Social justice in rural underserved areas: Community readiness for smoke-free policy development

The purpose is to evaluate the effects of a tailored community intervention on readiness for smoke-free policy and policy outcomes in rural underserved communities. Only 41% of Americans are covered by comprehensive smoke-free workplace legislation including restaurants and bars. Rural residents are disproportionately affected by smoking and secondhand smoke and less likely to be covered by these laws. A 5-year randomized, controlled community-based trial involves annual telephone surveys with community advocates and policymakers from 30 rural counties [treatment (n=22); control (n=8)] to assess community readiness for smoke-free policy development. Communities randomized to treatment receive ongoing evidence-based dissemination and implementation strategies delivered by trained advisors. Treatment communities had higher overall readiness scores than controls at Year 3. Between baseline and Year 3, the political climate score for the treatment group increased nearly 30%, compared to no change in controls. Similarly, the increase in community climate for treatment counties was 10%, compared with a less than 1% increase for control counties. There also was a positive relationship between population size and overall readiness. Overall capacity for tobacco control was most strongly predictive of readiness in these rural communities. Controlling for whether smoke-free legislation had been drafted at baseline, treatment counties were 10 times more likely to have drafted smoke-free legislation by Year 2, compared with controls (χ2 = 4.0, p = .04). Rural communities present with special challenges for policy development and implementation. Lessons learned working with rural communities will be presented in addition to study outcome data.