Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Robin Vanderpool, DrPH, CHES

Committee Member

Angela Carman, DrPH

Committee Member

Ramona Stone, PhD, MPH


In 1964, the first United States (U.S.) Surgeon General’s Report explicitly stating the dangers of smoking, including an increased risk of lung cancer, was released. Fifty years later, the U.S. continues to carry the significant health and economic burdens for failing to heed this public health warning. Owsley County, Kentucky, located in the heart of the Appalachian is one of the most impoverished and medically underserved counties in the U.S., ranking last in almost every category of overall health outcomes in the state. The county is also entirely rural, with no major cities within an 80-mile radius. In every health behavior measured, Owsley County fairs worse than the Kentucky average. Although 26% of Kentucky adults regularly smoke cigarettes, a staggering 41% of Owsley County adults smoke. Within a five year period (2009-2013) the age-adjusted lung and bronchial cancer incidence rate was 148.1 per 100,000 [107.8-199.9] compared to Kentucky’s 96.7 [95.4-97.9]. These statistics are startling, and highlights the need for effective smoking cessation services and initiation prevention in this community.

The Kentucky River District Health Department (KRDHD) is requesting funds, in collaboration with the Owsley County Health Center (OCHC), to modify the evidence-based tobacco cessation program, Enough Snuff, to “Enough Smoke” in order to provide a targeted and tailored smoking cessation program for the adult males in Owsley County. Participates must be male, 21 years of age or older, have smoked at least one cigarette a day for at least one year, and must have the desire to quit. Enough Smoke is designed to decrease the number of cigarettes smoked per day, increase quit attempts, and improve smoking abstinence among adults. The project’s long-term outcome is the widespread adoption of this evidence-based, sustainable cessation program in Owsley County. We also hope to observe a decrease in the prevalence of adult smoking and smoking-related morbidities. Our outcomes will be measured by a repeated measures, within subjects study design via self-report surveys at baseline, 3-months, 6-months, and 12-months. We have employed a multi-method recruitment approach including newspaper ads, flyers, billboards, and radio ads. Additionally, we will collaborate with the GIFTS program which targets female smokers, in order to recruit husbands or male friends/family members that may qualify for the intervention. Our project team has extensive experience in delivering and evaluating evidence-based programming and has partnered with key stakeholders in the community that will greatly contribute to the efforts of the project. Enough Smoke will contribute to the overall reduction of smoking in Owsley County, however it is not possible for the program to stand alone in this effort. In order to sustainably reduce smoking in the community there must be a cultural shift in smoking norms in addition to policies that support the behavior. The introduction of Enough Smoke serves as a basis for these high impact changes.

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