American Lung Association Report Aims to Reduce Tobacco Use in Maine’s Rural Communities

Today, the American Lung Association released its latest lung health disparity report, “Cutting Tobacco’s Rural Roots:  Tobacco Use in Rural Communities,” which examines tobacco addiction and exposure to secondhand smoke in rural America, particularly among rural youth. More than 60 percent of Maine’s population lives in rural areas, the highest percentage in the country. 

Tobacco use is higher in rural communities than in suburban and urban communities, and smokeless tobacco use is shockingly twice as common.  Rural youth are more likely to use tobacco and to start earlier than urban youth, perpetuating the cycle of tobacco addiction and death and disease.  Eighty-eight percent of adult smokers report starting prior to the age of 18, according to the Centers for Disease Control and Prevention (CDC).

For over a decade Maine has invested some of its Tobacco Settlement money into preventing tobacco use and helping smokers quit through the Fund for a Healthy Maine.  The results have been significant.  There has been a dramatic decline in youth smoking and the state’s overall smoking rate of 18% is 11% lower than the rural state average.

“Tobacco use is often more socially acceptable in rural areas, making it more likely that children living in these communities will also start to use tobacco,” said Jeff Seyler, President and CEO of the American Lung Association of the Northeast.  “We hope this report will make community leaders and the public more aware of this health disparity and encourage them to take a stand against the culture of tobacco.  We need to empower future generations to lead healthy, tobacco-free lives, ultimately preventing tobacco-related disease and death and saving lives.  This report stresses how important it is that people living in rural areas have access to ample quit smoking resources.”


There are a number of environmental and social factors that contribute to the generational cycle of tobacco use among youth and adults in rural America. 

Increased tobacco use is associated with lower education levels and lower income, which are both common in rural areas where there may be fewer opportunities for educational and economic advancement.  Exposure to secondhand smoke is also higher as rural communities are less likely to have smokefree air laws in place and residents are less likely to refuse to allow smoking in their homes or other indoor places.

Unlike many other rural states, Maine is a leader in protecting people from secondhand smoke exposure. In fact the state is the only one in the northeast to ban smoking in vehicles when children are present.

For decades, the tobacco industry has used rural imagery, such as the Marlboro Man, to promote its products and appeal to rural audiences.  Over the past several years, the tobacco industry’s marketing of smokeless tobacco products has skyrocketed. Sadly as the tobacco industry spends millions of dollars targeting rural youth, these youth are less likely to be exposed to tobacco counter-marketing campaigns.  Maine has dedicated funding for counter-marketing that reaches rural areas of the state as part of its comprehensive program. 

Increasing the price of tobacco products is one of the most effective ways to prevent youth from starting to smoke but many rural states have low tobacco taxes.  Unfortunately Maine has dropped its leadership role in this area.   The state cigarette tax has been $2.00 since 2005. After New Hampshire, it is the lowest in the northeast. 

Rural tobacco users are also less likely to have access to programs and services to help them quit. Most rural states fail to adequately promote state quit-smoking counseling services by phone or online.  As a result these services are not frequently used. However, that is not the case in Maine where the Tobacco Helpline is heavily promoted and utilized.

“Maine was recognized last fall by the American Lung Association as being the most ‘quit-friendly’ state in the nation,” say Edward Miller, Senior Vice President for Public Policy in the American Lung Association of the Northeast’s Augusta office. “The Maine Tobacco Helpline not only reaches thousands of people each year but its success rate of over 30% makes it a national leader.”

The American Lung Association in Maine is calling on government agencies, the research and funding community, health systems and insurers, community leaders, schools and families to continue to cut tobacco’s rural roots.  “Rural communities here in Maine and across the country need special attention if we’re going to make a major dent in tobacco prevalence,” said Miller.  “If residents, community leaders, organizations and decision-makers all work together, we can make progress in reducing the health disparity caused by tobacco use in rural communities.”   

The American Lung Association in Maine is a strong supporter of the Maine Tobacco Helpline (800-207-1230).  The ALA also offers smoking cessation resources to help people quit smoking.   These include Freedom From Smoking® and the Lung HelpLine.  The Lung HelpLine, reachable at 1-800-LUNG-USA, offers one-on-one support from registered nurses and respiratory therapists.  Individuals have the opportunity to seek guidance on lung health and find out how to participate in and join the Lung Association smoking cessation programs.   

Specific action steps are detailed in the full report. These include the following: state and federal tobacco control programs must make a concerted effort and dedicate funding to reach rural communities; the research community should focus attention and resources on identifying effective cessation treatments for smokeless tobacco use; and school, health and employment systems in rural areas must all implement effective tobacco control strategies including smokefree air policies and access to cessation services.

This report is part of the Lung Association’s Disparities in Lung Health Series.  To download a copy of the report, visit: www.lung.org/rural-tobacco-use.