{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T05:29:49Z","timestamp":1769578189034,"version":"3.49.0"},"reference-count":35,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2015,12,22]],"date-time":"2015-12-22T00:00:00Z","timestamp":1450742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute on Minority Health and Health Disparities in the National Institutes of Health","award":["P20MD002329"],"award-info":[{"award-number":["P20MD002329"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Remarkable disparities in smoking rates in the United States contribute significantly to socioeconomic and minority health disparities. Access to treatment for tobacco use can help address these disparities, but quitlines, our most ubiquitous treatment resource, reach just 1%\u20132% of smokers. We used community-based participatory methods to develop a survey instrument to assess barriers to use of the quitline in the Arkansas Mississippi delta. Barriers were quitline specific and barriers to cessation more broadly. Over one-third (34.9%) of respondents (n = 799) did not have access to a telephone that they could use for the quitline. Respondents reported low levels of knowledge about the quitline, quitting, and trust in tobacco treatment programs as well as considerable ambivalence about quitting including significant concerns about getting sick if they quit and strong faith-based beliefs about quitting. These findings suggest quitlines are not accessible to all lower socioeconomic groups and that significant barriers to use include barriers to cessation. These findings suggest targets for providing accessible tobacco use treatment services and addressing concerns about cessation among lower income, ethnic minority, and rural groups.<\/jats:p>","DOI":"10.3390\/ijerph13010015","type":"journal-article","created":{"date-parts":[[2015,12,23]],"date-time":"2015-12-23T06:52:19Z","timestamp":1450853539000},"page":"15","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["When Free Is Not for Me: Confronting the Barriers to Use of Free Quitline Telephone Counseling for Tobacco Dependence"],"prefix":"10.3390","volume":"13","author":[{"given":"Christine","family":"Sheffer","sequence":"first","affiliation":[{"name":"Sophie Davis School of Biomedical Education, City College of New York, New York, NY 10031, USA"},{"name":"Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Brackman","sequence":"additional","affiliation":[{"name":"Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charnette","family":"Lercara","sequence":"additional","affiliation":[{"name":"Sophie Davis School of Biomedical Education, City College of New York, New York, NY 10031, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naomi","family":"Cottoms","sequence":"additional","affiliation":[{"name":"Walnut Street Works, Inc., Helena-West Helena, AR 72342, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Olson","sequence":"additional","affiliation":[{"name":"Walnut Street Works, Inc., Helena-West Helena, AR 72342, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luana","family":"Panissidi","sequence":"additional","affiliation":[{"name":"Sophie Davis School of Biomedical Education, City College of New York, New York, NY 10031, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jami","family":"Pittman","sequence":"additional","affiliation":[{"name":"Sophie Davis School of Biomedical Education, City College of New York, New York, NY 10031, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Stayna","sequence":"additional","affiliation":[{"name":"Sophie Davis School of Biomedical Education, City College of New York, New York, NY 10031, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2015,12,22]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (2011). Current cigarette smoking prevalence among working adults\u2014United States, 2004\u20132010. MMWR Morb. Mortal. Wkly. Rep., 60, 1305\u20131309."},{"key":"ref_2","unstructured":"Centers for Disease Control and Prevention (2011). Vital signs: Current cigarette smoking among adults aged \u226518 years\u2014United States, 2005\u20132010. MMWR Morb. Mortal. Wkly. Rep., 60, 1207\u20131212."},{"key":"ref_3","unstructured":"ACS (2013). Cancer Facts and Figures 2013, American Cancer Society."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/S0140-6736(06)68975-7","article-title":"Social inequalities in male mortality, and in male mortality from smoking: Indirect estimation from national death rates in England and Wales, Poland, and North America","volume":"368","author":"Jha","year":"2006","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1001\/jama.291.10.1238","article-title":"Actual causes of death in the United States, 2000","volume":"291","author":"Mokdad","year":"2004","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2348","DOI":"10.1001\/archinte.166.21.2348","article-title":"Socioeconomic status and trends in disparities in 4 major risk factors for cardiovascular disease among U.S. adults, 1971\u20132002","volume":"166","author":"Kanjilal","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_7","unstructured":"Centers for Disease Control and Prevention (2014). 2014 Surgeon General\u2019s Report: The Health Consequences of Smoking\u201450 Years of Progress, Centers for Disease Control and Prevention."},{"key":"ref_8","unstructured":"Centers for Disease Control and Prevention (2013). Behavioral Risk Factor Surveillance System Survey Data, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention."},{"key":"ref_9","unstructured":"Bishaw, A., and Stern, S. (2006). Evaluation of Poverty Estimates: A Comparison of American Community Survey and the Current Population Survey, U.S. Census Bureau."},{"key":"ref_10","unstructured":"U.S. Census Bureau (2000). Census 2000 Urban and Rural Classification, Available online: www.census.gov."