Do smoke-free laws in rural, underserved counties encourage cessation?

Adult smokers in communities with smoke-free laws are more likely to quit smoking compared to those from communities without these laws. However, this has not been studied in rural, economically distressed areas that are disproportionately affected by smoking. The purpose was to examine the association between a longstanding smoke-free law and smoking behaviors and secondhand smoke (SHS) exposure among current and recent former smokers in rural, underserved communities. A quasi-experimental, two-group design compared the smoking/cessation behaviors and SHS exposure between participants from a rural, distressed community with a 3-year old smoke-free law (treatment; n = 252) and those in four rural, economically distressed communities without smoke-free laws (control; n = 250). The four control counties were matched to the treatment county on educational attainment, income and smoking prevalence. Current and recent former smokers were recruited using random digit dialing and were eligible to participate if they were smoking at the time of enactment of the smoke-free law in the treatment county. Those in the treatment county had a greater level of education and were more dependent on tobacco. There was no treatment group difference in the number of cigarettes smoked per day, time since last cigarette, readiness to quit smoking, or quit smoking attempts. Those in the treatment county were more likely to report ever having tried to quit cigars, pipes and smokeless tobacco. Current and former smokers in the treatment county were more likely to report a smoke-free policy at work, but more likely to report smoking in the home. One limitation is that this was a cross-sectional analysis without pre-law comparisons. Smokers living in smoke-free communities may be more hardened compared to those not in smoke-free communities. Our findings are consistent with other research that some subgroups may be more likely to smoke in the home when living in smoke-free communities. In spite of significantly greater nicotine dependence, those in the treatment group were not less likely to report quit attempts, nor did they differ on cigs/day or time since last cigarette. Establishing nonsmoking as a social norm may be more difficult in rural, underserved smoke-free areas.