title: A controlled community-based trial to promote smoke-free policy in rural communities.
abstract: OBJECTIVE
  Rural, tobacco-growing areas are disproportionately affected by tobacco use, secondhand smoke, and weak tobacco control policies. The purpose was to test the effects of a stage-specific, tailored policy-focused intervention on readiness for smoke-free policy, and policy outcomes in rural underserved communities.
  
  
  METHODS
  A controlled community-based trial including 37 rural counties. Data were collected annually with community advocates (n = 330) and elected officials (n = 158) in 19 intervention counties and 18 comparison counties over 5 years (average response rate = 68%). Intervention communities received policy development strategies from community advisors tailored to their stage of readiness and designed to build capacity, build demand, and translate and disseminate science. Policy outcomes were tracked over 5 years.
  
  
  RESULTS
  Communities receiving the stage-specific, tailored intervention had higher overall community readiness scores and better policy outcomes than the comparison counties, controlling for county-level smoking rate, population size, and education. Nearly one-third of the intervention counties adopted smoke-free laws covering restaurants, bars, and all workplaces compared to none of the comparison counties.
  
  
  CONCLUSIONS
  The stage-specific, tailored policy-focused intervention acted as a value-added resource to local smoke-free campaigns by promoting readiness for policy, as well as actual policy change in rural communities. Although actual policy change and percent covered by the policies were modest, these areas need additional resources and efforts to build capacity, build demand, and translate and disseminate science in order to accelerate smoke-free policy change and reduce the enormous toll from tobacco in these high-risk communities.
authors.affiliation: University of Kentucky College of Nursing, Tobacco Policy Research Program, Kentucky Center for Smoke-Free Policy, Lexington, Kentucky.
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Hahn
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Rayens
authors.forename: Sarah
authors.initials: S
authors.lastname: Adkins
authors.forename: Kathy
authors.initials: K
authors.lastname: Begley
authors.forename: Nancy
authors.initials: N
authors.lastname: York
mesh_terms: D003153:Community Health Services / Q000379:methods; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D011050:Policy Making; D015397:Program Evaluation; D012147:Restaurants / Q000592:standards; D012424:Rural Population / Q000639:trends*; D061845:Smoke-Free Policy; D017132:Workplace / Q000592:standards
keywords: health disparities; health promotion; policy; tobacco