Report on national tobacco use cites challenges for rural Maine
Courtesy / University of Southern Maine
Jean Talbot, a research associate with the Maine Rural Health Research Center at the University of Southern Maine's Muskie School of Public Policy, is the lead author of a report that looks at the disproportionate health effect tobacco use has on rural communities.
A new national report written by a Maine researcher highlights the significant toll tobacco has on rural communities, and also finds strengths in rural communities that will help combat the issue.
The report by the Maine Public Health Institute and the National Association of Chronic Disease Directors, “Advancing Tobacco Prevention and Control in Rural America,” looks at the disproportionate health effect tobacco use has on rural communities.
Jean Talbot, a research associate with the Maine Rural Health Research Center at the University of Southern Maine’s Muskie School of Public Policy, is the lead author of the report, which had contributors from 15 organizations. It explores rates and patterns of commercial tobacco use across rural populations, aspects of the rural context that may affect tobacco prevention and control efforts.
The report includes recommendations for advancing rural tobacco control initiatives and suggestions for future research.
Maine’s role in the report comes with the fact that tobacco use has a big impact on health in the state.
On a per capita basis, Maine is sixth among all states for lung cancer and 16th for deaths from lung cancer, which is the second most common cancer diagnosed in Maine and its biggest cancer killer, according to the Maine Rural Health Research Center’s news release.
One in five Mainers smokes, making the state first in New England and 14th in the nation.
The overwhelming smoking prevalence places Maine 14th among all US states and number one in New England, the release said.
The national data showed “marked rural-urban tobacco use disparities in many subpopulations,” said Talbot, in a news release from the National Network of Public Health Institutes. “To arrive at a more complete understanding of these disparities, we explored not just sociodemographic risk factors, but also rural infrastructure, policy environment, and cultural norms as possible contributing factors.”
She said that the research found core strengths of rural communities “that can be leveraged to support rural tobacco prevention and control, including strong social networks, high levels of community engagement and experience in forming cross-sector collaborations.”
Leading cause of preventable death
Tobacco use remains the leading cause of preventable disease, disability and death in the United States, according to the national Centers of Disease Control and Prevention, said Vincent Lafronza president of the National Network of Public Health Institutes, which released the report.
Since the health of people living in rural areas is affected by tobacco use more so than those in urban and metropolitan areas, the group “assembled a team to explore the rural context in greater depth, highlighting challenges and opportunities for improving rural health through tobacco prevention and control.”
Rural communities are implementing CDC Best Practices guidelines for tobacco use prevention and control, said Paula Clayton, a consultant to the National Association of Chronic Disease Directors. Clayton said the guidelines offer proven approaches that can be replicated and scaled to reduce the prevalence of commercial tobacco use and improve public health.
Key findings
Some key findings of the report are:
- In a national sample of adults, past-month use of tobacco, cigarettes and smokeless products was higher for rural non-Hispanic whites, people with mental illness, people with substance use disorders and veterans than for their urban counterparts.
- Rural Hispanics, pregnant women and sexual and gender minorities also showed higher rates than their urban peers on some tobacco use measures.
- Current smoking prevalence for rural adolescents was 7.3%, as compared to 3.8% for their urban peers, and adjusted odds of smoking were 54% higher for rural than for urban youth.
- Relative to other rural racial/ethnic groups, American Indian/Alaska Natives had the highest rates of current commercial cigarette use.
- Prevalence and patterns of rural tobacco use varied across regions, with rural-urban disparities appearing in the Northeast, in the South, and among impoverished populations of the Midwest.
- Rural populations showed higher rates of smokeless tobacco use in all four U.S. Census Bureau regions.
- Smoking prevalence is elevated in Tobacco Nation, a 12-state region in the Midwest and South where rural residents make up over 20% of the population in each state.
Rural benefits, challenges
The study found that some rural communities may share cultural strengths that could support rural tobacco control and prevention, including strong social networks, high levels of community engagement in mutual aid and experience in forming cross-sector collaborations to enhance shared quality of life.
But the study also found that rural cultural factors may present obstacles to tobacco control efforts.
Rural populations, including those in tribal territories, continue to be a target for tobacco industry marketing, the study says.
Cultural norms favoring tobacco use are prevalent in certain rural areas, including states with historical ties to tobacco cultivation.
“Cultural considerations are especially important in addressing commercial tobacco use among tribal populations in rural areas,” the report said. “Experts within the American Indian community recommend an approach to tobacco control that expresses value for the use of sacred traditional tobacco in clearly defined ceremonial contexts, while emphasizing the importance of protecting community members from health harms related to commercial tobacco use.”
Rural health infrastructure also plays a role, the study says, including hospitals closing in those areas.
The study also says federal and state formulas for tobacco control funding may put rural local health departments at a disadvantage in relation to urban ones.
“Individual rural residents may have greater difficulty accessing tobacco control and prevention services, due to local health care provider shortages, lower incomes and elevated rates of uninsurance,” the report says.
Rural initiatives work
Despite the obstacles they face, rural communities are mounting successful efforts to increase their tobacco control capacity, the study says.
Rural hospitals, health departments, Federally Qualified Health Centers and other stakeholders within and outside the health sector “often collaborate closely to conduct community health needs assessments, educate the public about health issues and lead health improvement initiatives, including tobacco control programs.”
“Some rural initiatives have enhanced rural residents’ access to tobacco control services through the use of distance technologies such as state quitlines, telemedicine and mobile phone-based strategies,” the report said.
Innovative, texting-based programs that deliver tobacco cessation support to rural populations also work.
The report said efforts should focus on:
- Cessation: Successful rural cessation initiatives included policy interventions, media campaigns promoting cessation and delivery of cessation treatments in both health care and non-clinical settings. Many rural cessation programs address obstacles by bringing cessation services to rural tobacco users’ homes and communities, and using technology such as telemedicine, cell phones and Web-based applications. Cost barriers can be addressed by advocating for improved insurance coverage of cessation, providing free services and offering financial incentives for quitting tobacco use.
- Prevention of Initiation: Successful rural prevention activities use policy strategies and counter-marketing campaigns, including restricting tobacco advertising, increasing the unit price of tobacco through taxation and raising the minimum legal sales age.
- Promotion of Smoke-Free Air: Smoke-free interventions are diverse in settings and scope, the study says.. Many initiatives created smoke-free air policies for particular contexts, such as schools or public parks, whereas others focused more broadly on ordinances covering multiple settings.
National Network of Public Health Institutes is the lead planning partner for the upcoming 2019 National Conference on Tobacco or Health, at which tobacco control professionals from across the country gather to share insights and discuss trends. The conference takes place in August in Minneapolis.
Christopher Kinabrew, chief strategy officer for the network said that the report and strategies will be discussed at the conference.
“Reducing the rural-urban disparities articulated in this report should motivate all of us who value health to ramp up efforts in prevention of initiation, cessation, and promotion of smoke-free air… while keeping rural context, culture and infrastructure in mind,” Kinabrew said.
To download the report.
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