Qualitative RPCI study evaluates attitudes toward smoking cessation in Northern Appalachia

Significant differences in attitudes toward smoking cessation are reported between two generations of smokers in Northern Appalachia in new research from Roswell Park Cancer Institute (RPCI). The qualitative study about beliefs, attitudes and experiences of current and former smokers in Northern Appalachian communities, published online ahead of print in the Journal of Community Health, contributes novel information about smoking cessation.

"This novel study offers a better understanding of the perspectives of younger and older, current and former smokers in Northern Appalachia and will inform improvements to relevant cessation interventions. Ultimately, the goal is to improve the health status among this underserved and at-risk population," says Elisa Rodriguez, PhD, lead author of the study and Assistant Professor of Oncology in the Office of Cancer Health Disparities Research and the Center For Personalized Medicine at RPCI.

Northern Appalachia contains 14 New York state counties, including Chautauqua County. This region is designated as a medically underserved area. Participants were recruited from three small towns within Chautauqua County where the smoking rate, at 25.3%, is much higher than the New York state average. Six focus groups with 54 participants total were stratified by two age groups: (a) 18-39 years old and (b) 40 years and older. Among the participants, 50% had less than a high school education; 39% were Medicaid recipients; and more than 60% reported household incomes of less than $15,000. Overall, 83% reported being a current smoker and smoking status did not differ by age group.

This study found that young smokers continue to report less worry and less recognition of the difficulty of quitting smoking. Younger smokers also reported no desire to be approached about their tobacco use within a discussion of an addictive health problem that requires assistance. Conversely, participants age 40 and older more readily acknowledged the health risks of smoking and had a greater interest in quitting assistance.

Other results include:
•On the role of government and tobacco companies in smoking: Participants ages 18-39 acknowledged their role in quitting smoking yet they also stated the perception that the tobacco companies profited from their habit. Participants in the 40+ age group blamed the government for not protecting them from tobacco companies or addiction.
•Behavior and practices with the use of social media and the Internet: Social media use was common among both age groups. Neither age group discussed the use of the Internet for health-related purposes.
•Automated calling with quit smoking messages: Both age groups expressed limited receptivity to receiving automated calls with tips on quitting smoking.
•Attitudes toward media and public service announcements regarding smoking cessation: The 18-39 age group was familiar with New York State Smokers' Quitline commercials and talked about how those advertisements influenced their willingness to stop smoking. Although identical questions were asked of both groups, the 40+ age group did not discuss or offer commentary about the commercials.

"The findings from this study add both novel and important information about the beliefs, attitudes and experiences of current and former smokers living in an understudied area of Northern Appalachia. Future studies should further explore the application of innovative smoking cessation interventions within Appalachian communities that make use of social media and other novel technologies," adds Dr. Rodriguez.

Martin Mahoney, MD, PhD, senior author of the research and Professor of Oncology in the Department of Medicine at RPCI, adds, "This study demonstrated that the Appalachian population confronts increased health risks associated with tobacco use when compared to many of their national counterparts. Therefore, it is essential to focus efforts on preventive health care programs with an emphasis on tobacco control and smoking cessation."