Do Smoke-Free Laws in Rural, Distressed Counties Encourage Cessation?

The authors examined the association between smoke-free laws and smoking/cessation behaviors and secondhand smoke exposure among current and former smokers in rural, distressed counties. A quasi-experimental, two-group design compared outcomes between participants from a county with a longstanding smoke-free law (n = 252) and those living in four demographically similar counties without smoke-free laws (n = 250). Participants were recruited using random digit dialing. Controlling for demographic factors, those in the treatment group reported greater nicotine dependence, were more likely to have smoke-free workplaces, and less likely to have smoke-free homes. There were no differences in smoking status, past-year quit attempts, intent to quit in 5 years, cigarettes per day, or time since last cigarette. Smokers in the treatment group were just as likely to attempt to quit, despite greater nicotine dependence. Findings showed that making nonsmoking the social norm through policy change may be more difficult in rural, distressed areas. Keywords rural health, health disparities, outcomes measurement Although secondhand smoke (SHS) exposure has declined overall in the United States, due in large part to the explosion of smoke-free legislation in the past decade (Americans for Nonsmokers ’ Rights Foundation, 2010), health dispari-ties in SHS exposure remain. Exposure to SHS is known to vary by gender, socioeconomic status, race/ethnicity, and age (Greaves & Hemsing, 2009). Blue-collar workers, non-Hispanic Black males, manufacturing and construction workers, and those working in the service sector have the highest serum cotinine levels of all worker groups (Arheart et al., 2008). Smoke-free legislation may affect underserved popula-tions such as low-income groups in different ways (Bell et al., 2009). Low-educated populations are less likely to live in a location covered by smoke-free restaurant regulation