American Lung Association Report Aims to Reduce Tobacco Use in New Hampshire’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 39 percent of New Hampshire’s population lives in rural areas.

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).

“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 smoke free air laws in place and residents are less likely to not allow smoking in their homes or other indoor places.


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 young people, these young people are less likely to be exposed to tobacco counter-marketing campaigns. 

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, New Hampshire has the lowest cigarette tax in New England and in 2011, in spite of opposition by the American Lung Association in New Hampshire and a number of other public health organizations; the tobacco tax was actually lowered.   Since the tobacco industry failed to decrease the retail price, the only result of this decrease was a loss in state revenues.

Rural tobacco users are also less likely to have access to programs and services to help them quit. Many rural states don’t allocate funds in order to promote state phone or online quit-smoking counseling services.  As a result these services are not being used. The New Hampshire Tobacco Helpline, 1-800-QUIT-NOW (800-784-8669), offers free, confidential phone counseling from certified tobacco treatment specialists.


“New Hampshire is 84% rural land mass - where 40% of the population resides. This rural population has a significantly higher rate of underinsurance across all age ranges under 65, with nearly one quarter of rural residents age 18-34 being uninsured,” says Alisa Druzba, administrator for the NH Rural Health and Primary Care Office. “On top of coping with reduced access to care and provider shortages, rural residents face employment challenges as large industry, such as paper mills, close in NH. Overall, these rural populations have maintained higher tobacco use rates in both adult and youth tobacco use as compared to non-rural areas.”

The American Lung Association in New Hampshire 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 New Hampshire and across the country need special attention if we’re going to make a major dent in tobacco prevalence,” said Lee Gilman, Senior Director for Health Education in the American Lung Association of the Northeast’s Manchester office.   “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 New Hampshire is a strong supporter of the New Hampshire Tobacco Helpline (800-QUIT-NOW).  The ALA also offers smoking cessation resources to help people quit smoking.   These include Freedom From Smoking® and the Lung HelpLine.  The Lung HelpLine, 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.