Eliminating Disparities by Advancing Smoke-Free Policy in Rural Communities

Audience: Tobacco control advocates, researchers, and policymakers Key Points: This 5-year randomized, controlled community-based trial tested the effects of a stage-based, tailored intervention on readiness for smoke-free policy, media favorability, and policy outcomes in rural underserved communities. Rural residents are disproportionately affected by smoking and secondhand smoke and less likely to be covered by these laws. Twenty-two communities randomized to treatment received evidence-based dissemination and implementation strategies by trained advisors over five years. The Community Readiness Model guided the intervention to build capacity, build demand, and translate and disseminate science. Eighteen counties comprised the two control groups. Annual telephone surveys were conducted with community advocates and elected officials. Control I counties participated in annual surveys; Control II counties were only surveyed in Year 5. The Treatment group exceeded both Control groups in community readiness, but there was no difference between Control I and Control II. The intervention may be particularly effective in boosting coalition leadership, community climate, and efforts to increase community knowledge. 19 of the 22 Treatment communities leveraged a total of $456,150 in small grant funding for smoke-free policy ($0 in Control II; $5,000 in Control II), representing nearly a 2:1 match. Treatment communities were significantly more likely to enact comprehensive smoke-free laws than control counties. Educational Experience: Lecture/panel or interactive poster Benefits: Policy development in rural communities takes time, persistence, and patience. The intervention reduced disparities for smoke-free policy by leveraging funding in rural communities. Lessons learned from this study can be applied to other rural communities.