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Rural Health Information Hub

Implementation Challenges

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 that integrating 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.