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

南部各州农村社区采用无烟法律和自愿政策

基本信息

批准号：
9979792
负责人：
Amanda FALLIN-BENNETT
金额：
$ 38.97万
依托单位：
UNIVERSITY OF KENTUCKY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-01 至 2021-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9979792
关键词：
Address Adopted Adoption Advocacy Advocate Affect Alabama Area Cities Communities Complex Consensus Demographic Factors Environment Event Feedback Fostering Future Goals Government Health Intervention Interview Kentucky Laws Lead Methods Mississippi Modeling Municipalities Outcome Participant Policies Policy Developments Politics Population Population Sizes Psychosocial Factor Public Health Public Housing Published Comment Qualitative Methods Readiness Research Rural Rural Community Schools Science Smoke Smoking Social Change Social Justice South Carolina Stream Surveys Telephone Tobacco Tobacco smoke Tobacco use Work Workplace base case control design evidence base experience health disparity improved informant innovation reduce tobacco use rural America rural area rurality self reliance smoke-free policy smoking prevalence social norm societal costs success theories tobacco control tobacco-free treatment group

项目摘要

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.

抽象的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很高。近几十年来，虽然 58.3% 的美国公民受到全面无烟 (SF) 法律的保护，但只有居住在东南中部或南大西洋地区的 16.7% 的公民受到保护。 SF 法宣传实践未能有效缩小农村、南部地区的覆盖率差距同时，采取自愿政策（例如无烟学校、公共住房、户外活动）空间）在全国范围内加速实施，自愿政策的存在可能会增加对SF政策的准备。否，它们可能会阻碍南方各州农村地区对 SF 法律的采用。我们的研究具有创新性。因为我们将纳入政治理论，即 Kingdon 的多流框架，来指导 SF 法律的采用在存在烟草使用差异的地区进行的研究具体目标是： 1) 确定差异。有和没有 SF 法的农村城市之间关于社区准备情况、问题指标的比较（例如，吸烟率）、焦点事件和反馈；政治（例如，建立共识的政策因素）；（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农村城市的无烟政策（例如，无烟学校、公共住房、户外空间的百分比）没有 SF 法律；以及 2) 描述影响社会政治环境的促进因素和障碍倡导策略、政策窗口（例如政策采用的临界点）以及 SF 法律的颁布我们将使用混合方法、病例对照设计来进行。电话和在线调查，与当地倡导者（N = 150-250）和当选者一起评估政策采纳因素来自 50 个直辖市（城市、城镇或村庄）的官员（N = 150）（25 个案例；25 个对照）嵌套在四个州：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 SF 法。过去 3 年内；控制措施将根据社区人口规模与每个州的病例相匹配我们还将采用定性方法对社区领导、公民进行深入访谈。积极分子和政策制定者，如果市政当局拥有最新的 SF 法及其相应的控制措施每个州（每个州两个社区；每个社区 10-15 名关键信息提供者）。描述影响 SF 政策采用的因素，并要求对可能做出贡献的关键事件发表评论由 8 名烟草控制和 SF 领域的领导者组成的社区咨询委员会。农村地区法律的通过和代表南方四个州的立法将指导这项研究的各个方面。研究将把当前的研究范式转变为一种新的方式来理解农村、南部地区的 SF 法律的采用与烟草相关的健康差异将继续导致不良的健康结果和巨大的直到我们能够推进可持续发展政策采用的科学性之前，我们才能降低南部农村城市的社会成本。