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Pilehvari A, Krukowski RA, Wiseman KP, Little MA. Tobacco Quitline utilization compared with cigarette smoking prevalence in Virginia across rurality and Appalachian Status, 2011-2019. Prev Med Rep 2024; 42:102716. [PMID: 38707246 PMCID: PMC11066663 DOI: 10.1016/j.pmedr.2024.102716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction While cigarette smoking rates have declined, rural and Appalachian populations in the United States have not seen similar decreases. Quitline programs are promising strategies in reducing disparities in these areas, but research on their usage is limited. Methods We employed Small Area Estimation on the Virginia Behavioral Risk Factor Surveillance System (2011-2019) to estimate county-level smoking prevalence and utilized The Quit Now Virginia Quitline data (2011-2019) to estimate Quitline users. We analyzed differences in Quitline utilization by rurality and Appalachian status using statistical t-tests. Stepwise regression assessed the absolute estimate of county features, including poverty rate, tobacco retailer density, physician availability, coal mining industry, and tobacco agriculture, on Quitline usage. Results While the average smoking rate overall was 15.3 %, only 7.4 % of smokers accessed Quitline services from 2011 to 2019. Appalachian regions exhibited higher smoking rates (20.9 %) and lower quitline usage (4.8 %) compared to non-Appalachian areas (14 % smoking prevalence, 8 % quitline usage). Rural regions had higher smoking prevalence (19.0 %) than urban areas (12.9 %), but no significant difference in Quitline utilization (7.6 % vs. 7.2 %, p = 0.7). Stepwise regression revealed counties with more tobacco agriculture had 3.2 % (p = 0.04) lower Quitline utilization. Also, more physicians availability in the county was associated with 3.9 % higher Quitline usage (p = 0.03) and Appalachian counties exhibited a 3.6 % lower Quitline usage rate compared to non-Appalachian counties. Conclusion A significant gap exists between cigarette smoking prevalence and Quitline utilization, particularly in underserved rural and Appalachian areas, despite no clear barriers to accessing this remote cessation resource. Implication The study underscores persistent disparities in smoking rates, with rural and Appalachian regions in the United States facing higher smoking prevalence and limited utilization of Quitline services. Despite no clear barriers to access, the gap between smoking prevalence and Quitline usage remains significant, particularly in underserved areas. Tailoring interventions to address regional disparities and factors like tobacco agriculture and physician availability is essential to reduce smoking rates and improve Quitline utilization in these communities.
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Affiliation(s)
- Asal Pilehvari
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
- UVA Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Rebecca Anne Krukowski
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
- UVA Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Kara Philips Wiseman
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
- UVA Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Melissa Ashley Little
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
- UVA Comprehensive Cancer Center, Charlottesville, VA, USA
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Vander Weg MW, Howren MB, Grant KM, Prochazka AV, Duffy S, Burke R, Cretzmeyer M, Parker C, Thomas EBK, Rizk MT, Bayer J, Kinner EM, Clark JM, Katz DA. A smoking cessation intervention for rural veterans tailored to individual risk factors: A multicenter randomized clinical trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209191. [PMID: 37866436 DOI: 10.1016/j.josat.2023.209191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/24/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Rates of cigarette use remain elevated among those living in rural areas. Depressive symptoms, risky alcohol use, and weight concerns frequently accompany cigarette smoking and may adversely affect quitting. Whether treatment for tobacco use that simultaneously addresses these issues affects cessation outcomes is uncertain. METHODS The study was a multicenter, two-group, randomized controlled trial involving mostly rural veterans who smoke (N = 358) receiving treatment at one of five Veterans Affairs Medical Centers. The study randomly assigned participants to a tailored telephone counseling intervention or referral to their state tobacco quitline. Both groups received guideline-recommended smoking cessation pharmacotherapy, selected using a shared decision-making approach. The primary outcome was self-reported seven-day point prevalence abstinence (PPA) at three and six months. The study used salivary cotinine to verify self-reported quitting at six months. RESULTS Self-reported PPA was significantly greater in participants assigned to Tailored Counseling at three (OR = 1.66; 95 % CI: 1.07-2.58) but not six (OR = 1.35; 95 % CI: 0.85-2.15) months. Post hoc subgroup analyses examining treatment group differences based on whether participants had a positive screen for elevated depressive symptoms, risky alcohol use, and/or concerns about weight gain indicated that the cessation benefit of Tailored Counseling at three months was limited to those with ≥1 accompanying concern (OR = 2.02, 95 % CI: 1.20-3.42). Biochemical verification suggested low rates of misreporting. CONCLUSIONS A tailored smoking cessation intervention addressing concomitant risk factors enhanced short-term abstinence but did not significantly improve long-term quitting. Extending the duration of treatment may be necessary to sustain treatment effects.
