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

> **NIH NIH R37** · UNIVERSITY OF KENTUCKY · 2022 · $380,206

## Abstract

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 par...

## Key facts

- **NIH application ID:** 10475845
- **Project number:** 5R37CA229337-05
- **Recipient organization:** UNIVERSITY OF KENTUCKY
- **Principal Investigator:** Amanda FALLIN-BENNETT
- **Activity code:** R37 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $380,206
- **Award type:** 5
- **Project period:** 2018-08-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10475845

## Citation

> US National Institutes of Health, RePORTER application 10475845, Adoption of Smoke-free Laws and Voluntary Policies in Rural Communities in Southern States (5R37CA229337-05). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10475845. Licensed CC0.

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