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People in Some Geographic Areas Encounter Barriers to Quitting Successfully										Related Pages
										Photo of a doctor with his patientPeople who live in certain geographic regions may not receive advice to quit smoking from a health care provider.
Most people who smoke want to quit, and more than half of them try to do so each year.20 People who live in rural areas may have less access to quitting resources, or face more barriers when trying to quit than people in urban areas.3
Photo of a doctor with his patientPeople who live in certain geographic regions may not receive advice to quit smoking from a health care provider.
For example:
Anti-tobacco messages can increase smoking cessation and prevent tobacco use initiation, but youth in rural areas are less likely than urban youth to see or hear anti-tobacco messages in the media.3,40
One study conducted in a large Midwest health system found that patients who smoked and were seen at an outpatient clinic in a rural area were nearly three times less likely to receive smoking cessation treatment than those seen at an urban area clinic.41
In 2015, more adults who smoked and lived in the Northeast reported receiving advice to quit smoking from a health care provider than those living in the South or West.20Advised to Quit Smoking by a Health Care Provider (2015)20:
Region
PercentageNortheast
65%Midwest
60%South
55%West
51%Tried to Quit Smoking in the Past Year (2015)42:
Region
PercentageNortheast
59%West
57%Midwest
54%South
54%Connecting every person who wants to quit with treatment proven to help them quit for good is important for improving people’s health.Some strategies that states and communities can use are:Medical history tablet with a no smoking sign and illustrating the age range of under 65**Provide barrier-free, widely promoted coverage for all evidence-based cessation treatments by all types of health insurance.**
For example, as of 2018, only 15 state Medicaid programs fully covered tobacco cessation (quitting) services for all enrollees in traditional Medicaid.43Stethoscope with a no smoking sign.**Integrate clinical screening and treatment for commercial tobacco* use in all health care settings and with all types of patients.**
Community health centers and low-cost health clinics serve people who are more likely to use commercial tobacco products.44,45 Talking to people about commercial tobacco use and quitting as a regular part of health care visits in these settings will help make sure that all people can get effective treatment to help them quit.No smoking messages coming out of a person's mouth.**Increase access to culturally tailored cessation services.**
When it comes to health issues, one size does not fit all. Different people and communities have varying needs and make decisions in different ways. For example, people in rural areas tend to use more smokeless tobacco, like dip or chew, which may require different quitting strategies than cigarettes. Treatment services also might need to be provided virtually, online, or through mobile clinics that can visit remote, rural areas.television monitor icon with no smoking sign**Share health messages that reach people in geographic areas with the highest tobacco use and in rural areas.**
Mass media campaigns are proven to increase smoking cessation, prevent tobacco use initiation, and reduce the prevalence of tobacco use.1,20Anti-commercial tobacco messaging and mass media campaigns, like CDC’s *Tips From Former Smokers® (Tips®)*, are effective in reaching many groups. Such campaigns can help to reduce geographic disparities in commercial tobacco use and exposure by connecting people to treatment resources.ResourcesAdvancing Tobacco Prevention and Control in Rural America [PDF-3.76 MB]
Best Practices User Guide Health Equity in Tobacco Prevention and Control [5.04 MB]
Point-of-Sale Report to the Nation [PDF-9.96 MB]
Point-of-Sale Strategies: A Tobacco Control Guide 2014 [PDF-7.81 MB]WebsitesGeographic Health Equity Alliance
CDC’s State Tobacco Activities Tracking and Evaluation (STATE) System
**“Commercial tobacco” means harmful products that are made and sold by tobacco companies. It does not include “traditional tobacco” used by Indigenous groups for religious or ceremonial purposes*.
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Pierce JP, Sargent JD, Portnoy DB, et al. Association Between Receptivity to Tobacco Advertising and Progression to Tobacco Use in Youth and Young Adults in the PATH Study. JAMA Pediatr. 2018;172(5):444–451 [accessed 2022 Mar 22].
Henriksen L, Schleicher NC, Feighery EC, Fortmann SP. A longitudinal study of exposure to retail cigarette advertising and smoking initiation. Pediatrics. 2010;126(2):232-238 [accessed 2022 Mar 22].
U.S. Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General [PDF – 9.8 MB]. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020 [accessed 2022 Mar 22].
Henriksen L, Schleicher NC, Johnson TO, Roeseler A, Zhu SH. Retail Tobacco Marketing in Rural Versus Nonrural Counties: Product Availability, Discounts, and Prices. Health Promotion Practice. 2020; 21(1_suppl):27S-36S [accessed 2022 Mar 22].
Pamela M. Ling, Lawrence A. Haber, and Stefani Wedl. Branding the Rodeo: A Case Study of Tobacco Sports Sponsorship. American Journal of Public Health. 2010; 100, 32_41 [accessed 2022 Apr 28].
Ling PM, Haber LA, Wedl S. Branding the rodeo: a case study of tobacco sports sponsorship. American Journal of Public Health. 2010;100(1):32-41 [accessed 2022 Mar 22].
Hall J, Cho HD, Maldonado-Molina M, George Jr TJ, Shenkman EA, Salloum RG. Rural-urban disparities in tobacco retail access in the southeastern United States: CVS vs. the dollar stores.  Preventive Medicine Reports. 2019;15, 100935 [accessed 2022 Mar 22].
Robertson L, McGee R, Marsh L, Hoek J. A systematic review on the impact of point-of-sale tobacco promotion on smoking. Nicotine & Tobacco Research. 2015;17(1): 2-17 [accessed 2022 Mar 22].
Hafez AY, Gonzalez M, Kulik MC, Vijayaraghavan M, Glantz SA. Uneven access to smoke-free laws and policies and its effect on health equity in the United States: 2000–2019. American Journal of Public Health. 2019;109(11): 1568-1575 [accessed 2022 Mar 22].
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Slopen N, Dutra LM, Williams DR, et al. Psychosocial stressors and cigarette smoking among African American adults in midlife.Nicotine Tobacco Res. 2012;14(10):1161-1169 [accessed 2022 Mar 22].
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Slopen N, Kontos EZ, Ryff CD, Ayanian JZ, Albert MA, Williams DR. Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9-10 years: a prospective study of middle-aged adults in the United States. Cancer Causes Control. 2013;24(10):1849-1863 [accessed 2022 Apr 28].
Purnell JQ, Peppone LJ, Alcaraz K, et al. Perceived discrimination, psychological distress, and current smoking status: results from the Behavioral Risk Factor Surveillance System Reactions to Race module, 2004-2008. Am J Public Health. 2012;102(5):844-851 [accessed 2022 Apr 28].
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							Last Reviewed:  June 27, 2022						Source: 	Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion
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