Transcript Slide 1

An Intervention to Promote
Smoke free Policy
Development in Rural
Kentucky
Ellen Hahn, DNS, RN, Principal Investigator
University of Kentucky College of Nursing
National Heart, Lung, and Blood Institute (NHLBI)
RO1 HL086450
October 8, 2008
PAR-06-039 Dissemination and Implementation Research in Health
Study Purpose
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To test the effects of a community
intervention on smoke-free policy outcomes
in rural underserved communities.
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To accelerate the ‘diffusion-of-innovations curve’
in rural communities through tailored, evidencebased dissemination and implementation efforts.
Long-term Goal
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To develop a best practices framework for
disseminating the information on the state of
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.
Background
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Enacting smoke-free laws typically depends
on the readiness of local people who have
the greatest and most sustainable impact in
solving local problems.
Rural residents more likely to be exposed to
secondhand smoke than those living in urban
areas, reflecting a major rural-urban disparity
in smoke-free laws.
Kentucky Communities with 100%
Smoke-free Workplace* and/or Public Place
Ordinances or Regulations
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Lexington
Georgetown*
Letcher County
Morehead*
Frankfort
Ashland*
Elizabethtown*
Paducah
Hardin County*
(unincorporated areas)
Madison County*
Louisville*
Danville*
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4/27/04
10/1/05
7/1/06
8/1/06
8/22/06
10/1/06
12/1/06
4/1/07
4/1/07
6/11/07
7/1/07 and 1/11/08
8/8/08
Primary Hypotheses
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Controlling for contextual factors:
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H1: The overall change in stage of readiness for
smoke-free policy will be greater for Treatment
than Control communities;
H2: Media coverage will be more favorable toward
smoke-free environments in Treatment than
Control communities; and
H3: Treatment communities will be more likely
than Control communities to demonstrate initial,
intermediate, and final smoke-free policy
outcomes.
Secondary Aims
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Test the effects of community readiness
assessment on stage of community
readiness and smoke-free policy outcomes;
Evaluate the implementation of the
intervention; and
Test for the influence of secular trends in
diminishing the difference between Treatment
and Control communities in change over
time.
Research Design
Treatment
O1
X1X2
O2
X1X2
O3
X1X2
O4
X1X2
O5 X1
Control I
O1
X1
O2
X1
O3
X1
O4
X1
O5 X1
Control II
O1
O2
O3
O4
O5 X1
O = Community observations: print media evaluation, smoke-free policy outcomes, secular trends, contextual variables
X1 = Intervention component I: Assessment of stage of community readiness.
X2 = Intervention component II: Stage-specific, tailored strategies.
Study Counties
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Treatment (n = 22)
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Control I (n = 8)
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Readiness Assessment Annually and Intervention
Readiness Assessment Annually
Control II (n = 10)
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Readiness Assessment Year 5 Only
*Note. The PRC CAB is taking a leadership role in
Perry County, an Eastern Kentucky county.
Study Intervention
Figure 5: Study Intervention Components
Component 1: Assessment of
Community Readiness
Political climate
Community
climate
Resources
Community
knowledge about
SHS & existing
efforts
Existing smokefree policies
Component I: Stage of
Readiness
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Unawareness
Vague Awareness
Pre-planning
Preparation
Initiation
Endorsement
Leadership
Component II:
Stage-specific Tailored Strategies
• Translation and dissemination of
knowledge
• Building capacity for smoke-free policy
• Building demand for smoke-free policy
Translation & Dissemination
of Science
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Policymaker Assessments
Public Opinion Studies
Air Quality Studies
Smoke-free Toolkit
Building Capacity
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Coalition Building
Building Organizational Capacity
Basic Legal Information
Growing Legislative Champions
Training on local policymaking process
Leveraging funds (each county awarded minigrant, $2500 per year x 5 years)
Building Demand
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Build on the existing rural infrastructure
Media advocacy
Advocacy: grassroots and grasstops
Branding a smoke-free campaign
Primary Measures
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Community Readiness
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Print Media Evaluation
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3-5 Key Informants (community advocates)
Mayors and County Judge Executives
NewsClipz
Smoke-free Outcomes
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No policy outcomes (0); work group or resolution
(1); draft ordinance (2); ordinance enacted (3);
comprehensive ordinance (4)
Project Staff
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Community Advisors
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Shevawn Akers/Heather Robertson
Carol Riker
Brenda Vestal
Carol Whipple/Sarah Cavendish
Community Liaisons
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Baretta Casey, MD, Director, UK Center for Rural
Health
Peggy Lewis, State Office of Rural Health
James Rousey, Public Health Director, Madison
County Health Department
Project Consultants
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Judy Owens, JD, Legal Consultant
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Collaborates with the Tobacco Control Legal
Consortium at the University of Minnesota.
