title: When Free Is Not for Me: Confronting the Barriers to Use of Free Quitline Telephone Counseling for Tobacco Dependence.
abstract: Remarkable disparities in smoking rates in the United States contribute significantly to socioeconomic and minority health disparities. Access to treatment for tobacco use can help address these disparities, but quitlines, our most ubiquitous treatment resource, reach just 1%-2% of smokers. We used community-based participatory methods to develop a survey instrument to assess barriers to use of the quitline in the Arkansas Mississippi delta. Barriers were quitline specific and barriers to cessation more broadly. Over one-third (34.9%) of respondents (n = 799) did not have access to a telephone that they could use for the quitline. Respondents reported low levels of knowledge about the quitline, quitting, and trust in tobacco treatment programs as well as considerable ambivalence about quitting including significant concerns about getting sick if they quit and strong faith-based beliefs about quitting. These findings suggest quitlines are not accessible to all lower socioeconomic groups and that significant barriers to use include barriers to cessation. These findings suggest targets for providing accessible tobacco use treatment services and addressing concerns about cessation among lower income, ethnic minority, and rural groups.
authors.affiliation: Sophie Davis School of Biomedical Education, City College of New York, New York, NY 10031, USA. csheffer@med.cuny.edu.|Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. csheffer@med.cuny.edu.
authors.forename: Christine
authors.initials: C
authors.lastname: Sheffer
authors.affiliation: Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. csheffer@med.cuny.edu.
authors.forename: Sharon
authors.initials: S
authors.lastname: Brackman
authors.affiliation: Sophie Davis School of Biomedical Education, City College of New York, New York, NY 10031, USA. charnettelercara@gmail.com.
authors.forename: Charnette
authors.initials: C
authors.lastname: Lercara
authors.affiliation: Walnut Street Works, Inc., Helena-West Helena, AR 72342, USA. ncottoms@aol.com.
authors.forename: Naomi
authors.initials: N
authors.lastname: Cottoms
authors.affiliation: Walnut Street Works, Inc., Helena-West Helena, AR 72342, USA. molson144@yahoo.com.
authors.forename: Mary
authors.initials: M
authors.lastname: Olson
authors.affiliation: Sophie Davis School of Biomedical Education, City College of New York, New York, NY 10031, USA. lpanissidi@med.cuny.edu.
authors.forename: Luana
authors.initials: L
authors.lastname: Panissidi
authors.affiliation: Sophie Davis School of Biomedical Education, City College of New York, New York, NY 10031, USA. jpittman@med.cuny.edu.
authors.forename: Jami
authors.initials: J
authors.lastname: Pittman
authors.affiliation: Sophie Davis School of Biomedical Education, City College of New York, New York, NY 10031, USA. hstayna@med.cuny.edu.
authors.forename: Helen
authors.initials: H
authors.lastname: Stayna
mesh_terms: D000328:Adult; D000368:Aged; D001131:Arkansas / Q000453:epidemiology; D003144:Communication Barriers; D055812:Community-Based Participatory Research; D003376:Counseling / Q000706:statistics & numerical data*; D005260:Female; D015277:Hotlines / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013689:Telephone; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology
keywords: barriers to treatment; ethnic minority; low-income; quitline; rural; tobacco dependence