Tobacco-Related Health Disparities around Tobacco Use and Cessation in Rural Georgia

The literature suggests that the use of tobacco is more prevalent in rural compared to urban communities. Clinch County, a rural county, ranks in the lowest 1/3 of all Georgia counties in health outcomes, access to clinical care, social and economic factors, and health behaviors. Twenty-three percent of its residents report fair or poor health, 14% over 65 is uninsured, 32% of children are in poverty, and only 25% have access to healthy foods. A “Clinch County Tobacco Disparities Coalition” (the Coalition) including juvenile justice workers, nurses, teachers, community leaders, and health department personnel was convened (2008) to identify culturally-relevant ways of eliminating tobacco use, initiation and cessation. We conducted a community assessment which revealed for adults, a greater number of males (36%) were self-reported smokers compared to females (29%), education level was a strong determinant for smoking and smoking risk perception, 30.1% smoke at least 100 cigarettes during their life-time, with 59.0% smoking at least 10 cigarettes per day. For youth, 28.5% youth had puffed a cigarette in the last year, 16.8% use smokeless tobacco, 29% initiated smoking at 13 or 14 years old, 47.6% indicate their parents ‘never' or ‘rarely' discuss dangers of tobacco use, nor does their school have special classes for students wanting to quit. The Coalition identified two disparate groups. A community-based culturally relevant health promotion program was developed encapsulating: community-based strategies; school strategies; public awareness and media advocacy; and policy and enforcement strategies. Our study evaluated the effectiveness of these strategies will be presented.