RESEARCH PAPER
Socioeconomic characteristics, tobacco use, and service utilization by county poverty status among Oklahoma tobacco helpline registrants: A cross-sectional study
1
TSET Health Promotion Research
Center, Stephenson Cancer Center,
The University of Oklahoma
Health Campus, Oklahoma City,
United States
2
Department of Biostatistics and
Epidemiology, Hudson College of
Public Health, The University of
Oklahoma Health Campus,
Oklahoma City, United States
3
Department of Family and
Preventive Medicine, The
University of Oklahoma Health
Campus, Oklahoma City, United
States
4
Department of Internal
Medicine, Section of Hematology/
Oncology, Stephenson Cancer
Center, The University of
Oklahoma Health Campus,
Oklahoma City, United States
Submission date: 2026-01-08
Final revision date: 2026-02-19
Acceptance date: 2026-02-22
Publication date: 2026-07-16
Corresponding author
Gaurav Kumar
TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Campus, Oklahoma City, Oklahoma, United States, 73104
TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Campus, Oklahoma City, Oklahoma, United States, 73104
Tob. Prev. Cessation 2026;12(July):41
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Residents of counties with higher poverty levels experience elevated smoking rates and disproportionate tobacco-related cancer mortality. This study examined differences in sociodemographic characteristics, tobacco use, and service utilization among Oklahoma Tobacco Helpline (OTH) registrants across county poverty designations.
Methods:
In this cross-sectional study, data were analyzed from 33847 adults registered with the OTH between 1 July 2023 and 30 June 2024. Counties were classified as persistent poverty (PPC: ≥20% of residents in poverty for ≥30 years), current poverty (CPC: ≥20% of residents in poverty currently for <30 years), or non-poverty (NPC: <20% of residents in poverty). Group differences were examined using the chi-squared test and analysis of variance. Adjusted multinomial logistic regression analyses evaluated associations between poverty status, tobacco use, and service utilization, controlling for age, sex/gender, race, education level, household income, health insurance, and chronic conditions.
Results:
Registrants residing in PPCs and CPCs differed from those in NPCs in terms of age and race, and they had lower education, income, and greater Medicaid coverage (all P<0.05). In adjusted models, PPC registrants had higher odds of smoking >1 pack/day (heavy smoking) (AOR=1.49; 95% CI: 1.30–1.70; p<0.001) and learning about OTH through personal networks (AOR=1.42; 95% CI: 1.16–1.73; p<0.001) compared with NPCs. Compared with registrants residing in non-poverty counties (NPCs), CPC registrants had higher odds of smoking >1 pack/day (AOR=1.39; 95% CI: 1.16–1.65; p<0.001) and learning about OTH through community/social organizations (AOR=1.77; 95% CI: 1.33– 2.35; p<0.001). Service type and nicotine replacement therapy receipt/duration were similar across poverty designations.
Conclusions:
PPC and CPC registrants showed greater socioeconomic disadvantage and nicotine dependence than NPC registrants but had distinct information pathways. These findings highlight geographically concentrated poverty as a potential contributor to tobacco-related disparities and suggest that interventions addressing social and environmental conditions in PPCs may help enhance cessation engagement and reduce tobacco-related inequities.
Residents of counties with higher poverty levels experience elevated smoking rates and disproportionate tobacco-related cancer mortality. This study examined differences in sociodemographic characteristics, tobacco use, and service utilization among Oklahoma Tobacco Helpline (OTH) registrants across county poverty designations.
Methods:
In this cross-sectional study, data were analyzed from 33847 adults registered with the OTH between 1 July 2023 and 30 June 2024. Counties were classified as persistent poverty (PPC: ≥20% of residents in poverty for ≥30 years), current poverty (CPC: ≥20% of residents in poverty currently for <30 years), or non-poverty (NPC: <20% of residents in poverty). Group differences were examined using the chi-squared test and analysis of variance. Adjusted multinomial logistic regression analyses evaluated associations between poverty status, tobacco use, and service utilization, controlling for age, sex/gender, race, education level, household income, health insurance, and chronic conditions.
