The Importance of Location for Tobacco Cessation: Rural–Urban Disparities in Quit Success in Underserved West Virginia Counties |
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Authors: | Mary E Northridge PhD MPH ; Donna Vallone PhD ; Haijun Xiao MS ; Molly Green MPH ; Julia Weikle Blackwood MA MPH CHES ; Suzanne E Kemper MPH ; Jennifer Duke PhD ; Kimberly A Watson BS ; Barri Burrus PhD ; and Henrie M Treadwell PhD |
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Institution: | Department of Sociomedical Sciences, Mailman School of Public Health at Columbia University, New York, NY.;Research and Evaluation, American Legacy Foundation, Washington, DC.;Charleston Area Medical Center Health Education and Research Institute, Charleston, WVa.;Center for Health Services and Outcomes Research, Charleston Area Medical Center, Charleston, WVa.;Research Triangle Institute (RTI) International, Research Triangle Park, NC.;National Center for Primary Care, Morehouse School of Medicine, Atlanta, Ga. |
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Abstract: | ABSTRACT: Context: Adults who live in rural areas of the United States have among the highest smoking rates in the country. Rural populations, including Appalachian adults, have been historically underserved by tobacco control programs and policies and little is known about their effectiveness. Purpose: To examine the end-of-class quit success of participants in A Tobacco Cessation Project for Disadvantaged West Virginia Communities by place of residence (rural West Virginia and the urban area of Greater Charleston). Methods: This collaborative program was implemented in 5 underserved rural counties in West Virginia and consisted of 4 intervention approaches: (1) a medical examination; (2) an 8-session educational and behavioral modification program; (3) an 8-week supply of pharmacotherapy; and (4) follow-up support group meetings. Findings: Of the 725 program participants, 385 (53.1%) had successfully quit using tobacco at the last group cessation class they attended. Participants who lived in rural West Virginia counties had a lower end-of-class quit success rate than those who lived in the urban area of Greater Charleston (unadjusted odds ratio OR]= 0.69, 95% confidence interval CI]= 0.48, 0.99), even after taking into account other characteristics known to influence quit success (adjusted OR = 0.58, 95% CI = 0.35, 0.94). Conclusions: Tobacco control programs in rural West Virginia would do well to build upon the positive aspects of rural life while addressing the infrastructure and economic needs of the region. End-of-class quit success may usefully be viewed as a stage on the continuum of change toward long-term quit success. |
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