Smoke-free policy development in rural communities: Predictors of leadership

Purpose: To examine community factors associated with leadership, a dimension of community readiness for smoke-free policy development. Smoke-free laws are highly effective in reducing community smoking rates and improving health outcomes. However, rural communities are less likely to enact smoke-free laws than urban communities. Leadership has been found to be associated with overall community readiness for smoke-free policy development.

Methods: As part of a five-year randomized controlled trial, 30 rural Kentucky communities were evaluated at baseline on six dimensions of readiness for smoke-free policy development including leadership, political climate, community climate, resources, existing smoke-free policies, and community knowledge. Leadership included perceived effectiveness/experience of coalition leaders; perceived leadership from the health department, government officials, business leaders and others; and willingness to lobby for smoke-free legislation. Data were collected on other community factors, including pounds of burley tobacco production and the county's alcohol policy.

Findings: Leadership score was predicted by pounds of burley produced, alcohol policy and existing policies. The more burley tobacco produced, the lower the leadership score. Counties with unrestricted alcohol sales had higher leadership scores than those with limited/no sales. Communities with more existing smoke-free public places, workplaces and schools had higher leadership scores.

Discussion: Since effective community leadership is crucial to passage of smoke-free laws, these findings will assist public health professionals to facilitate leadership development in rural communities. In tobacco growing communities, potential community leaders need to be educated and cultivated. Promoting voluntary smoke-free policy may be an intermediate step in developing smoke-free laws in rural communities.