An Intervention for Promoting Smoke-free Policy in Rural Kentucky

描述（由申请人提供）：本研究的目的是测试社区干预对农村服务不足社区无烟政策结果的影响。该干预措施将社区准备情况评估与量身定制的循证传播和实施战略相结合。农村居民比城市居民更容易接触到二手烟，这反映了城乡在无烟法律方面的巨大差异。这项研究的总体目标是通过有针对性的、基于证据的传播和实施工作，加速农村社区的“创新扩散曲线”。长期目标是制定最佳做法框架，以传播有关二手烟影响和无烟法律的科学知识，并在服务不足的农村社区实施有效的社区政策变革和维护战略。将使用前测后测、三组准实验设计来检验主要假设：控制背景因素，(A)治疗组对无烟政策准备阶段的总体变化将大于对照组；(b)媒体报道将比控制社区更有利于治疗社区的无烟环境；(c)治疗社区将比控制社区更有可能展示无烟政策的成果。在社区准备模型的指导下，干预将包括两个组成部分：(1)评估社区准备阶段；(2)针对不同阶段、量身定制的传播和实施策略。干预措施第二部分的主要内容包括翻译和传播知识，以及建设无烟政策的能力和需求。治疗社区（n = 20）将参与干预的两个组成部分。对照一社区（n = 10）将参加基线和年度社区准备情况评估。对照II社区（n = 10）仅在研究结束时参与社区准备阶段评估。社区利益攸关方将参加关键信息提供者电话访谈，以评估社区对无烟政策的准备情况。将对研究县所有51份日报和非日报的印刷媒体剪报进行评估，以确定与无烟环境有关的利弊。将衡量无烟政策的初始、中期和最终结果。将分析长期趋势对这种社区干预影响的潜在影响。该提案与公共卫生直接相关，因为它有可能保护农村和服务不足社区的居民免于过早死亡和因接触二手烟而患病。

DESCRIPTION (provided by applicant): 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 posttest, three-group quasi- experimental 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.