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Rural Health Information Hub

Barriers to Establishing Tobacco Prevention and Control Programs in Rural Communities

This section provides an overview of barriers to establishing tobacco prevention and control programs in rural communities.

Access to Tobacco Cessation Services

Studies have shown that brief tobacco cessation counseling sessions can have a significant impact on influencing individuals to quit smoking. However, rural community members may face barriers in accessing healthcare services that are designed to help them quit tobacco use. For example, patients may have to travel long distances to receive in-person cessation services. In addition, while practitioners may advise their patients to quit smoking, they may not always provide resources that help ensure successful tobacco cessation (for example, referrals to counseling or access to low-cost nicotine replacement therapy). Inadequate health insurance coverage or high out-of-pocket costs may also deter rural individuals from accessing or seeking tobacco cessation services.

Social Attitudes and Personal Beliefs

Tobacco use is deeply embedded in the social environment of many rural communities. Youth are likely to be surrounded by tobacco-using role models and unlikely to receive anti-tobacco messages through available media channels. Rural community members may also be more likely to perceive anti-tobacco policies as a violation of their individual rights or their personal freedoms. The tobacco industry has capitalized on this argument by establishing an image of rugged individualism that is associated with tobacco use.

Tobacco-Free Policies

Rural communities may face barriers to enacting tobacco-free policies. State and local governments in rural areas have been less likely to enact policies that have successfully reduced tobacco use in other areas. For example, policymakers in rural areas are less likely to increase excise taxes or eliminate exposure to secondhand smoke in the workplace or other publicly frequented areas. In addition, rural schools are much less likely to have tobacco-free campus policies. A study found that only 28% of schools in Kentucky reported adhering to a 100% tobacco-free policy.

Additionally, local businesses may have concerns about the economic impacts of smoke-free policies. For example, one study found that some business owners involved in tourism feared that visitors from areas with fewer smoke-free policies would not return. Restaurant and bar owners may also view smoke-free policies as detrimental to business revenue.


Anti-tobacco media campaigns that advertise the dangers of tobacco use and expose the deceptive marketing tactics of tobacco companies can effectively decrease tobacco use and initiation. However, many of these mass media campaigns are broadcast in metropolitan areas and may not have a large presence in rural communities.