title: Understanding smoking cessation in rural communities.
abstract: BACKGROUND
  Rural communities are adversely impacted by increased rates of tobacco use. Rural residents may be exposed to unique communal norms and other factors that influence smoking cessation.
  
  
  OBJECTIVE
  This study explored facilitating factors and barriers to cessation and the role of rural health care systems in the smoking-cessation process.
  
  
  METHODS
  Focus groups were conducted with smokers (N = 63) in 7 Midwestern rural communities. Qualitative analysis and thematic coding of transcripts was conducted.
  
  
  RESULTS
  Three levels of pertinent themes--intrinsic, health-system resource, and community/social factors--were identified. Intrinsic factors facilitating cessation included willingness to try various cessation methods, beliefs about consequences of continuing smoking (eg, smoking-related illnesses), and benefits of quitting (eg, saving money). Intrinsic barriers included skepticism about resources, low self-efficacy and motivation for smoking cessation, concern about negative consequences of quitting (eg, weight gain), and perceived benefits of continued smoking (eg, enjoyment). Key health-system resource facilitators were pharmacotherapy use and physician visits. Resource barriers included infrequent physician visits, lack of medical/financial resources, limited local smoking-cessation programs, and lack of knowledge of existing resources. In terms of community/social factors, participants acknowledged the negative social impact/image of smoking, but also cited a lack of alternative activities, few public restrictions, stressors, and exposure to other smokers as barriers to cessation.
  
  
  CONCLUSIONS
  Smokers in rural communities face significant challenges that must be addressed. A multilevel model centered on improving access to health care system resources while addressing intrinsic and community/social factors might enhance smoking-cessation interventions and programs in rural communities.
authors.affiliation: University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Kansas City, KS 66160-7313, USA. tresza@ku.edu
authors.forename: Tresza D
authors.initials: TD
authors.lastname: Hutcheson
authors.forename: K Allen
authors.initials: KA
authors.lastname: Greiner
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
authors.forename: Shawn K
authors.initials: SK
authors.lastname: Jeffries
authors.forename: Laura M
authors.initials: LM
authors.lastname: Mussulman
authors.forename: Genevieve N
authors.initials: GN
authors.lastname: Casey
mesh_terms: D000328:Adult; D001294:Attitude to Health; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008297:Male; D018722:Nicotinic Agonists / Q000627:therapeutic use; D010819:Physician's Role; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology*; D012931:Social Environment; D014481:United States
chemical_list: D018722:Nicotinic Agonists