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The purpose of this study is to test the effects of a
community intervention on smoke-free policy outcomes in
rural underserved communities. The intervention combines
assessment of community readiness with tailored,
evidence-based dissemination and implementation strategies.
Rural residents are more likely to be exposed to secondhand
smoke than those living in urban areas, reflecting a major
rural-urban disparity in smoke-free laws. The overall goal
of the study is to accelerate the ‘diffusion-of-innovations
curve’ in rural communities through tailored, evidence-based
dissemination and implementation efforts. The long-term goal
is to develop a best practices framework for disseminating
scientific knowledge about the effects of secondhand smoke
and smoke-free laws and implementing effective community
policy change and maintenance strategies in rural
underserved communities.
A pre-post, three-group quasi-experimental design will be
used to test the primary hypotheses: Controlling for
contextual factors,
- The overall change in stage of readiness for
smoke-free policy will be greater for Treatment than
Control communities.
- Media coverage will be more favorable toward
smoke-free environments in Treatment than Control
communities.
- Treatment communities will be more likely than
Control communities to demonstrate smoke-free policy
outcomes.
Guided by a community readiness model, the Intervention
will have two components:
- assessment of community stage of readiness
- stage-specific, tailored dissemination and
implementation strategies.
The main elements of Component II of the Intervention
include translating and disseminating knowledge, and
building capacity and demand for smoke-free policy. All
counties (N = 40) were randomly selected. The Treatment
communities (n = 20) will participate in both components of
the Intervention. Control I communities (n = 10) will
participate only in the community assessment of readiness at
baseline and end of study. The Control II communities (n =
10) will participate in community assessment of stage of
readiness at the end of the study. Community stakeholders
will participate in key informant telephone interviews to
assess community readiness for smoke-free policy. Print
media clippings from all 51 daily and non-daily newspapers
in study counties will be evaluated for pro/con slant
related to smoke-free environments. Initial, intermediate,
and final smoke-free policy outcomes will be measured. The
potential influence of secular trends on the impact of this
community intervention will be analyzed.
The proposal is directly relevant to public health in
that it will protect residents in rural, underserved
communities from premature death and disease from exposure
to secondhand smoke.
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