Policy Outcomes and Readiness for Smoke-free Legislation in Rural Communities

Implementing smoke-free policies is the most effective method for reducing secondhand exposure among nonsmokers. Rural residents are more likely to be exposed to secondhand smoke than those living in urban areas, a reflection of major rural-urban disparity in smoke-free laws. The purpose is to test the effects of a community intervention on community readiness and smoke-free policy outcomes in rural underserved communities in Kentucky. Community advocates and policymakers from 30 rural counties participated in telephone surveys at baseline and again at 1 and 2 years post-baseline to assess community readiness for tobacco policy development (with six dimensions and a total score) and policy outcomes. Both treatment (n=22) and control (n=8) counties participated in the annual surveys; communities randomized to the treatment group receive ongoing tailored, evidence-based dissemination and implementation strategies. Preliminary findings from the first follow-up assessment indicate that policy outcomes in the treatment counties exceeded those in control counties. Controlling for whether smoke-free legislation had been drafted by the baseline interview, treatment counties were 10 times more likely to have drafted this type of legislation by the first follow-up. The average percent change was positive for all seven readiness indicators in the treatment group, while some of the measures exhibited a slight decline from baseline to the first follow-up in the control group. Data from the second follow-up will illustrate the trajectory of change in readiness and policy outcomes for both treatment and control rural communities.