An Intervention for Promoting Smoke-free Policy in Rural Kentucky

描述(申请人提供)：这项研究的目的是测试社区干预对服务不足的农村社区无烟政策结果的影响。干预措施将评估社区准备情况与量身定做的、基于证据的传播和实施战略结合起来。农村居民比城市居民更容易暴露在二手烟中，这反映了无烟法中城乡之间的巨大差异。这项研究的总体目标是通过量身定做的、以证据为基础的传播和实施努力，加速农村社区的“创新扩散曲线”。长期目标是制定一个最佳做法框架，以传播关于二手烟和无烟法的影响的科学知识，并在服务不足的农村社区实施有效的社区政策变化和维护战略。三组准实验设计的前测后测将被用来检验基本假设：(A)对背景因素进行控制，(A)无烟政策准备阶段的总体变化将比对照社区更大；(B)媒体报道将比对照社区更有利于治疗社区的无烟环境；以及(C)治疗社区比对照社区更有可能展示无烟政策结果。在社区准备模式的指导下，干预将包括两个组成部分：(1)社区准备阶段的评估；(2)针对阶段的、量身定做的传播和实施战略。干预措施第二部分的主要内容包括知识的转化和传播，以及无烟政策的能力建设和需求。治疗社区(n=20)将参与干预的两个部分。第一控制社区(n=10)将参加社区在基线和每年进行的准备情况评估。控制II社区(n=10)将仅在研究结束时参与社区对准备阶段的评估。社区利益攸关方将参与主要线人的电话采访，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与无烟环境相关的支持/反对的评估。将衡量无烟政策的初步、中期和最终结果。将分析长期趋势对这种社区干预的影响的潜在影响。该提案与公共卫生直接相关，因为它有可能保护农村、服务不足的社区的居民免受过早死亡和接触二手烟的疾病的影响。

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.