Barriers to use of the tobacco quitline in the Arkansas Mississippi delta region

Understanding the utilization of evidence-based telephone counseling (quitlines) for tobacco use for lower socioeconomic (SES) groups is important given higher prevalence of tobacco use in lower SES groups and the recent CDC recommendations promoting quitlines. All 50 states provide a quitline with the assumption that the quitline is particularly acceptable and accessible to lower SES groups. Method: Community-based participatory methods were used to collect qualitative and quantitative data in the Arkansas Mississippi delta that addressed access and use of the Arkansas quitline. Qualitative outcomes were used to develop a survey instrument which was administered to 799 delta residents. Results: Most residents were unaware of the quitline and expressed distrust of the quitline provider. Beliefs related to use of the quitline included concerns about providing personal information over the telephone; getting sick when they quit tobacco; the stressful socio-economic context; and strong beliefs in the role of God and faith in the process of quitting. Few differences in the intensity of these beliefs between African-American and White tobacco users were found, but there were numerous differences between lower and higher SES groups. Importantly, 35% of tobacco users did not have access to adequate telephone services to use the quitline. Conclusions: Communications about the quitline should be tailored to the concerns of lower SES groups by using trusted local sources and acknowledging the challenging socio-economic context as well as the significant role of faith. The assumption that quitlines are acceptable and accessible to lower SES groups may need to be reconsidered.