Exploring the Link between Altitude of Residence and Smoking Patterns in the United States

Author:

Boxer Danielle Jeanne-Marie1ORCID,Sung Young-Hoon1,Nunez Nicolas A.12,Fitzgerald Colleen Elizabeth13,Renshaw Perry Franklin14,Kondo Douglas Gavin14

Affiliation:

1. Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84112, USA

2. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA

3. Intermountain Health, Oncology Clinical Trials, Intermountain Health, Salt Lake City, UT 84107, USA

4. Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), George E. Whalen Department of Veterans Affairs (VA) Medical Center, Salt Lake City, UT 84148, USA

Abstract

Introduction: Smoking-related diseases affect 16 million Americans, causing approximately 480,000 deaths annually. The prevalence of cigarette smoking varies regionally across the United States, and previous research indicates that regional rates of smoking-related diseases demonstrate a negative association with altitude. The purpose of this study was to determine the relationship between altitude and the prevalence of cigarette smoking by county (N = 3106) in the United States. We hypothesized that smoking prevalence among adults would be negatively associated with mean county altitude. Methods: A multivariate linear regression was performed to examine the relationship between county-level mean altitude and county smoking rate. Covariates were individually correlated with 2020 smoking data, and significant associations were included in the final model. Results: The multivariate linear regression indicated that the county-level smoking rates are significantly reduced at high altitudes (p < 0.001). The model accounted for 89.5% of the variance in smoking prevalence, and for each 1000-foot increase in altitude above sea level, smoking rates decreased by 0.143%. Based on multivariate linear regression, the following variables remained independently and significantly associated: race, sex, educational attainment, socioeconomic status, unemployment, physical inactivity, drinking behavior, mental distress, and tobacco taxation. Conclusions: Our results indicate that smoking rates are negatively associated with altitude, which may suggest that altitude affects the pharmacokinetics, pharmacodynamics, and mechanistic pathways involved in cigarette use. Further research is needed to explore the relationship between altitude and smoking and how altitude may serve as a protective factor in the acquisition and maintenance of tobacco use disorders.

Funder

National Institutes of Health

U.S. Department of Veterans Affairs

Utah Science and Technology Research initiative

Publisher

MDPI AG

Reference79 articles.

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3. World Health Organization (2013). WHO Report on the Global Tobacco Epidemic, 2013: Enforcing Bans on Tobacco Advertising, Promotion and Sponsorship, World Health Organization.

4. Current Cigarette Smoking Among Adults—United States, 2005–2015;Jamal;MMWR Morb. Mortal. Wkly. Rep.,2016

5. Tobacco product use among adults—United States, 2020;Cornelius;MMWR Morb. Mortal. Wkly. Rep.,2022

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