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. 2025 Sep 4:23.
doi: 10.18332/tid/207082. eCollection 2025.

Rural and Appalachian cancer survivors' responses to tobacco use screening and tobacco treatment offer

Abigayle R Feather  1   2 , Brent J Shelton  2   3 , Courtney Blair  2 , D Bront Davis  2 , Joan Scales  2 , Audrey Darville  4 , Joseph Valentino  2   5 , Laurie E McLouth  2   6 , Jessica L Burris  1   2
Affiliations

Rural and Appalachian cancer survivors' responses to tobacco use screening and tobacco treatment offer

Abigayle R Feather et al. Tob Induc Dis. .

Abstract

Introduction: Smoking after a cancer diagnosis is associated with poor outcomes whereas smoking cessation improves survival and other outcomes. Although professional societies and practice guidelines call for equitable tobacco treatment delivery in healthcare, disparities in tobacco-related disease burden persist.

Methods: In the context of an outpatient US cancer center's population-based tobacco treatment program, this study examines associations between cancer survivors' rural and Appalachian residence status and: 1) current tobacco use status, 2) decision to decline tobacco treatment, and 3) reason for declining assistance. A cross-sectional, retrospective analysis was conducted using electronic health record data from 16839 adults: 64.04% female, 88.49% non-Hispanic White, mean age 59.19 ± 14.52 years, 35.97% rural residence, 53.14% Appalachian residence, who sought cancer care in 2019. Descriptive statistics and logistic regression models were applied.

Results: The portion of patients that reported current tobacco use was 21.75%. Rural patients had higher odds of tobacco use than urban (OR=1.22; 95% CI: 1.12- 1.34), as did Appalachian patients compared to non-Appalachian (OR=1.41; 95% CI: 1.28-1.54). Neither rural nor Appalachian residence status was significantly associated with responses to tobacco treatment offers (76.65% declined the offer) or reason for declining (65.19% declined because they were 'not ready to quit').

Conclusions: Findings highlight continued need for population-level tobacco use screening and proactive tobacco treatment offers, given elevated tobacco use in some minority groups and overall low rates of tobacco treatment acceptance. This large study helps shed light on the association between geographical residence and tobacco-related outcomes among patients with cancer, and underscores room for improvement in tobacco treatment uptake in cancer care.

Keywords: cancer survivors; patient acceptance of healthcare; rural population; tobacco use cessation.

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Conflict of interest statement

The authors have each completed and submitted an ICMJE form for Disclosure of Potential Conflicts of Interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. All authors declare receiving funding from the National Institutes of Health under grant award (P30 CA177558 and P30 CA177558-05S5). The University of Kentucky, Cancer Center Support Grant award supported this work through both a project-specific grant award and the assistance of its Shared Resource Facilities. A. Darville reports that in the past 36 months she has received travel support/conference fee from University of Kentucky College of Nursing for the National Conference on Tobacco or Health, June 2022. She also reports unpaid volunteer service as a Board Member of the Association for the Treatment of Tobacco Use and Dependence. L.E. McLouth reports receiving, in the past 36 months, a grant from the National Cancer Institute of the National Institutes of Health (R01 CA283929).

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