While overall smoking rates among U.S. adults are declining — dropping from 15.1% to 12.5% between 2015 and 2020 — many communities remain disproportionately burdened by commercial tobacco use and the negative health consequences that accompany it. For example, smoking prevalence among rural adults stood at 19.2% in 2020, compared to 14.4% for their urban counterparts. Previous research has also shown that rural people start smoking at younger ages and smoke more heavily than non-rural residents. 

Given these disparities, it is even more pressing to identify strategies that help people quit smoking. A new study from the University of Minnesota School of Public Health (SPH) addresses this need by examining the factors associated with attempts to quit smoking among rural adults. 

Using survey data gathered from rural, adult, daily smokers, SPH researchers evaluated the number of quit attempts (QA) they undertook in the previous year, as well as the factors that promoted or impeded attempts to quit smoking. The study, published in Nicotine and Tobacco Research, found: 

• Prevalence of a QA in the past 12 months was 25.6%
• Factors associated with greater odds of attempting to quit smoking included: 
  • Having a level of education beyond high school.
  • Disapproval of smoking from friends or family. 
  • The use of e-cigarettes (the odds of a QA were 35% higher among those who used an e-cigarette in the past 30 days).
  • Being advised to quit by a doctor.
  • Self-perception of being in fair or poor physical and/or mental health.
  • Thinking more frequently about the health harms of tobacco use.
• Factors associated with lower odds of a QA included use of smokeless tobacco products (such as stuff and chewing tobacco) and heavier smoking (i.e. more cigarettes smoked per day)

The study underscores another key health disparity between rural and urban residents: Previous studies have shown that 55.1% of US smokers attempt to quit smoking annually, but the current research demonstrates that only 25.6% of rural smokers do. 

“Along with higher smoking rates and lower QAs, rural communities face limited access to programs, medication, and healthcare professionals as tools to help them quit smoking,” said Lorna Bittencourt, SPH doctoral student and lead author. “We found that negative perceptions of smoking and disapproval of the habit among friends and family are leading factors associated with attempts to quit smoking. Given that, health communications campaigns and policies that emphasize family support for quit attempts should be a key priority in rural areas.” 

The paper also recommends that public health initiatives should develop cultural-sensitivity training that can be used with health care professionals who advise patients to quit smoking. The researchers also call attention to digital resources such as the National Cancer Institute’s Smokefree.gov program, which can provide tobacco users with immediate access to smoking-cessation support.