Introduction:
People with psychiatric disorders (PDs) are disproportionately affected by tobacco use and its associated harms. Although several unique risk factors are known for this population, few studies have examined differences based on urban or rural residence.

Objectives:
We aim to examine factors associated with tobacco use and consumption among rural and urban patients with PDs.

Methods:
This is a retrospective correlational study using clinical data of 2,060 patients admitted to a government inpatient psychiatric facility between January 1, 2016 and December 31, 2016. Information was obtained on demographics, rurality status, smoke free policy status, substance use history, psychiatric diagnosis, and history of tobacco use. Logistic and multilinear regression analyses were performed to examine factors associated with tobacco use and consumption, stratified by urban and rural status.

Results:
Tobacco users were significantly more likely to reside in rural as compared to urban settings (67.2% vs. 58.8%; p<0.001). Factors significantly associated with tobacco use among the urban population were male sex, history of substance use and treatment, and externalizing disorder. Among the rural population, history of substance use and treatment, less than high school education, decreasing age, and shorter length of hospital stay increased the risk of tobacco use. White, less than high school education, and psychotic disorder were significantly correlated with greater tobacco consumption in the urban population. For the rural population, male and less than high school education were positively associated with increased tobacco consumption.

Conclusions:
Although rural patients with PDs are more likely to use tobacco, they face similar risk factors as compared to their urban counterparts. This suggests the need to increase access to treatment for rural individuals with PDs to reduce such disproportionate tobacco use prevalence and related disease risk.