Rural communities may face unique challenges when implementing a tobacco cessation and prevention intervention.
Lack of Anonymity
Some rural tobacco cessation programs report that individuals decline group counseling because they
are hesitant to share their experiences with other community members. Maintaining anonymity is
especially challenging in small rural communities. One rural program addressed this issue by offering
smoking cessation counseling over the phone. Other programs offer in-person individual counseling or
refer community members to state quitlines and online cessation services. Some rural clinics find
primary and behavioral care helps address the stigma that may be associated with seeking services
for tobacco dependence.
Telephone counseling and quitlines can also help rural communities overcome transportation barriers
that limit access to in-person cessation services in healthcare facilities. In addition, some state
quitlines send nicotine replacement therapy via mail, which allows rural residents to receive
cessation medication without traveling to a prescriber and pharmacy. Cessation services offered
through the workplace and community-based organizations can also help eliminate access barriers
related to travel.
State-level laws can preempt
local governments from passing laws that regulate the sale and use of tobacco, including ordinances that
regulate tobacco advertising, mandate tobacco- and smoke-free spaces, restrict youth access to tobacco, and
tobacco retailer licensure. The American
Medical Association and the Robert Wood Johnson Foundation's SmokeLess
States National Tobacco Policy Initiative developed a report
that describes how some local governments have addressed preemption in their states.
Cultural Ties to Tobacco
Rural communities may have deep cultural ties to tobacco use and production. Some activities linked to rural
culture, such as rodeos, hunting, and mining, are
associated with tobacco sponsorship or disproportionately high levels of tobacco use. Several rural
communities have created tailored tobacco prevention and cessation materials that specifically address the
cultural implications of tobacco use:
One of many of the cultural-based videos for Down and Dirty
focuses on tobacco-free hunting. Other approaches,
based on primary research, include strong family ties and the effect of tobacco on younger siblings.
As part of the communications effort for the Montana State Quitline, the Department of Health and
Human Services created advertisements (Rodeo
Carson, Rodeo Charley) that feature
rodeo riders promoting tobacco-free living.
The Southern Coalfields Tobacco Prevention
Network in West Virginia provided tobacco cessation classes at mining sites and
creating advertisements promoting tobacco cessation that highlighted the support of local mining companies.
In addition, some rural community members who live in tobacco-producing regions or are involved in raising
tobacco themselves may have concerns about the effects of tobacco control on the local economy.