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Affiliation(s)
- Mark W Vander Weg
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, United States of America; Department of Community and Behavioral Health, University of Iowa College of Public Health, United States of America; Department of Internal Medicine, University of Iowa Carver College of Medicine, United States of America; Department of Psychological and Brain Sciences, University of Iowa, United States of America; VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, United States of America.
| | - M Bryant Howren
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, United States of America; Department of Behavioral Sciences and Social Medicine, Florida State University, United States of America; Florida Blue Center for Rural Health Research & Policy, United States of America
| | - Kathleen M Grant
- VA Nebraska-Western Iowa Health Care System, United States of America; University of Nebraska Medical Center Department of Medicine, United States of America
| | - Allan V Prochazka
- Primary Care, VA Eastern Colorado Health Care System, United States of America; Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), United States of America
| | - Sonia Duffy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States of America; College of Nursing, Ohio State University, United States of America
| | - Randy Burke
- Mental Health Service, G.V. (Sonny) Montgomery VA Medical Center, United States of America; Department of Psychiatry, University of Mississippi School of Medicine, United States of America
| | | | - Christopher Parker
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, United States of America
| | - Emily B K Thomas
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | | | - Jennifer Bayer
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - Ellen M Kinner
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - Jennifer M Clark
- Department of Neurology, University of Iowa, Carver College of Medicine, United States of America
| | - David A Katz
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, United States of America; Department of Internal Medicine, University of Iowa Carver College of Medicine, United States of America; Department of Epidemiology, University of Iowa College of Public Health, United States of America
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Wattick RA, Olfert IM, Olfert MD. Psychosocial Factors Associated with E-Cigarette Use among Young Adults in a 4-Year University in Appalachia. Subst Use Misuse 2021; 56:1182-1189. [PMID: 33941034 DOI: 10.1080/10826084.2021.1914102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES In order to determine methods to reduce vaping prevalence, motivations for use and co-occurring health behaviors and disorders need to be determined. This study investigated vaping characteristics and associated health behaviors in a young adult Appalachian college population. METHODS Students attending an Appalachian university were invited to participate in an online survey measuring their use of e-cigarettes, motivations for use, mental health, and Adverse Childhood Experiences (ACEs). Analysis included prevalence of e-cigarette use and associations between e-cigarette use and Appalachian identity, mental health, and ACEs. RESULTS Participants (N = 3398) stated that the most common motivator for using e-cigarettes was to decrease stress, followed by the good taste, friends' usage, and wanting to quit cigarettes. E-cigarette use was associated with alcohol use, anxiety, depression, stress, and Adverse Childhood Experiences (ACEs) and these variables were placed into a full logistic regression model, in which anxiety and stress were no longer significant, and alcohol use was the strongest association (OR 1.36 95% CI 1.35-1.42, p<.0001).Conclusions/importance: Findings demonstrate a need for efforts to reduce e-cigarette use to focus on the co-use of alcohol, co-occurring mental health disorders, and the social and enjoyment motivations for use.
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Affiliation(s)
- Rachel A Wattick
- Davis College of Agriculture, Natural Resources, and Design, Division of Animal and Nutritional Sciences, West Virginia University, Morgantown, West Virginia, USA
| | - I Mark Olfert
- School of Medicine, Department of Human Performance and Exercise Physiology, West Virginia University, Morgantown, West Virginia, USA
| | - Melissa D Olfert
- Davis College of Agriculture, Natural Resources, and Design, Division of Animal and Nutritional Sciences, West Virginia University, Morgantown, West Virginia, USA
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Community-engaged research in translational science: Innovations to improve health in Appalachia. J Clin Transl Sci 2021; 5:e200. [PMID: 35047212 PMCID: PMC8727706 DOI: 10.1017/cts.2021.862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/29/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022] Open
Abstract
Health disparities between Appalachia and the rest of the country are widening. To address this, the Appalachian Translational Research Network (ATRN) organizes an annual ATRN Health Summit. The most recent Summit was held online September 22–23, 2020, and hosted by Wake Forest Clinical and Translational Science Institute in partnership with the Northwest Area Health Education Center. The Summit, titled “Community-Engaged Research in Translational Science: Innovations to Improve Health in Appalachia,” brought together a diverse group of 141 stakeholders from communities, academic institutions, and the National Center for Advancing Translational Science (NCATS) to highlight current research, identify innovative approaches to translational science and community-engaged research, develop cross-regional research partnerships, and establish and disseminate priorities for future Appalachian-focused research. The Summit included three plenary presentations and 39 presentations within 12 concurrent breakout sessions. Here, we describe the Summit planning process and implementation, highlight some of the research presented, and outline nine emergent themes to guide future Appalachian-focused research.
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Alashoor T, Han S. The smoking paradox: exploring why attitudes toward cigarette smoking are a weak predictor of cigarette smoking. Psychol Health 2020; 36:847-861. [PMID: 32862721 DOI: 10.1080/08870446.2020.1798958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE An attitude change perspective represents a central line of research in the smoking literature. This line of research focuses on influencing individuals' attitudes toward smoking in order to alleviate the negative outcomes of smoking and to achieve positive smoking behaviours. This line of research, however, does not explain why attitudes toward cigarette smoking are a weak predictor of cigarette smoking, an indication of a smoking paradox. The current study introduces two domain-general factors to explore this smoking paradox. DESIGN We used an online survey and collected data from American subjects (n = 328) via a crowdsourcing platform, Amazon Mechanical Turk, in 2018. RESULTS We found that the association between attitude toward smoking and the likelihood of smoking is significantly weaker when individuals perceive a low probability of risk and/or believe that this probable risk will only occur in the distant future, after many years. These results suggest that smoking may not be consistent with attitude because individuals perceive low probability of risk and/or they temporally discount the occurrence of this probable risk. CONCLUSION The results suggest that novel strategies that incorporate the concepts of perceived risk probability and temporal discounting of the probable risk are needed for smoking cessation.
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Affiliation(s)
- Tawfiq Alashoor
- Information Technology, Analytics, and Operations, Mendoza College of Business, University of Notre Dame, Notre Dame, IN, USA.,Information Systems & Operations Management, KFUPM Business School, King Fahd University of Petroleum and Minerals, Dhahran, Saudi Arabia
| | - Sehee Han
- Institute of Social Sciences, Kookmin University, Seongbok-gu, South Korea
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