The importance of location for tobacco cessation: rural-urban disparities in quit success in underserved West Virginia Counties.
BACKGROUND
Adults who live in rural areas of the United States have among the highest smoking rates in the country. Rural populations, including Appalachian adults, have been historically underserved by tobacco control programs and policies and little is known about their effectiveness.


OBJECTIVE
To examine the end-of-class quit success of participants in A Tobacco Cessation Project for Disadvantaged West Virginia Communities by place of residence (rural West Virginia and the urban area of Greater Charleston).


METHODS
This collaborative program was implemented in 5 underserved rural counties in West Virginia and consisted of 4 intervention approaches: (1) a medical examination; (2) an 8-session educational and behavioral modification program; (3) an 8-week supply of pharmacotherapy; and (4) follow-up support group meetings.


RESULTS
Of the 725 program participants, 385 (53.1%) had successfully quit using tobacco at the last group cessation class they attended. Participants who lived in rural West Virginia counties had a lower end-of-class quit success rate than those who lived in the urban area of Greater Charleston (unadjusted odds ratio [OR]= 0.69, 95% confidence interval [CI]= 0.48, 0.99), even after taking into account other characteristics known to influence quit success (adjusted OR = 0.58, 95% CI = 0.35, 0.94).


CONCLUSIONS
Tobacco control programs in rural West Virginia would do well to build upon the positive aspects of rural life while addressing the infrastructure and economic needs of the region. End-of-class quit success may usefully be viewed as a stage on the continuum of change toward long-term quit success.
Northridge
Mary E
ME
Department of Sociomedical Sciences, Mailman School of Public Health at Columbia University, New York, NY 10032, USA. men11@columbia.edu
Vallone
Donna
D
Xiao
Haijun
H
Green
Molly
M
Weikle Blackwood
Julia
J
Kemper
Suzanne E
SE
Duke
Jennifer
J
Watson
Kimberly A
KA
Burrus
Barri
B
Treadwell
Henrie M
HM
D005260:Female; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D012424:Rural Population / Q000706:statistics & numerical data*; D016540:Smoking Cessation / Q000379:methods*; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D014903:West Virginia