For young women growing up inAppalachian communities in whichtobacco is the main commodity,smoking is part of life and getting cigarettescan be easier than sneaking into an R-ratedmovie. The addictive crop surrounds teens,as anyone from their teachers to theirpreachers may work in the tobacco industry.

For teens who smoke in these communities, kicking the habit is especially hard, says Sharon Denham, a professor of nursing at Ohio University. Denham recently worked with Toborg Associates, a private research group out of Washington, D.C., on a study of smoking cessation in Appalachia. The project — funded through grants from the U.S. Department of Health and Human Services, National Institutes of Health, and National Cancer Institute — focused on teenage girls in Ohio, Tennessee, and Virginia. The girls, who were between the ages of 12 and 14, were divided into six focus groups. The researchers also interviewed community health counselors about their knowledge of and involvement in tobacco issues, as well as strategies for helping teens to quit smoking.

Tobacco-growing communities have a greater acceptance of tobacco use, and some parents condone smoking, Denham learned. One health counselor recounted a story of a girl finding cigarettes in her Christmas stocking. “The young girls were quite adamant that they never had trouble getting cigarettes,” Denham says.“If they don’t steal them from their parents, they have friends steal from theirs, but they may not call it stealing.”

Not all parents have a cigarette waiting for their child after school — some actively discourage smoking. But the tobacco culture is hard to ignore. Many girls constantly see tobacco crops and growers, and some harvested tobacco or had friends who did.

In an environment where everyone is comfortable with tobacco, teachers are less likely to talk about the perils of smoking, and law enforcement is less likely to enforce laws related to tobacco use, Denham says. “It is an issue in rural areas, where everyone knows everyone,” she says. “Local carryouts are less likely to enforce the laws. Even if the kids get caught, there is little available to help them quit and court-ordered programs are just not enough.”

What Denham found most interesting is that many of these girls were knowledgeable about the harm of secondhand smoke and were concerned about the health of younger siblings. However, many did not think they were addicted and felt they could quit at anytime. Denham also was surprised that some girls, who began smoking at age 9, were already heavily addicted by 16. Like most teenagers, relationships with their peers influenced their decisions. “Smoking has the appeal of being cool, being accepted, and feeling more mature,” says Denham, who presented her findings at the Appalachian Studies Association Conference in Richmond, Kentucky.

But there are few effective programs that encourage and motivate the girls to quit, Denham says. In this study she discovered that three out of four teen smokers have made one serious, yet unsuccessful effort to quit — usually without the help of programs or medications, but by simply going cold turkey. In a tobacco-growing community smoking cessation must be approached differently than in other communities, she says, and materials and programs need to be culturally, socially, and economically relevant. To address that issue, Toborg Associates will develop materials such as brochures, posters, and school programs to be used by community members and families to help teens quit smoking — or prevent them from ever starting.

For more information about Sharon Denham’s work, visit the Web at http://www.hhs.ohiou.edu./nrse/staffdetail.asp?section=NRSE&id=DenhamSharon.