Results:
Registrants residing in PPCs and CPCs differed from those in NPCs in terms of age and race, and they had lower education, income, and greater Medicaid coverage (all P<0.05). In adjusted models, PPC registrants had higher odds of smoking >1 pack/day (heavy smoking) (AOR=1.49; 95% CI: 1.30–1.70; p<0.001) and learning about OTH through personal networks (AOR=1.42; 95% CI: 1.16–1.73; p<0.001) compared with NPCs. Compared with registrants residing in non-poverty counties (NPCs), CPC registrants had higher odds of smoking >1 pack/day (AOR=1.39; 95% CI: 1.16–1.65; p<0.001) and learning about OTH through community/social organizations (AOR=1.77; 95% CI: 1.33– 2.35; p<0.001). Service type and nicotine replacement therapy receipt/duration were similar across poverty designations.
Conclusions:
PPC and CPC registrants showed greater socioeconomic disadvantage and nicotine dependence than NPC registrants but had distinct information pathways. These findings highlight geographically concentrated poverty as a potential contributor to tobacco-related disparities and suggest that interventions addressing social and environmental conditions in PPCs may help enhance cessation engagement and reduce tobacco-related inequities.
ACKNOWLEDGEMENTS
The authors thank the Oklahoma Tobacco Helpline for providing the data
used in this study. The authors also acknowledge the support of the
Stephenson Cancer Center and the TSET Health Promotion Research Center.
CONFLICTS OF INTEREST
The authors have each completed and submitted an ICMJE form for
disclosure of potential conflicts of interest. The authors declare that they
have no competing interests, financial or otherwise, related to the current
work. G. Kumar reports that since the initial planning of the work he
was funded from the American Cancer Society (CHERC-24-1160021-01-
CHERC), the Oklahoma Tobacco Settlement Endowment Trust (TSET) and the
National Cancer Institute (P30CA225520). L.A. Beebe reports that since the
initial planning of the work she was funded from the Tobacco Settlement
Endowment Trust (TSET) of Oklahoma. She is the PI of a TSET contract
through her institution to evaluate their programs, including the Oklahoma
Tobacco Helpline. L.A. Beebe reports that in the past 36 months she received
grants or contracts from the Tobacco Settlement Endowment Trust (TSET)
of Oklahoma. N. Choradia reports that in the past 36 months he received
grants or contracts from the Presbyterian Health Foundation and the Robert
A. Winn Career Development Award. N.M. Machado reports that in the
past 36 months he received grants or contracts from the American Cancer
Society (2025-2027) and the American Association of University Women
(2022-2023). He also received support for attending meetings from the
Society for Research on Nicotine and Tobacco-Europe (SRNT-E) and the
Society for Research on Nicotine and Tobacco (SRNT). He also received the
2023 Early Career Travel Scholarship Award and the 2023 Health Equity
Network, Travel Scholarship Award. He also participated in the American
Heart Association (AHA) as a workgroup member - development of the
Certified Professional by the American Heart Association (CPAHA) -Tobacco
Treatment certification (unpaid). He also had a leadership/fiduciary role in
Society for Research on Nicotine and Tobacco (SRNT). He was a Planning
Committee member; Co-chair, Public Health Track, 2026 Annual SRNT
Meeting (unpaid).
FUNDING
This research was primarily supported by the Oklahoma Tobacco Settlement
Endowment Trust (TSET). Additional support was provided by the National
Cancer Institute (NCI) Cancer Center Support Grant P30CA225520 awarded
to the Stephenson Cancer Center. Additional funding support was provided
by the American Cancer Society through grants PF-24-1198256-01-HOPS to
NMM and CHERC-24-1160021-01-CHERC to DEK and GK.
ETHICAL APPROVAL AND INFORMED CONSENT
Ethical approval and informed consent were not required for this study as it
was a secondary analysis of existing data.
DATA AVAILABILITY
Τhe data supporting this research are available from the authors on
reasonable request.
AUTHORS' CONTRIBUTIONS
GK: conceptualization, formal analysis, writing of the original draft, and
writing, reviewing, and editing of the manuscript. LAB: conceptualization,
data curation, supervision, and writing, reviewing, and editing of the
manuscript. DEK: conceptualization, supervision, and writing, reviewing, and
editing of the manuscript. MEO, MPD, RN, NC, LKB and NMM: reviewed and
edited the manuscript. All authors read and approved the final version of the
manuscript.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer-reviewed.
SUPPLEMENTARY FILE DISCLAIMER
The content has been provided by the author(s) and has not been reviewed, verified, or endorsed by European Publishing. It may not have undergone peer review. The views, opinions, and recommendations expressed are solely those of the author(s) and do not necessarily reflect the position of European Publishing. European Publishing accepts no responsibility or liability for any consequences arising from the use of, or reliance on, this content.
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