Todd A. Warnick, MA, MHA, CADC, Smokefree Campaign Consultant
Key Support Staff
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Kathy Begley, Data Management Coordinator
Karen Arrowood, Research Assistant
Amanda Fallin, Research Associate
Erin Lee, Project Assistant
Kiyoung Lee, Assistant Professor and
Environmental Scientist, UK College of Public
Health
Mary Kay Rayens, Professor and Mei Zhang, Data
Analyst
Heather Robertson, Manager, Clean Indoor Air
Partnership
5-Year Project Summary
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Readiness Interviews (Spring/Summer)
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Advocates
Elected Officials (County Judge Executives and Mayors)
Readiness Reports to Communities (September)
Community Advisors serve communities as they
develop/revise a tailored roadmap for next steps or
review existing plans (ongoing)
Community and Community Advisor prepare scope
of work for mini-grant contract with UK (annually)
Community advocates use roadmap to take action
based on stage of readiness (ongoing, regular
contact with Community Advisor as needed)
What Have We Learned?
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The community with the highest overall
baseline readiness score at baseline (Year 1)
enacted a comprehensive smoke-free
ordinance in Year 2.
Communities with more Capacity for tobacco
control (i.e., leadership, numbers of personnel
committed to tobacco control as well as
linkages between key agencies and advocacy
groups) are more ready for smoke-free policy.
Communities that report more Efforts related
to tobacco control (i.e., time spent on media
advocacy, training and technical assistance,
policy advocacy) are more ready for smokefree policy.
Average readiness scores by group, with
comparisons based on two-sample ttests for means (N = 30)
Readiness dimension
Leadership
Political climate
Community climate
Resources
Existing smoke-free policies
Community knowledge
Overall readiness
Treatment
Mean (SD)
(n = 22)
0.51 (.09)
0.56 (.15)
0.44 (.09)
0.61 (.08)
0.42 (.13)
0.40 (.17)
2.94 (.52)
Control I
Mean (SD)
(n = 8)
0.42 (.09)
0.55 (.08)
0.43 (.08)
0.55 (.08)
0.35 (.17)
0.27 (.09)
2.58 (.31)
t-test (pvalue)
2.2 (.03)
0.1 (1.0)
0.4 (.7)
1.7 (.1)
1.2 (.2)
2.1 (.04)
1.8 (.08)
Note. The community with the highest baseline readiness score enacted a
comprehensive smoke-free ordinance in Year 2.
Lessons Learned
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Tailoring interventions
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Popular, low-cost communication channels (e.g.,
weekly shopper bulletins and weekend ‘trader’
radio shows)
Opposition tactics (e.g., ‘little tobacco’)
Air quality monitoring
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Special concerns in small communities where
everyone knows everyone
Concerns that businesses do not have advance
notice when monitoring conducted
Summary
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The Rural Smoke-free Communities
Project assists rural partners and acts as
a value-added resource as they work
toward implementing comprehensive
smoke-free policies in their communities.
We believe that successfully moving
toward smoke-free policy goals needs to
be a carefully planned, community driven
effort by committed local advocates.