Socioeconomic Characteristics, Tobacco Use, and Service Utilization by County Poverty Status among Oklahoma Tobacco Helpline Registrants: A Cross-Sectional Study

Introduction: Residents of counties with higher poverty levels experience elevated smoking rates and disproportionate tobacco-related cancer mortality. This study examined differences in sociodemographic characteristics, tobacco use, and service utilization among Oklahoma Tobacco Helpline (OTH) registrants across county poverty designations. Methods: In this cross-sectional study, data were analyzed from 33847 adults registered with the OTH between 1 July 2023 and 30 June 2024. Counties were classified as persistent poverty (PPC: ≥20% of residents in poverty for ≥30 years), current poverty (CPC: ≥20% of residents in poverty currently for <30 years), or non-poverty (NPC: <20% of residents in poverty). Group differences were examined using the chi-squared test and analysis of variance. Adjusted multinomial logistic regression analyses evaluated associations between poverty status, tobacco use, and service utilization, controlling for age, sex/gender, race, education level, household income, health insurance, and chronic conditions. Results: Registrants residing in PPCs and CPCs differed from those in NPCs in terms of age and race, and they had lower education, income, and greater Medicaid coverage (all P<0.05). In adjusted models, PPC registrants had higher odds of smoking >1 pack/day (heavy smoking) (AOR=1.49; 95% CI: 1.30-1.70; p<0.001) and learning about OTH through personal networks (AOR=1.42; 95% CI: 1.16-1.73; p<0.001) compared with NPCs. Compared with registrants residing in non-poverty counties (NPCs), CPC registrants had higher odds of smoking >1 pack/day (AOR=1.39; 95% CI: 1.16-1.65; p<0.001) and learning about OTH through community/social organizations (AOR=1.77; 95% CI: 1.33-2.35; p<0.001). Service type and nicotine replacement therapy receipt/duration were similar across poverty designations. Conclusions: PPC and CPC registrants showed greater socioeconomic disadvantage and nicotine dependence than NPC registrants but had distinct information pathways. These findings highlight geographically concentrated poverty as a potential contributor to tobacco-related disparities and suggest that interventions addressing social and environmental conditions in PPCs may help enhance cessation engagement and reduce tobacco-related inequities.