AN ENVIRONMENTAL SCAN AND NEEDS ASSESSMENT OF TOBACCO CONTROL IN APPALACHIAN KENTUCKY USING SECONDARY DATA Open Access
Talbert, Emily Catherine (2013)
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
About this Master's Thesis
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