Smoke-free Policy Development in Rural Kentucky: Year 5 Outcomes from a Randomized Controlled Community-based Trial

The purpose of this study is to test the effects of a stage-based, tailored community intervention on readiness for smoke-free policy, media favorability, and policy outcomes in rural underserved communities. Rural residents are less likely to be covered by comprehensive smoke-free workplace legislation and are disproportionately affected by smoking and secondhand smoke exposure. Our 5-year randomized, controlled community-based trial includes annual telephone surveys with community advocates and elected officials from rural Kentucky counties; 22 counties in the Treatment group, 8 in Control I and 10 in Control II. Communities randomized to treatment receive ongoing evidence-based dissemination and implementation strategies delivered by trained advisors. The Community Readiness Model guides the evidence-based intervention and includes community-based strategies to build capacity, build demand, and translate and disseminate science with community coalitions. Control I counties only participate in annual surveys each year while Control II counties will only be surveyed in Year 5. Community readiness, media favorability, and policy outcomes data for Year 5 will be presented. Preliminary findings show that Treatment communities had higher overall readiness scores than Control I at Year 4. Five treatment counties and none of the control counties had at least one community with a comprehensive law covering all workplaces (p=.03). The average percent of the population covered by a comprehensive smoke-free law by Year 4 was 5.9% in the 22 treatment counties and 0% in the 18 control counties (p=.03). Rural communities present with special challenges for policy development and implementation.