An evidence-based cessation strategy using rural smokers' experiences with tobacco

Geographic isolation predicts tobacco product use among youth: A latent class analysis

PURPOSE

The purpose of the current study was to evaluate associations between geographic rurality and tobacco use patterns among adolescents.

METHODS

High school students (N = 566) from north-central Appalachia reported on their lifetime and/or current use of cigarettes, electronic cigarettes (ECIGs), cigars, and smokeless tobacco. Geographic rurality was measured via the Isolation scale, whereby residential ZIP Codes determined the degree to which respondents have access to health-related resources. Latent class analysis (LCA) was used to identify discrete classes of adolescent tobacco users based on their use of tobacco products. Then, associations between participants' geographic rurality and class membership were evaluated using a series of multinomial logistic regressions.

FINDINGS

LCA classified participants as Nonusers, Current ECIG Users, Cigarette/ECIG Experimenters, and Polytobacco Users. Individuals with higher Isolation scores were more likely to be Polytobacco Users and Cigarette/ECIG Experimenters than Nonusers, and were more likely to be Polytobacco Users than Current ECIG Users.

CONCLUSIONS

The continuous Isolation scale used in the present study predicted polytobacco use patterns among adolescents in a manner that is consistent with, while simultaneously expanding upon, prior work. Tobacco control practices and policies should be viewed through a lens that considers the unique needs of geographically isolated areas.

A pre-evaluation of psychological factors may positively affect the outcomes of smoking cessation treatments: A comparison in terms of smoking behavior

INTRODUCTION

The aim of this study was to compare smoking behavior in out-patients in terms of psychological factors with a view to supporting cessation treatment.

METHODS

We conducted a cross-sectional and analytical study through face-to-face interviews by the primary care physician with 765 volunteer participants who applied to our hospital for any reason between March and July 2019. The questionnaire administered had two parts: questions about sociodemographic characteristics and usage of tobacco and tobacco products, and questions of the UCLA Loneliness Scale, Multidimensional Scale of Perceived Social Support (MSPSS), Warwick-Edinburgh Mental Wellbeing Scale (WEMBS), and Fagerström Test for Nicotine Dependence (FTND).

RESULTS

The study was completed with 765 participants of which 53.1% (n=406) were female and 46.9% (n=359) male. Multidimensional perceived social support scale mean score of the participants was 69.9±15.2 (min=12, max=84). There was a significant relation between mean MPSS and mean WEMBS (p<0.05). As nicotine scores increased, the mean scores both in MPSS and WEMBS decreased (p<0.05).

CONCLUSIONS

We suggest that the results of the psychometric preliminary evaluations should be customized for individuals applying to smoking cessation clinics and that including the individual's close social connections in the process can facilitate the decision to quit, thus increase smoking cessation rates.

Smoking cessation interventions for people living in rural and remote areas: a systematic review protocol

INTRODUCTION

Smoking rates among people living in rural and remote areas are higher and quit rates are lower over the past 10 years compared with people living in suburban and urban areas. Higher smoking rates contribute to greater tobacco-related disease and morbidity in rural and remote areas. Physical and social isolation, greater exposure to pro-tobacco marketing, pro-tobacco social norms, and lower socioeconomic and educational levels are contributing to these higher smoking rates and lower quit rates. Smoking cessation interventions for people in rural and remote areas have been conducted, however little is known about their effectiveness or their mechanisms of action as well as the quality of such research. Behaviour change techniques (BCTs) are mechanisms of action derived from behaviour change theory, such as goal setting and reward. Improved understanding of the contribution of BCTs for smoking cessation in the rural and remote population will support future intervention development. We aim to review the literature on smoking cessation interventions for people living in rural and remote areas to inform evidence about intervention effectiveness and mechanisms of action.

METHODS AND ANALYSIS

We will conduct a systematic review using seven scientific databases (EMBASE, MedLine, PsycINFO, CINAHL, Cochrane, Informit Health and Scopus). We will include peer-reviewed journal articles published in English that examine a smoking cessation intervention delivered to people living in rural and remote areas in the USA, Canada and Australia. We will examine outcome data relating to intervention effectiveness (eg, point prevalence abstinence or continuous abstinence), as well as the BCTs used in included interventions and their relationship with intervention outcomes. We will also assess the feasibility, acceptability and quality of research interventions of included articles, and provide graded recommendations based on the review outcomes. Data will be synthesised using narrative approaches and interpreted using content analysis.

ETHICS AND DISSEMINATION

Ethics was not required for this systematic review. The results will be disseminated through peer-reviewed publication and at conferences by presentations.

PROSPERO REGISTRATION NUMBER

177398.

Perspectives on Smoking Cessation in Northern Appalachia

This study applies qualitative research methods to explore perspectives on cessation among smokers/former smokers recruited from an area of Northern Appalachia. Six focus groups, stratified by age group (18-39 years old and 40 years and older), were conducted among participants (n = 54) recruited from community settings. Participants described varied interest in and challenges with quitting smoking. Smokers 40 years and older more readily endorsed the health risks of smoking and had greater interest in quitting assistance. Participants expressed frustration with the US government for allowing a harmful product (e.g., cigarettes) to be promoted with minimal regulation. Use of social media was robust among both age groups; participants expressed limited interest in various social media/technology platforms for promoting smoking cessation. Findings from this understudied area of northern Appalachia reflect the heterogeneity of this region and contribute novel information about the beliefs, attitudes, and experiences of current and formers smokers with regard to cessation.

Creating Effective Media Messaging for Rural Smoke-free Policy

OBJECTIVES

Objectives were to (1) explore perceived effectiveness of existing smoke-free print advertisements in rural communities and (2) generate message content, characteristics, and media delivery channels that resonate with residents.

