Smoking Quit Attempts and Associated Factors Among Rural Adults Who Smoke Daily in the United States

Introduction: Rural American communities are heavily affected by tobacco-related health disparities. This study aims to evaluate the prevalence of quit attempts (QAs) and factors that promote or impede QA among rural adults who smoke daily.Methods: Data from Wave 5 of the Population Assessment of Tobacco and Health study were analyzed. Multivariable logistic regression was used to identify factors associated with QA. Backward selection was used to identify variables included in the final model with statistical significance set at p < .05.Results: Among 1610 rural adults who smoked daily, the prevalence of a QA in the past 12 months was 25.6% (95% confidence interval [CI]: 23.2, 28.2). Factors associated with greater QA odds: having greater education (adjusted odds ratio [aOR] = 1.35, 95% CI: 1.03, 1.77), e-cigarette use (aOR = 1.35 95% CI: 1.03, 1.80), disapproval of smoking from friends/family (aOR = 1.46, 95% CI: 1.09-1.94), greater frequency of thinking about the harm of tobacco (aOR = 1.48, 95% CI: 1.28, 1.71), fair/poor physical health (aOR = 1.31, 95% CI: 1.00, 1.70), and being advised to quit by a doctor (aOR = 1.63, 95% CI:1.25, 2.13). Smokeless tobacco use (aOR = 0.67, 95% CI: 0.47, 0.96) and greater cigarettes per day (aOR = 0.67, 95% CI: 0.47, 0.96) were associated with QA lower odds.Conclusions: Only one in four rural adults who smoke made a past-year QA. Interventions that promote provider advice to quit smoking, tobacco health harms, and normative beliefs may increase QAs in rural communities.Implications: Along with higher smoking rates and lower QAs, rural communities face limited access to programs, medication, and health care professionals as tools to help them quit smoking. Public Health initiatives should focus on developing cultural sensitivity training targeting health care professionals to advise patients to quit smoking and the role of multiple tobacco product use. Furthermore, given the low rates of smoking QAs, future mixed-methods research is needed to inform policies and interventions targeted at eliminating tobacco-related health disparities.