Adoption of Smoke-free Laws and Voluntary Policies in Rural Communities in Southern States

摘要 尽管美国其他地区的吸烟率迅速下降，但美国南部农村人口的吸烟率仍然居高不下。 在最近几十年里。虽然58.3%的美国公民受到全面无烟法的保护，但只有 生活在东部、中南部或南大西洋地区的16.7%的公民受到保护。当前最好的 SF法律宣传的做法在缩小农村、南部和南部地区覆盖范围方面的差距方面并不有效 居民。同时，采取自愿政策(例如，无烟学校、公共住房、户外活动 空间)在全国范围内加速。自愿保单的存在可以增加对SF保单的准备 否则，他们可能会破坏SF法律在南部各州农村城市的采用。我们的研究是创新的 因为我们将结合政治理论，金登的多流框架，来指导SF法律的采用 在烟草使用差异较大的地区进行研究。具体目标是：1)确定差异 在有和没有SF法律的农村直辖市之间关于社区准备情况、问题指标 (如吸烟率)、重点活动和反馈；政治(如建立共识)；政策因素 (例如，预期的限制)；和政策企业家(例如，烟草控制的力度)，控制 人口规模和其他人口因素；1a)比较自愿吸烟的数量和类型--和 无烟政策(例如，%的无烟学校、公共住房、户外空间) 以及2)描述社会政治环境中的促进者和障碍 宣传战略、政策窗口(例如，政策通过的临界点)，以及在#年颁布自然科学法律 有或没有SF法律的农村直辖市。我们将采用混合方法，病例对照设计进行 电话和在线调查，以评估当地倡导者(N=150-250)的政策采纳因素并当选 来自50个市(市、镇或村)的官员(N=150)(25例；25个对照)嵌套在4个 州：阿拉巴马州、肯塔基州、密西西比州和南卡罗来纳州。凯斯市将颁布一项SF法律 在过去3年内；将根据社区人口规模将控制措施与每个州的病例相匹配 和乡村风情。运用定性的方法，我们还将对社区领袖、市民进行深入访谈 活动家和政策制定者如果市政当局拥有最新的SF法律及其与之相匹配的控制措施 每个州(每个州两个社区；每个社区10-15个关键线人)。参与者将被要求 描述影响SF政策采用的因素，并被要求对可能造成影响的关键事件发表评论 支持或阻止政策的采纳。由8名烟草控制和SF领导人组成的社区咨询委员会 农村地区和代表南部四个州的法律通过将指导这项研究的所有方面。这 这项研究将把当前的研究范式转变为理解南部农村地区采用SF法律的新方式 市政当局。与烟草有关的健康差距将继续导致不良的健康结果和巨大的 在我们能够推进科普政策采纳的科学性之前，南部农村市镇的社会成本。

Abstract Smoking remains high in America’s rural southern population despite rapid declines in other regions of the U.S. in recent decades. While 58.3% of U.S. citizens are covered by comprehensive smoke-free (SF) laws, only 16.7% of citizens living in the East South Central or the South Atlantic regions are protected. Current best practices for SF law advocacy have not been effective in closing the gaps in coverage for rural, southern residents. Meanwhile, adoption of voluntary policies (e.g, tobacco-free schools, public housing, outdoor spaces) have accelerated nationwide. The presence of voluntary policies may increase readiness for SF policy adoption or they may derail SF law adoption in rural municipalities in southern states. Our study is innovative because we will incorporate a political theory, Kingdon’s Multiple Streams framework, to guide SF law adoption research in a region with tobacco use disparities. The Specific Aims are to: 1) determine the differences between rural municipalities with and without SF laws in regard to community readiness, problem indicators (e.g., smoking prevalence), focusing events, and feedback; politics (e.g., consensus building); policy factors (e.g., anticipated constraints); and policy entrepreneurs (e.g., strength of tobacco control), controlling for population size and other demographic factors; 1a) compare the number and type of voluntary smoke- and tobacco-free policies (e.g, % tobacco-free schools, public housing, outdoor spaces) in rural municipalities with and without SF laws; and 2) describe facilitators and barriers in the sociopolitical environment that impact advocacy strategies, the policy window (e.g., the tipping point for policy adoption), and enactment of SF laws in rural municipalities with and without SF laws. We will use a mixed methods, case-control design to conduct telephone and online surveys to assess policy adoption factors with local advocates (N = 150-250) and elected officials (N = 150) from 50 municipalities (cities, towns or villages) (25 cases; 25 controls) nested within four states: Alabama, Kentucky, Mississippi, and South Carolina. Case municipalities will have enacted a SF law within the past 3 years; controls will be matched with cases in each state based on community population size and rurality. Using qualitative methods, we also will conduct in-depth interviews with community leaders, citizen activists, and policymakers in case municipalities with the most recent SF law and their matched controls from each state (two communities per state; 10-15 key informants per community). Participants will be asked to describe factors affecting SF policy adoption and asked to comment on key events that may have contributed to or inhibited policy adoption. A Community Advisory Board consisting of 8 leaders in tobacco control and SF law adoption in rural areas and representing the four southern states will guide all aspects of the study. This study will shift the current research paradigm to a new way of understanding SF law adoption in rural, southern municipalities. Tobacco-related health disparities will continue to lead to poor health outcomes and enormous societal costs in rural southern municipalities until we can advance the science of SF policy adoption.