Population considerations:

  • Access to services. People living in rural communities may have trouble accessing health care. They may have very few health care resources in their surrounding areas as opposed to people living in more urban or populated areas. They may not have the transportation to places to receive education or help with issues related to tobacco use (Stevens, 2003). Rural-dwelling adults are less likely to have health insurance coverage, must travel longer distances for health care, have health care providers and have limited access to smoking cessation programs and interventions (Hutcheson, 2008).
  • Absence of alternatives. Prevalence of cigarette smoking among both adults and adolescents in some rural areas may be higher than in suburban or urban communities and rural smokers tend to smoke more cigarettes per day than non-rural smokers (Hutcheson, 2008). In terms of community/social factors, rural individuals acknowledge the negative social impact/image of smoking, but state that a lack of alternative activities and few public restrictions are barriers to cessation (Hutcheson, 2008).

  Strategies to address these considerations:

  • Increase knowledge. Individuals may be unaware of the growing body of national hotline, online resources and state-sponsored programs, which have been shown to be important aspects to addressing tobacco use and cessation. To combat the lack of knowledge of existing resources, advertising through media, billboards, informational booths at community events, flyers and brochures in physicians’ offices, community health centers, recreation centers and schools is essential (Hutcheson, 2008).
  • Increase access. Telephone counseling, internet or e-mail-based programs and telemedicine are all potential cost-effective mediums for delivering smoking cessation interventions (Hutcheson, 2008). Self-help materials and campaigns and promotions may provide a means for rural communities to access information from their homes, which may be more convenient and help overcome transportation barriers.
  • Train health care providers. Health care providers are in a unique position to offer brief, effective interventions to the majority of smokers each year. This may be vital for rural smokers who have limited access to other smoking cessation resources (Hutcheson, 2008). Local providers should receive training on how to counsel rural populations since they may be one of the only smoking cessation resources in the community.
  • Involve the community. Interventions should not be relegated only to the “health care” arena. Community organizations, schools, churches and local businesses need to be involved through forming coalitions, helping secure continuous funding for resources, leading public health campaigns and being a potential route of administration for smoking cessation programs for community tobacco control (Hutcheson, 2008). Effective community programs involve and influence people in their homes, worksites, schools, places of worship, places of entertainment, health care settings, civic organizations and other public places. Changing policies that can influence societal organizations, systems and networks requires the involvement of community partners (CDC, 1999).
  • Establish environmental support. Increasing environmental supports such as instilling smoke-free establishments in rural communities would be optimal (Hutcheson, 2008).
  • Enact Smoke-Free Laws. Smoke-free legislation has had a significant effect on adult smoking rates and can be applied in rural settings (Hahn, 2008).
  • Target treatments and education. With spit tobacco users, the most effective treatment studies have been in dental care settings, in which dental hygienists play an active role in educating and treating spit tobacco users. Direct linkage and demonstration of spit tobacco use with tangible negative health consequences may be particularly effective in enhancing motivation to quit. (Hatsukami, 1999).

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