Although overall smoking rates have declined across the country in recent years, they remain significantly higher in rural communities—where about 18% of adults still smoke, compared to just 11% in urban areas. This elevated burden results in thousands of preventable deaths each year, with rural residents facing higher rates of lung cancer and other smoking-related diseases.

Several factors contribute to the higher rates of smoking—and lower rates of quitting smoking—among rural Americans. Rural communities experience more tobacco advertising, and less exposure to communications platforms that feature anti-smoking campaigns. In addition, rural people can face lower access to healthcare due to long travel distances, limited transportation, and less insurance coverage. And while rural people who smoke are just as likely as urban people who smoke to express a desire to quit, they are less likely to use effective treatments like nicotine replacement therapy (NRT), despite being more nicotine dependent and in greater need of support than urban people who smoke.

With a new $3.2 million grant from the National Institutes of Health (NIH), School of Public Health (SPH) researchers aim to address the elevated rate of smoking among rural Americans. In collaboration with researchers from Rutgers University and Duke University, the study will test a practical approach to help rural people who smoke to quit: mailing them a free “starter kit” of nicotine patches and lozenges, along with easy-to-access digital education and smoking cessation resources at Smokefree.gov.

Specifically, the study has three key aims:

• Testing whether mailing starter kits of nicotine patches and lozenges and referrals to digital cessation tools like Smokefree.gov improves quit rates among rural smokers.
• Among people who do not quit smoking, assessing whether education on less harmful tobacco products (i.e., non-combustible tobacco products like e-cigarettes or  nicotine pouches) and access to cessation resources like Smokefree.gov increases understanding and use of these products as an alternative to smoking cigarettes and a pathway to harm reduction.
• Conducting interviews with participants to understand their experiences in the study.

“Cigarette smoking is the leading cause of preventable death for rural Americans, and poses a disproportionate public health risk for millions of rural residents,” says Dana Carroll, lead researcher, associate professor, and director of the tobacco research programs at the Masonic Cancer Center. “For rural people who may not be able to easily access healthcare providers, this study aims to adopt a straightforward, pragmatic strategy to increase access to smoking cessation services by providing them through the mail. We believe this is an approach that could be adopted by local public health departments, health organizations, and insurance companies to help people in rural America quit smoking and avoid the negative health outcomes associated with smoking.”