title: Communities of excellence in tobacco control: changes in local policy and key outcomes.
abstract: BACKGROUND
  The Oklahoma Communities of Excellence in Tobacco Control (CX) program was established in 2004. Thirty-three CX grants have been funded to implement comprehensive tobacco control programs in 50 counties and one tribal nation.
  
  
  OBJECTIVE
  To describe local tobacco policy gains within CX counties and short-term and intermediate outcomes such as Oklahoma Tobacco Helpline registration and awareness, quit attempts, and home smoking bans among adults.
  
  
  METHODS
  A before-and-after study design examined outcomes within CX counties and among CX urban and rural counties. Comparisons were made with non-funded counties when possible. Local policy tracking databases were reviewed for the number of policies implemented from 2004 to 2013 in CX counties. Population-level tobacco indicators, using Helpline registration and 2004-2010 Behavioral Risk Factor Surveillance System data, quantified changes over time. Data were collected in 2003-2013 and analyzed in 2013.
  
  
  RESULTS
  Eight hundred thirty-one legislated and voluntary policies were implemented in CX counties and high levels of Helpline registration were maintained. Statistically significant increases were observed in CX counties for the proportion of smokers making a quit attempt, Helpline awareness, and home smoking bans among smokers. These observed increases were greater in rural CX counties than urban. Non-CX counties only experienced a statistically significant increase in Helpline awareness.
  
  
  CONCLUSIONS
  Using community-based best practices in tobacco control while focusing on social norm change, CX counties experienced positive changes in smoking-related attitudes and behaviors. This study expands the evidence base for statewide tobacco control programming and underscores the value of community-based tobacco control programs.
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Electronic address: rebekah-rhoades@ouhsc.edu.
authors.forename: Rebekah R
authors.initials: RR
authors.lastname: Rhoades
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Beebe
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Boeckman
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Williams
mesh_terms: D000328:Adult; D001294:Attitude to Health; D019058:Community Networks / Q000191:economics / Q000458:organization & administration*; D005381:Financing, Organized; D015438:Health Behavior; D006291:Health Policy; D015277:Hotlines / Q000706:statistics & numerical data; D006801:Humans; D009825:Oklahoma; D012907:Smoking / Q000191:economics / Q000331:legislation & jurisprudence; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D066262:Social Norms; D013997:Time Factors