural and highly rural areas (p=<0.001).
- Cessation counseling rates also increased overall over time and were similar between urban and rural areas and lower in highly rural areas.
- Among people who had ever-smoked aged 50-80 years with no diagnosis of lung cancer, LDCT screening increased over the study period, with higher increases in urban areas and similar in rural and highly rural areas.
- Among people who currently smoke, LDCT screening increased over the study period, with higher increases in urban than rural or highly rural areas.
- After the new screening guidelines in 2021, rates in all areas increased year-on-year.
Community Impact
Smoking prevalence, cessation interventions, and lung cancer screening improved from 2014-2023 across the rural-urban continuum. Unfortunately, smoking prevalence remained higher and cessation interventions and screening rates lower in rural compared to urban areas. The persistent patterns underscore the need for strategies to overcome barriers for rural residents and improve lung cancer prevention and early detection in all areas.
A paper on further analysis of the data will be submitted later this year, helping to address health needs in rural communities.
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