Promoting healthy behaviors in a rural community using culturally sensitive smoking cessation outreach strategies

Background: Tobacco use remains the single most preventable cause of death in the US. Little is known about the most effective population-based strategies to reach rural smokers. This study examines fidelity, acceptability, practicality, effectiveness and reach of culturally sensitive interventions in motivating smokers in a rural southern community to participate in tobacco dependence treatment. Methods: Personal testimonials were developed from focus groups with smokers/former smokers (N=21) for use in interventions. Themes included access to tobacco programs, quitting with support of family, faith, quitting for health, freedom of individual choice, and pride of place. Interventions included printed materials, earned/paid media, and a quilt made by local artisans representing the themes. Cooperative Extension agents utilized brief lay-delivered tobacco dependence treatment interventions and chose from a menu of intervention options. Results: Intervention materials are being pilot-tested in 2009-2010. Surveys and key informant interviews with agents will yield data on fidelity, acceptability, practicality, and perceived effectiveness. A random-digit survey of county residents will evaluate intervention reach. Pilot findings will guide future studies to improve rural health outcomes by testing the effects of the interventions to promote tobacco dependence treatment on enrollment, attendance, nicotine dependence, and quit outcomes.

Conclusions: Culturally sensitive messaging is a data-rich strategy for the development of population-based interventions aimed at rural smokers. Use of personal testimonials with brief tobacco dependence treatment interventions combines two evidence-based strategies which can be economically and effectively delivered by Cooperative Extension agents and local health departments to promote healthy behaviors and improve smoking-related health outcomes.