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Original Research

Knowledge and perceptions of tobacco-related media in rural Appalachia

Submitted: 13 May 2014
Revised: 28 August 2014
Accepted: 28 August 2014
Published: 8 March 2015

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Author(s) : Branstetter SA, Lengerich E, Dignan M, Muscat J.

Steven BranstetterJoshua Muscat

Citation: Branstetter SA, Lengerich E, Dignan M, Muscat J.  Knowledge and perceptions of tobacco-related media in rural Appalachia. Rural and Remote Health (Internet) 2015; 15: 3136. Available: (Accessed 17 October 2017)


Introduction:  A critical component of the US Food and Drug Administration’s new authority to regulate tobacco products is understanding communications and marketing of tobacco products and their perceived risks in different geographic, age, race, ethnic and socioeconomic groups. Such information might be particularly useful in subgroups of the population or geographic areas that experience high tobacco use and suffer a disproportionate burden from tobacco-related diseases. For certain populations, there may be additional cultural factors unique to the geographical region which may promote smoking behavior. The purpose of the present study was to examine the perceptions of tobacco-related media messages among a sample of rural Appalachian natives, a population with smoking rates higher than the national average and who are disproportionately affected by tobacco-related and other cancers.
Methods:  A series of four focus group sessions were conducted in a north-central area of Pennsylvania, in one of 52 counties in Pennsylvania designated as within the Appalachian region. Participants were recruited via direct mail letters, advertisements in a local newspaper, and recruiting flyers posted at the local library. The focus groups were moderated by trained professional staff from The Pennsylvania State University’s Center for Survey Research (CSR). Focus group sessions sought to examine perceptions of tobacco-related media in an Appalachian region of Pennsylvania. The sessions were audiotaped and transcribed, and the data was analyzed using qualitative approaches.
Results:  Participants reported that pro-tobacco ads and favorable messages were received through the internet, direct mail, convenience stores, billboards, movies, and other sources. Anti-tobacco messages were identified primarily from television and magazines. In general, participants concluded that quitting was a matter of choice and was not influenced by pro- or anti-tobacco media.
Conclusions:  These results indicate that both pro- and anti-tobacco messages from a variety of sources are highly recognized and remembered in detail in Appalachia, but the effectiveness of anti-tobacco messages is questionable within this group. It was found that, without exception, group members reported that no media messages – either pro- or anti-tobacco – had any meaningful impact on their current behavior. Group members did, however, recognize that media messages influenced their behavior at the time they were first starting to smoke. The failure of these messages to connect with this population may reflect the lack of specific tailoring of messages to fit the distinct culture and values of this Appalachian population.

Key words: advertisements, Appalachia, focus group, media, messaging, smokers, tobacco.

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