Rural smokers found success in quitting with IU cessation programs

After nearly 50 years of struggling to quit smoking, Loretta Kendall, 65, of Washington, Ind., is finally breathing easy. 

"It's amazing how good I feel. It's amazing how well I breathe," said Kendall, whose official quit date is March 19, 2024.  

What helped her finally put down cigarettes for good? A Daviess County smoking cessation program made possible through a partnership between IU and the Indiana Healthy Opportunities for People Everywhere, or I-HOPE, initiative.  

Funded by a $34.8 million grant from the CDC, I-HOPE was a two-year initiative involving dozens of Indiana organizations to address COVID-19 health disparities and advance health equity in Indiana. 

According to the Indiana Department of Health, smokers are at a higher risk of severe respiratory illnesses such as COVID-19. Secondhand smoke also poses a threat to nonsmokers, particularly children. Research indicates that rural areas struggle with higher smoking rates and lower quitting rates compared to urban areas. 

Through I-HOPE, the IU Center for Rural Engagement and the IU School of Public Health-Bloomington collaborated with rural Indiana healthcare providers to provide free smoking cessation programs throughout southern Indiana. The initiative, originally developed by Jon Macy, assistant dean for graduate education at the School of Public Health, focused on helping pregnant women quit smoking before expanding to assist a broader audience of rural tobacco users.  

Priscilla Barnes, associate professor at the School of Public Health-Bloomington, and her team deployed the program as part of an Indiana Department of Health initiative, Heart Healthy Hoosiers. Health organizations participating in the program received a resource toolkit that included a Smokerlyzer, a hand-held carbon monoxide monitor that measures an individual's CO levels and gives them immediate feedback on their progress.  

Kendall's journey to quit smoking started in January 2024 at WrightChoice Healthcare in Washington, Ind. Every two weeks, she'd check in to log her blood pressure, weight, and CO levels. The program offered Kendall smoking replacement options, and she discovered that nicotine patches worked well for her.  

She was also given ongoing encouragement from the staff at WrightChoice. "They were very supportive and always there if I needed anything—if I was struggling," she said.  

One of those supporters was Jessica Wright, nurse practitioner and owner of WrightChoice. She led the program Kendall participated in along with a smoking cessation program at Perdue Farms in Washington geared toward helping employees quit, another program supported by I-HOPE. 

At WrightChoice, the cessation program started with around 17 participants. When it ended, 10 participants were still enrolled, and four had successfully quit, according to Wright. 

While the numbers may sound small, she said, the potential long-term health implications are enormous.  

"When you think about the life and livelihood of four people, that's massively changed the trajectory of their entire life, between COPD, lung cancers, bowel cancers, bladder cancers, heart disease, stroke—all the things that I see in my practice that we may have just prevented." 

Nearly 70 percent of people who smoke cigarettes want to quit, but fewer than 10 percent are successful each year, according to the Centers for Disease Control and Prevention (CDC). 

Wright credits the program's success to the regularly scheduled check-ins and the fact that funding made it free of charge for participants.  

"When I've talked to patients about [tobacco cessation], it's usually either, 'It's not the right time,' or they don't feel like they can afford it. We were able to provide them something that was much needed, and it wasn't an extra expense for them. That was huge."  

Wendy Bailey is another I-HOPE smoking cessation program leader who saw success at her clinic. She's a certified community health worker, insurance navigator, and tobacco treatment specialist for Greene County Health in Linton. 

Through a combination of incentive gift cards, breathing exercises, nicotine replacement therapies, and regular check-ins, she helped more than 20 participants make strides in conquering their tobacco addiction.  

Like Wright, she believes offering regular in-person support was vital to many participants' success. Some enjoyed the program so much that they've maintained regular contact with the clinic.  

"I have some participants who've graduated, and they're like, 'I don't really want it to be over. I just want to come in and do a check-in with you,'" said Bailey, who plans to continue offering tobacco cessation programs in Greene County. 

Though Indiana's smoking rate has significantly declined since 2011, it's still consistently higher than the U.S. median (16.2 percent versus 14.0 percent), according to the Indiana Department of Health. 

And smoking doesn't just have negative impacts on health and quality of life—it also comes with a staggering price tag. According to a 2024 State of Tobacco Control report by the American Lung Association, smoking results in approximately $2.9 billion in healthcare costs for Indiana each year. 

But there's some good news. Indiana's cigarette consumption decreased by 13% from 2020 to 2023, a change that the American Lung Association in Indiana credits to tobacco prevention and cessation programs. 

Hoosiers who want to end their tobacco dependence can access Quit Now Indiana, a network of free programs and resources aimed at helping Indiana residents quit. 

This initiative was supported by funds made available from the Centers for Disease Control and Prevention, Center for State, Tribal, Local and Territorial Support, under NH75OT000073. The content of this storyis that of the authors and do not necessarily represent the official position of or endorsement by the Centers for Disease Control and Prevention.