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A small rural community of fewer than 5,131 residents, Ringgold County is one of the poorest counties in Iowa.  Approximately 12% of the total population lives under the Federal poverty level.  Iowa adults living at or under the Federal poverty level are nearly twice as likely to be current smokers compared to adults at higher income levels.  While Ringgold County is pursuing tobacco-free fairgrounds and parks environments aimed at all community members, certain initiatives target high-risk groups, including tobacco use for women of reproductive age and youth. Tobacco use during pregnancy is a particular challenge, as Ringgold ranks 15th highest of 99 counties in Iowa for mothers who smoke during pregnancy. Additionally, approximately 40% of 11th-grade students report having smoked cigarettes in the past 30 days.  Ringgold County is collaborating with health-care providers to encourage tobacco-cessation among patients who are identified as tobacco users.  Health-care professionals were provided a Mayo Clinic Nicotine Dependence training that highlighted how to address tobacco-cessation with patients, conduct motivational interviews, and move patients to the next stage of the continuum to quit tobacco.  As a result of the training, 55% of all quitline referrals came directly from health-care providers during the first quarter of 2011.  By encouraging health-care providers to refer patients to the state’s quitline, Ringgold County has reached 10% of the tobacco users in the community with tobacco-cessation messages.

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