AN ENVIRONMENTAL SCAN AND NEEDS ASSESSMENT OF TOBACCO CONTROL IN APPALACHIAN KENTUCKY USING SECONDARY DATA Open Access

Talbert, Emily Catherine (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/n583xv46p?locale=en
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Abstract

Although tobacco control efforts such as smoke-free laws, cigarette tax increases, tobacco advertising bans, limits on age of purchase, and mass media campaigns have helped curb tobacco use among Americans, cigarette smoking remains the leading cause of death and disease in the United States. However, the burden of tobacco use is not equally distributed across the nation. Due to a variety of individual, interpersonal, and environmental factors, people living in rural areas--especially those in rural Appalachian Kentucky--are far more likely to use tobacco and be disproportionally affected by its use. In fact, in some areas of rural Appalachian Kentucky, as many as 41% of adults currently smoke, and lung cancer rates can exceed the national average by as much as 89%. While tobacco use alone does not account for the disproportionately higher rates of morbidity and mortality in Appalachian Kentucky, tobacco use is a significant--if not leading--risk factor. Reducing the burden of tobacco use among this population requires evidence-based, culturally-tailored tobacco use interventions at all levels of influence, from the individual to the policy level.

Developing effective tobacco use interventions at multiple levels of influence requires understanding the full scope of current tobacco use and control trends in Appalachian Kentucky. To capture this scope, a broad environmental scan of secondary data sources was conducted to identify the primary factors driving tobacco use in this region. The primary goals of the tobacco control needs assessment included 1) understanding the unique challenges to reducing tobacco use in Appalachian Kentucky within the larger context of national tobacco control; and 2) recommending additional measures to prevent and reduce tobacco use in this region using a social ecological approach.

Given the range of tobacco use challenges at all levels of influence, recommendations for reducing tobacco use in Appalachian Kentucky are based on the World Health Organization's MPOWER framework with a few additional recommendations from the Centers for Disease Control. Where appropriate, recommendations are tailored to more specifically address the unique challenges facing Appalachian Kentucky to provide local tobacco control practitioners with a practical, comprehensive framework for reducing tobacco use in their communities.

Table of Contents

EXECUTIVE SUMMARY i

CHAPTER ONE: INTRODUCTION 1

Rationale for Needs Assessment 1

Purpose Statement 3

Statement of Significance 4

Definition of Key Terms 6

Appalachian Kentucky 6

Appalachian Region 7

Needs Assessment 8

Rural 8

Social Ecological Approach 9

Tobacco Control 10

CHAPTER TWO: LITERATURE REVIEW 11

Introduction 11

Current Tobacco Use Trends 12

General 12

Adults 13

Youth 17

Smoking-Related Morbidity & Mortality 20

Tobacco Use Risk and Protective Factors 21

Individual Factors 21

Interpersonal Factors 23

Sociopolitical Factors 23

Current Best Practices in Tobacco Control 25

Current Tobacco Control Efforts 28

CHAPTER THREE: METHODOLOGY 31

Introduction 31

Population and Sample 31

Research Design 32

Scientific Literature Review 32

Grey Literature Review 33

Secondary Data Analysis Sources 34

Limitations 35

CHAPTER FOUR: FINDINGS 36

Introduction 36

Current Tobacco Use Trends in Appalachian Kentucky 37

Adult Smoking 38

Adult Smoking During Pregnancy 41

Adult Smokeless Use 41

Youth Smoking 42

Secondhand Smoke Exposure 43

Current Tobacco Control Trends in Appalachian Kentucky 44

Primary Health Implications 53

Current Obstacles to Reducing Tobacco Use in Appalachian Kentucky 56

Low Socioeconomic Status, High Unemployment, and Low Educational Attainment 57

Economic Ties to Tobacco Growing and Deep-Seated Cultural Norms 57

Increased Access to Tobacco Products, High Exposure to Tobacco Advertising, and Low Exposure to Countermarking 59

Rurality and Poor Access to Health Services and Information 59

Prevailing Community Beliefs 60

Current Resources to Reduce Tobacco Use in Appalachian Kentucky 62

CHAPTER FIVE: DISCUSSION 69

Introduction 69

Summary of Major Findings 69

Recommendations 73

Conclusion 84

REFERENCES 85

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