Providing intensive, evidence-based treatment for tobacco dependence: Metropolitan vs. rural settings

Intensive, evidence-based treatment for tobacco dependence has been historically available only in academic medical centers in metropolitan areas. Implementation in rural areas faces a number of barriers including attracting enough patients to be cost-effective, attracting and supervising qualified personnel, and adherence to rigorous evaluation methods. This treatment has been implemented in 13 sites across Arkansas. The program is administered centrally, but delivered locally through local partnerships. The sites are located in large metropolitan areas (LMA; populations > 400,000), small metropolitan areas (SMA; populations 100,000-300,000), and rural incorporated cities (RIC; populations <100,000). Implementation faced the expected challenges. Outcomes from July 2005 through June 2007 will be presented. Preliminary outcomes from 12 sites and 704 patients (7-2005 through 12-2006) suggest no significant differences between LMA, SMA, and RIC sites in number of patients seen, reached for follow-up, and quit 6-months post-discharge as well as percentage of patients quit.

 

6-Month Post-Discharge Follow-up Results
	Mean Number
Type of Site	Pts Eligible	Completed Interviews	Pts Quit	Mean Percent Quit
LMA (n=5)	43.20	28.40	10.20	38.37%
SMA (n=4)	61.00	37.75	8.00	24.77%
RIC (n=4)	81.33	44.33	14.67	33.35%

 

Intensive, face-to-face, evidence-based treatment for tobacco dependence can be as effectively delivered in rural areas as in metropolitan areas as long as adequate systems exist to support the sites, the clinicians, and evaluation. Given the higher prevalence of tobacco use in rural areas, providing access to intensive cessation options is an important element of any tobacco control program.