A Qualitative Evaluation of Tobacco Consumption in the Rural Context

Abstract

Objectives: Understanding what rural adult tobacco users think about tobacco use, tobacco control policies and health may help create acceptable policies and interventions. Methods: We completed 8 focus groups in rural Michigan from winter 2016 through summer 2018. Interviews were transcribed and an iterative thematic analysis was completed during fall 2018. Results: Although our primary themes of Independence, Respect, Social Context, Economic Calculus, and Policy with an underlying theme of health were similar to themes that typically arise in tobacco control research, their application and social context appear to be unique in rural communities. Issues of respect for tobacco users, and well as third-party individuals affected by tobacco use, were paramount for participants. They viewed tobacco use as an individual choice and not a structural or policy-relevant issue, although they accepted restrictions on tobacco use in most settings where non-smokers are present. Conclusions: Participants understood that smoking is problematic and seem to be open to anti-smoking messaging and policies when correctly framed. Participants blame themselves for their smoking (ignoring industry responsibility) and used language that can be found in tobacco marketing. Framing tobacco control as a way to protect children while respecting smokers as people may be successful.