},{"key":"ref_11","unstructured":"CDC (2007). Best Practices for Comprehensive Tobacco Control Programs, U.S. Office on Smoking and Health, Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Cummins, S.E., Bailey, L., Campbell, S., Koon-Kirby, C., and Zhu, S.H. (2007). Tobacco cessation quitlines in North America: A descriptive study. Tob. Control, 16.","DOI":"10.1136\/tc.2007.020370"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1037\/a0018598","article-title":"Smoking cessation quitlines: An underrecognized intervention success story","volume":"65","author":"Lichtenstein","year":"2010","journal-title":"Am. Psychol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Varghese, M., Sheffer, C.E., Stitzer, M., Landes, R., Brackman, S.L., and Munn, T. (2014). Socioeconomic disparities in telephone-based treatment of tobacco dependence. Am. J. Public Health, 104.","DOI":"10.2105\/AJPH.2014.301951"},{"key":"ref_15","unstructured":"North American Quitline Consortium Increasing the Reach of Tobacco Cessation Quitlines: A Review of the Literature and Promising Practices. Available online: http:\/\/www.naquitline.org\/resource\/resmgr\/issue_papers\/naqc_issuepaper_increasingre.pdf."},{"key":"ref_16","unstructured":"U.S. Census Bureau (2010). US Census Profile of General Demographic Characteristics, U.S. Census Bureau."},{"key":"ref_17","unstructured":"Barnett, E., Capser, M., Halverson, J., and Elmes, G. (2001). Men and Heart Disease: An Atlas of Racial and Ethnic Disparities in Mortality, Office for Social Environment and Health Research, West Virginia University. [1st ed.]."},{"key":"ref_18","unstructured":"Capser, M., Barnett, E., Halverson, J., and Elmes, G. (2000). Women and Heart Disease: An Atlas of Racial and Ethnic Disparities in Mortality, Office for Social Environment and Health Research, West Virginia University. [2nd ed.]."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1097\/01.SMJ.0000145304.68009.02","article-title":"Health status in the Mississippi River Delta region","volume":"98","author":"Felix","year":"2005","journal-title":"South. Med. J."},{"key":"ref_20","unstructured":"Sheffer, C. (2007). Arkansas Statewide Tobacco Programs and Services Annual Report 2005\u20132006, University of Arkansas for Medical Sciences."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1080\/14622200410001676314","article-title":"Increasing access to smoking cessation treatment in a low-income, HIV-positive population: The feasibility of using cellular telephones","volume":"6","author":"Lazev","year":"2004","journal-title":"Nicotine Tob. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1093\/ntr\/ntu267","article-title":"Barriers to telephone quitline use among methadone-maintained smokers","volume":"17","author":"Griffin","year":"2015","journal-title":"Nicotine Tob. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1177\/1049732311404248","article-title":"Understanding the barriers to use of free, proactive telephone counseling for tobacco dependence","volume":"21","author":"Sheffer","year":"2011","journal-title":"Qual. Health Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1289\/ehp.7675","article-title":"Community-based participatory research: Lessons learned from the Centers for Children\u2019s Environmental Health and Disease Prevention Research","volume":"113","author":"Israel","year":"2005","journal-title":"Environ. Health Perspect."},{"key":"ref_25","unstructured":"U.S. Census Bureau (2008). American Community Survey, Selected Population Profile, U.S. Census Bureau."},{"key":"ref_26","unstructured":"Clinical Practice Guideline (2008). Treating Tobacco Use and Dependence: 2008 Update, Public Health Service."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Robertson, L., Iosua, E., McGee, R., and Hancox, R.J. (2015). Nondaily, low-rate daily, and high-rate daily smoking in young adults: A 17-year follow-up. Nicotine Tob. Res., in press.","DOI":"10.1093\/ntr\/ntv167"},{"key":"ref_28","unstructured":"Hinkle, D.E., Wiersma, W., and Jurs, S.G. (1988). Applied Statitistics for the Behavioral Sciences, Houghton Mifflin Company. [2nd ed.]."},{"key":"ref_29","unstructured":"Abdi, H. (2007). Bonferroni and Sidak Corrections for Multiple Comparisons, Sage."},{"key":"ref_30","unstructured":"Glaser, B., and Strauss, A. (1967). The Discovery of Grounded Theory, Transaction Publishers."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"874","DOI":"10.15288\/jsad.2012.73.874","article-title":"Barriers to effective tobacco-dependence treatment for the very poor","volume":"73","author":"Christiansen","year":"2012","journal-title":"J. Stud. Alcohol Drugs"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1093\/ntr\/ntq051","article-title":"Socioeconomic disparities in quit intentions, quit attempts, and smoking abstinence among smokers in four western countries: Findings from the International Tobacco Control Four Country Survey","volume":"12","author":"Reid","year":"2010","journal-title":"Nicotine Tob. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1093\/schbul\/sbq124","article-title":"Perception of smoking risks and motivation to quit among nontreatment-seeking smokers with and without schizophrenia","volume":"38","author":"Kelly","year":"2012","journal-title":"Schizophr. Bull."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1177\/1359105312474914","article-title":"Does the perception that God controls health outcomes matter for health behaviors?","volume":"19","author":"Karvinen","year":"2014","journal-title":"J. Health Psychol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1037\/a0027546","article-title":"Characteristics and smoking patterns of intermittent smokers","volume":"20","author":"Shiffman","year":"2012","journal-title":"Exp. Clin. Psychopharmacol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/13\/1\/15\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T20:54:31Z","timestamp":1760216071000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/13\/1\/15"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,12,22]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2016,1]]}},"alternative-id":["ijerph13010015"],"URL":"https:\/\/doi.org\/10.3390\/ijerph13010015","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,12,22]]}}}