How to Make an Impact in the Lives of Low-Income and Rural Tobacco Users

November 13, 2017|3:44 p.m.| ASTHO Staff

Donald R. Reed Jr.According to CDC, factors like income level and whether one lives in a metropolitan, urban, or rural area have a significant impact on one’s likelihood to smoke cigarettes or use other tobacco products. To gain a better perspective on tobacco control initiatives designed for rural and low-income tobacco users, ASTHO spoke with Donald R. Reed Jr. – a tobacco treatment specialist and faculty member with the West Virginia University Extension Service in McDowell County – after he participated in a Truth Initiative Warner Series panel discussion on eliminating tobacco use disparities. Reed’s insights on and experiences with reaching out to rural and low-income West Virginians can inform state and territorial health department efforts to deliver tobacco-free messaging and resources to populations that disproportionately shoulder the health burdens of tobacco use.

How have you collaborated with West Virginia Department of Health and Human Resources in your tobacco cessation work?

Since 2003, I have worked hand-in-hand with the West Virginia Department of Health and Human Resources Division of Tobacco Prevention. We have partnered on tobacco cessation and prevention projects, and they have been our major funder. We have also collaborated on tobacco research projects related to elementary-age smokeless tobacco education programs, and tobacco cessation interventions delivered by emergency room nurses.

From your perspective in West Virginia, why do low-income and rural populations struggle with addiction to tobacco products?

I think addiction to tobacco in West Virginia has many facets. There are generational factors that contribute to tobacco use in Appalachia, as tobacco is handed down as a rite of passage from father to son or uncle to nephew. Tobacco is viewed as part of our outdoor (e.g., hunting, fishing, riding all-terrain vehicles) culture, and tobacco is often used to self-medicate those who have some of the highest depression rates in the nation.

What unique barriers do rural and low-income populations face in living tobacco-free, and how can cessation interventions address these barriers?

The biggest barrier to cessation in rural, low-income communities is access to correct health information and cessation interventions. Many states rely solely upon telephone quit lines due to funding reductions and that is not a popular method of intervention in rural communities. In rural communities, we want to see, hear, and know the person we are speaking with. Health knowledge is often passed down to family members from a matriarchal standpoint, because the mother is often the one with the most education in the home. 

State health departments can expand the reach of tobacco cessation specialists and work with hospitals, primary care providers, and families to increase the focus on tobacco cessation with patients.

What strategies have you seen successfully encouraging people to quit smoking in West Virginia?

  • The power of the pulpit: Religion is a vital piece of West Virginia culture, and one successful intervention is to work with local faith leaders to make the church grounds tobacco-free, the church events tobacco-free, and for faith leaders to encourage cessation from the pulpit. In West Virginia, we partnered with almost 20 African American faith-based organizations to host tobacco-free Sundays, tobacco-free church events, and most importantly, tobacco cessation workshops within the church with members of the congregation. Faith leaders were trained in Follow the Signs by La Tanisha Wright to increase local understanding of how tobacco companies often target communities of color. The materials we used in West Virginia were very similar to those promoted by the National African American Tobacco Prevention Network as part of their No Menthol Sunday campaign.
  • Tobacco-free hunting: We held a successful campaign, like the one held in Rural Ohio Appalachia from 2009-2010, to break the connection between tobacco use and game hunting. As hunting is a cultural rite of passage in West Virginia, so is visiting ‘game checking stations’ after you have killed your prize deer, bear, etc. These game checking stations are normally stations within other businesses, such as the local gas station, the local hardware store, etc.  We partnered with the local businesses to have direct education at the game checking stations.  When you came to the station to check your game in, you got a “tobacco free hunter” hat and information about the dangers of spit tobacco and how the state tobacco quit line can assist in tobacco cessation.
  • Ladies night out: Focusing on the fact that from my experience, the mother or grandmothers are the most educated person in the household, we have held ‘ladies nights out’ events to educate women on the dangers of tobacco use. This allows correct, vital health information to get directly into peoples’ homes.

What can state health departments and other tobacco stakeholders do to reach out to these underserved populations?

The best approach for state health departments is to remember that “local people listen to local people best.” Let the champions in the local communities do to the work, but arm the champions with the best evidence based or promising practices in tobacco control efforts.

Mr. Donald R. Reed, Jr., M.A. CTTS, is a West Virginia University (WVU) extension service faculty member with a long personal and professional history in tobacco cessation work among West Virginia coal miners. Reed joins evidence based practices with effective partnerships to raise awareness about tobacco and influence social norms around tobacco use.

For more information on tobacco control in rural communities, please see the webinar recording and webinar slides from the ASTHO and NACCHO webinar “Opportunities for State and Local Health Department to Address Smokeless Tobacco Control in Rural Populations.”