ARRA: An Intervention for Promoting Smoke-free Policy in Rural Kentucky - Administrative Supplement

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 pretest posUest, three-group quasiexperimental design will be used to test the primary hypotheses: Controlling for contextual factors, (a) the overall change in stage of readiness for smoke-free policy will be greater for Treatment than Control communities; (b) media coverage will be more favorable toward smoke-free environments in Treatment than Control communities; and (c) 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: (1) assessment of community stage of readiness; and (2) 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. The Treatment communities (n = 20) will participate in both components of the Intervention. Control I communities (n = 10) will participate in the community assessment of readiness at baseline and annually. The Control II communities (n = 10) will participate in community assessment of stage of readiness at the end of the study only. 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 has the potential to protect residents in rural, underserved communities from premature death and disease from exposure to secondhand smoke.