Building demand for smoke-free policies in rural communities through low-cost media campaigns

The study evaluated reach and perceived effectiveness of low-cost tailored media campaigns promoting smoke-free policies in rural communities. A quasi-experimental study with three rural counties (2 treatment, 1 control) tested low-cost media interventions including direct-mail postcards, posters, newspaper ads, billboards, and branding materials using culturally appropriate message frames and appeal types based on findings from 11 formative focus groups. This study was part of a larger 5-year RCT to test the effects of a stage-based, tailored community intervention (n = 22 treatment counties; n = 8 control counties) on rural smoke-free policy. The two treatment counties in the highest and lowest tertiles of community readiness ran 6-month rural media campaigns with tailored technical assistance. The media control county (intermediate level of community readiness), received standard practice guidance in messaging and campaign design. Cross-sectional random-digit-dial telephone surveys with adult residents (n = 1500) in the three study counties assessed recall, recognition, frequency of exposure, level of understanding, and perceived message effectiveness (i.e., perceived seriousness of health risks associated with secondhand smoke exposure, opinion that the advertising affected support for smoke-free laws, and potential to prompt involvement in smoke-free campaigns). Knowledge of which demographic factors are related to these exposure and impact indicators will provide additional insight on how best to tailor media campaigns to reach the rural population and prompt them to action. Rural policy and health outcomes may be improved by using tested media interventions to build demand for policy change.