Smoking cessation experiences of chronic lung disease patients living in rural and urban areas of Virginia

Rural residents differ from individuals living in urban areas in their views about health and health behavior, their socioeconomic status, and their access to health care services. Such differences may have implications for health policy and the focus and design of health care services, including educational interventions. This paper reports findings from a comparative analysis of rural and urban chronic obstructive pulmonary disease (COPD) patients' smoking cessation experiences. The study's aims were to determine whether rural COPD patients differed from their urban counterparts in smoking patterns, smoking cessation attempts (i.e., number of quitting attempts, methods used, withdrawal symptoms, professional and personal supports for quitting smoking), and smoking cessation outcomes. Forty-eight rural and 86 urban COPD patients were interviewed by telephone using a pretested questionnaire. The rural and urban samples did not significantly differ in demographic characteristics, disease severity, functional status, smoking patterns, reasons for smoking, perceived benefits of smoking cessation, or withdrawal symptoms. However, the rural COPD patients used fewer smoking cessation methods and had fewer persons supporting their smoking cessation attempts. Rural patients' support networks for smoking cessation primarily consisted of family members, whereas those of urban patients were more varied. Similar percentages of rural and urban patients had been abstinent from smoking for at least six months at the time of the interview, controlling for age and disease severity. Logistic regressions were used to identify predictors of current smoking for the rural and urban samples. For the rural sample, less educated individuals were more likely to be current smokers. Spouse smoking predicted current smoking in the rural sample but was only marginally significant (P = 0.054). In the urban sample, use of daily medication for breathing (a proxy measure of disease severity) had a significant negative effect on current smoking. Smoking due to stress was a significant positive predictor of current smoking. Findings from this exploratory study suggest the existence of rural/urban differences in COPD patients' smoking cessation patterns that warrant further investigation.