DESIGN AND SAMPLE

Qualitative methods design. Thirty-nine rural adults recruited by community partners.

MEASURES

Content analysis of findings from individuals in four focus groups who participated in general discussion and reviewed eight print ads related to secondhand smoke (SHS) and smoke-free policy.

RESULTS

Six content themes were identified: smoking/SHS dangers, worker health, analogies, economic impact, rights, and nostalgia. Seven message characteristics were recognized: short/to the point, large enough to read, graphic images, poignant stories, statistics/charts/graphs, message sender, and messages targeting different groups. Four media delivery channels were considered most effective: local media, technology, billboard messages, and print materials.

CONCLUSIONS

Seeking input from key informants is essential to reaching rural residents. Use of analogies in media messaging is a distinct contribution to the literature on effective smoke-free campaigns. Other findings support previous studies of effective messaging and delivery channels. Further research is needed to examine effectiveness of themes related to message content in smoke-free ads and delivery strategies. Effective media messaging can lead to policy change in rural communities to reduce exposure to SHS.

Health behaviors and anthropometric variables among older adults with and without hypertension

The objective was to describe socioeconomic, demographic and morbidity and compare the prevalence and odds of prevalence of health behaviors, overweight, abdominal circumference and indicative of depression among those with and without hypertension. It is cross-sectional study of rural elderly. We conducted descriptive analysis, chi-square test and multiple binary logistic regression (p<0,05). Predominated, for both groups, age 60├70, married, 4├8 years, income of a minimum wage and living with their spouse. Elderly patients with hypertension had lower odds of prevalence for alcohol and smoking and higher odds of overweight, abdominal circumference inappropriate and indicative of depression compared to those without hypertension. Reinforces health actions directed to the rural elderly, through the cessation of smoking and alcohol consumption, weight control and reduction of abdominal circumference among those with hypertension.

'It's about the smoke, not the smoker': messages that motivate rural communities to support smoke-free policies

Rural residents are exposed to sophisticated tobacco advertising and tobacco growing represents an economic mainstay in many rural communities. There is a need for effective health messages to counter the pro-tobacco culture in these communities. To determine relevant cultural themes and key message features that affect receptivity to pro-health advertisements among rural residents, 11 exploratory focus groups and surveys with community advocates (N = 82) in three rural Kentucky counties were conducted. Participants reviewed and rated a collection of print media advertisements and branding materials used by rural communities to promote smoke-free policies. Findings reveal that negative emotional tone, loss framing, appeals to religiosity, and shifting focus away from smokers are effective strategies with rural audiences. Potential pitfalls were identified. Attacks on smokers may not be a useful strategy. Health risk messages reinforced beliefs of secondhand smoke harm but some argued that the messages needed to appeal to smokers and emphasize health hazards to smokers, rather than to non-smokers only. Messages describing ineffectiveness of smoking sections were understood but participants felt they were only relevant for restaurants and not all public spaces. Emphasis on religiosity and social norms shows promise as a culturally sensitive approach to promoting smoke-free environments in rural communities.

Culturally-specific smoking cessation outreach in a rural community

OBJECTIVE

Tobacco use is the leading preventable cause of death, resulting in 443,000 US deaths per year. Rural adults have higher smoking prevalence and less access to tobacco dependence treatment than their urban counterparts. This study examined exposure to a culturally specific smoking cessation outreach intervention, assessing whether exposure was associated with cessation behaviors.

DESIGN AND SAMPLE

Post-test only quasi-experimental study. Targeted adult smokers (N = 251) living in a rural, economically distressed southeastern US county for at least 6 months.

MEASUREMENTS

Five outreach elements (brochures/pushcards, posters, print and radio advertisements, quilt made by local artisans) based on themes from focus groups with current and former smokers and paired with brief tobacco cessation counseling, and were delivered over 6 months in 2009-2010. Exposure and cessation behavior indicators were collected via cross-sectional random-digit dial survey. The total intervention exposure score was 4.8 (SD = 4.3, range 0-19).

RESULTS

Intervention exposure was associated with having talked to a health care provider about quitting smoking in the past 6 months and planning to quit smoking in the next 6 months.

CONCLUSIONS

Culturally specific outreach materials based on personal narratives are a promising population-based intervention to motivate rural smokers to consider cessation.

Smoke-free homes, strength of smoke-free law, and children in the home

INTRODUCTION

Secondhand smoke (SHS) is a leading cause of childhood illness and premature death, especially in rural areas. The study examined the relationship of having a smoke-free home, strength of smoke-free law (SFL) in the county of residence, having one or more minor children in the home, rural/urban location, and demographics.

METHODS

An Internet-based panel survey was administered to Kentucky residents from 2007 to 2012. Sample size ranged from 400 to 513 per year; N = 2,653 total. Most were female, aged 35-54, had at least some college education, and lived in a smoke-free home. Almost half lived in a county with a comprehensive SFL; 14% lived in a county with a moderate or weak law.

RESULTS

Multivariate logistic regression revealed that the significant predictors of a smoke-free home included having education beyond high school, being a nonsmoker, living in an urban county, and having a year of participation in the survey. Controlling for smoking status and other personal characteristics, those who responded to the survey in the last 2 years of administration were more likely to have a smoke-free home compared to the reference year of 2007. Respondents living in urban counties were nearly 2 times more likely to report a smoke-free home than rural dwellers.

CONCLUSIONS

Smoke-free homes in urban areas, where SFLs may be the norm, may be more typical than in rural communities. Public awareness campaigns and education about the benefits of smoke-free homes is needed, especially in rural areas, targeting smokers, those with less education, and those with children living in the home.