Study: Neighborhood Disadvantage and Adolescent Substance Use: Differences by Urbanicity and Substance Type (DOI: 10.15288/jsad.25-00368)
Teens in disadvantaged neighborhoods are more likely to smoke, but it depends on whether they live in rural or urban areas.
A new University of Michigan study highlights a distinct rural-urban gap in adolescent health. It reports that the link between neighborhood disadvantage and cigarette use appears only in rural areas. Teens in poor rural neighborhoods are more likely to smoke cigarettes than their peers in less disadvantaged rural areas.
These results suggest that urban areas may offer different social influences.
"In rural areas, adults smoke at higher rates and quit at lower rates," said Joy Jang, assistant research scientist at U-M's Institute for Social Research. "That environment may lower the perceived risk of smoking for adolescents."
Published in the Journal of Studies on Alcohol and Drugs and funded by the National Institute on Drug Abuse, the study analyzed data from the Monitoring the Future Study.
Jang and colleague Megan Patrick, research professor at ISR and MTF principal investigator, also examined how the neighborhood socioeconomic environment relates to binge drinking and cannabis use among U.S. teens.
"We found that neighborhood contexts play an important role in adolescent substance use, although their associations vary by substance type and by the broader context of urbanicity," Jang said. "Cigarette use increased with neighborhood disadvantage, but the patterns were not the same everywhere."
The researchers said the study did not test mechanisms directly, but the pattern aligns with weaker tobacco control policies and more permissive smoking norms in rural communities.
Regarding binge drinking, the likelihood decreased as neighborhood disadvantage increased, regardless of urbanicity, but this link was driven by family socioeconomic status, measured via parental education as a proxy.
"The findings suggest that both neighborhood context and family resources matter," Jang said. "Prevention efforts should address both."
The urban cannabis gap
Cannabis use showed a different pattern. Teens in urban areas had a higher likelihood of cannabis use, no matter the neighborhood disadvantage. Findings match today's cannabis laws and access.
"Urban adolescents may be at particular risk for cannabis use with the shifts in the regulatory landscape and increased presence of cannabis retailers in their neighborhoods," Patrick said.
Patrick and Jang said their findings have long‑term implications for public health. More teen cigarette use in disadvantaged rural neighborhoods and more cannabis use in urban neighborhoods may reinforce health disparities into adulthood. There is a need for targeted, place‑based prevention strategies, they said.
"This study shows that neighborhood conditions are associated with substance use in different ways and we should pay attention to where adolescents live and what they are experiencing," Patrick said. "Understanding these patterns can help policymakers and communities design more effective interventions and target prevention resources to where they are needed most."
According to the authors, more research is needed to identify the mechanisms linking neighborhood contexts to substance use and to understand how adolescent environments influence substance use into adulthood.
