Readiness for Smoke-Free Policy and Overall Strength of Tobacco Control in Rural Tobacco-Growing Communities

Abstract

Rural, tobacco-growing areas are disproportionately affected by tobacco use, secondhand smoke, and weak policies. The study determined whether overall strength of Resources, Capacity and Efforts in tobacco control predicts readiness for smoke-free policy in rural communities, controlling for county population size and pounds of tobacco produced. This was a correlational, cross-sectional analysis of data from key informants (n = 148) and elected officials (n = 83) from 30 rural counties who participated in telephone interviews examining smoke-free policy. Six dimensions of community readiness (knowledge, leadership, resources, community climate, existing smoke-free policies, and political climate) were identified and summed to assess overall readiness for smoke-free policy. General strength of overall Resources, Capacity and Efforts in tobacco control at the county level was measured. Readiness for smoke-free policy was lower in communities with higher smoking rates, higher tobacco production, and smaller population. Efforts related to general tobacco control (i.e., media advocacy, training and technical assistance) predicted readiness for local smoke-free policy development (standardized β=.35, p=.05), controlling for county population size and pounds of tobacco produced. Given that small, rural tobacco-growing communities are least ready for smoke-free policy change, tailoring and testing culturally sensitive approaches that account for this tobacco-growing heritage are warranted.

A Controlled Community‐Based Trial to Promote Smoke‐Free Policy in Rural Communities

“…Rural communities present with special challenges for policy development and implementation; policy development takes time, persistence, and patience. In previous studies of the baseline data from this project, we reported that small versus larger rural communities are less ready for smoke-free policy, 72 less likely to portray the issue favorability in the media, 73 and less likely to have the resources and capacity for policy change. 68 We observed that policy change in small rural tobacco-growing communities requires development of trusting relationships with advocates and elected officials over time.…”

A Systematic Review of Community Readiness Tool Applications: Implications for Reporting

“…Eight other studies (20%) changed the data collection method from the traditional one-on-one interview to a group interview, online interview, or obtaining data from other, non-interview, sources. Two (5%) studies changed the scoring procedures and scales, using their own scales (one was changed to a score between 0 and 1 [ 23 ], the other to a score out of 4 [ 24 ]) instead of the usual 9 point anchored rating scale. Some studies made multiple changes to the CRT protocol.…”

“…One study did not conduct any interviews and used the CRT as a narrative tool to describe the changes that occurred in a community [ 27 ]. Another study only assessed leadership, conducted a single interview for each community and then assigned a community readiness score between 0 and 1 [ 23 ]. It is noteworthy to point out that some studies changed the CRT either by adding new dimensions or changing the wording of existing dimensions.…”

Organizational culture and the adoption of anti-smoking initiatives at small to very small workplaces: An organizational level analysis

“…We adjusted for several workplace characteristics theorized or shown to be associated with tobacco control in previous studies 7,30,31 . Covariate information was primarily obtained from executives, who reported the percentage of their employees that were employed full-time (0-25%; 26-50%; 51-75%; 76-100%), employees' primary work location (in the building; out in the field), and whether their workplace offered health insurance (yes, no, not sure).…”