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Spit It Out-West Virginia

  • Need: Due to West Virginia's high ranking for its use of smokeless tobacco, prevention and cessation education efforts were needed.
  • Intervention: Development and implementation of the Spit It Out-West Virginia program.
  • Results: Supported by a 2008-2010 grant allowing the program to be delivered to hundreds of people, 5 workplaces became tobacco free. The program continues to be delivered across the state and reaches hundreds with its face-to-face presentations and thousands with its specific media prevention and cessation messages.


Effective (About evidence-level criteria)


billboards for Spit It Out-West VirginiaIn the years prior to 2008, West Virginia — and especially McDowell County, located in southwestern West Virginia — had high rates of tobacco cigarette and smokeless tobacco use, the latter in the form of chew tobacco. Also referred to as “snus” or “snuff,” chew tobacco has significant adverse health impacts.

Early evidence suggested chew tobacco use in West Virginia was linked to several causes: lack of prevention and cessation services, and a deeply-entrenched rural culture that viewed sports and hunting as synonymous with smokeless tobacco use.

To offer prevention and cessation education, the Southern Coalfields Regional Tobacco Prevention Network Office (SCRTPNO), a community-based regional prevention coalition, decided to address this smokeless tobacco problem by implementing Spit It Out-West Virginia. The original 2008-2010 grant-funded program was based on evidence-informed science that provided culturally appropriate information.

The 2-year grant support was provided by the American Legacy Foundation, a non-profit public health organization now called the Truth Initiative. After the initial grant cycle, program delivery continued through its association with West Virginia University Extension and other partners.

For the past several years, program support by the the McDowell County Commission on Aging and the West Virginia Division of Tobacco Prevention, has allowed the continuation of statewide outreach.

Although current smokeless tobacco prevention and cessation work is frequently focused on the increased use of smokeless tobacco in the form of e-cigarettes, West Virginia's high chew tobacco rates still warrant prevention/cessation work as provided by the Spit It Out-West Virginia program.

Note: The original grant program's implementation and outcome data currently serves as a culturally-focused case study for a university's public health graduate program curriculum.

Services offered

The original grant-funded project had 2 main goals: to increase access to smokeless tobacco prevention and cessation services, and to increase tobacco-free workplaces and recreational venues.

To achieve these goals, the original Spit It Out program work included:

  • Placement of 6 billboards across the county providing information about the harmful effects of smokeless tobacco
  • Airing of 300 radio ads during hunting season on a local radio station
  • Provision of tobacco-free education at community events
  • Provision of print materials to local businesses and other public venues
  • Providing tobacco cessation workshops for miners at the Brooks Run Mining Company
  • Provision of individual counseling
  • Engagement with local faith-based organizations to promote tobacco prevention and cessation
  • Engagement with local businesses on implementation of tobacco-free workplaces

Today's program continues through the work of a project director — who is a tobacco cessation specialist — a nurse, and program partners who provide outreach to many West Virginia counties.

The program also continues to reach a broad audience not only because of its efforts specifically dedicated to chew tobacco cessation, but its inclusion in tobacco cessation and tobacco prevention programs.

Of note: Because of the technical changes in coal mining, the program is longer able to reach miners in their workplace.


The results from the initial 2008-2010 grant were:

  • 254 residents attended smokeless tobacco cessation workshops that focused on helping them quit smokeless tobacco during the project's first year
  • The tobacco cessation hotline enrollment from the county increased by 800%
  • 110 individuals received cessation counseling • 102 individuals received nicotine replacement therapy
  • 49 church representatives received smokeless tobacco prevention and cessation resources for their church
  • 6 mini-grants were awarded to local faith-based institutions to organize events to educate constituents about the dangers of smokeless tobacco use and the importance of cessation
  • 5 businesses adopted a tobacco-free workplace policy

Unique to the original program's outreach was partnering with local faith-based organizations to reach disadvantaged residents of McDowell County by. This partnership was considered a cornerstone of the initial project and played a large part in its success. More cessation success was seen when leveraging evidence that tobacco cessation in all forms can make an immediate positive impact on participants' families, as well as tobacco users themselves.

Recent 2022-2023 state-wide outreach results:

Tobacco Cessation Program:

  • 10 workshops with 60 participants

Tobacco Education Program:

  • 7 workshops with 60 participants

"Through with Chew" Media Campaign:

  • Media outreach to 30 West Virginia newspapers, 50 dentists, and a Facebook campaign: estimated 60,000 individuals reached.

Read further information about the program in academic articles:

A 2017 video reviews the previous project's successes and shares ideas about the continuing modern tobacco control approaches:


While the Spit It Out project was originally tailored to McDowell County's hunting, gaming, and coal mining community, other organizations can replicate it by using evidence-based smokeless tobacco free education packages and targeting the social norms and cultural traditions of their target population.

Efforts are strengthened when demonstrating that tobacco cessation in all forms can make an immediate positive impact on participants' families, as well as tobacco users themselves.

Contact Information

Donald R. Reed, Jr., DrPH, CPH McDowell County Commission on Aging

Tobacco use
Wellness, health promotion, and disease prevention

States served
West Virginia

Date added
April 14, 2010

Date updated or reviewed
February 27, 2024

Suggested citation: Rural Health Information Hub, 2024. Spit It Out-West Virginia [online]. Rural Health Information Hub. Available at: [Accessed 21 May 2024]

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.