Abstract
PURPOSE: The study investigated the relationships among local smoke-free public policies, county-level quitline call rate, and adult smoking status. DESIGN: A retrospective cross-sectional examination of demographic characteristics, smoking status of Kentuckians, and data from the Kentucky Tobacco Quitline were used to investigate the relationship of local smoke-free ordinances or Board of Health regulations together with county-level quitline use rates and population-level adult smoking status. SETTING: One hundred and four Kentucky counties. SUBJECTS: The sample was comprised of 14,184 Kentucky participants with complete demographic information collected from the 2009-2010 Behavioral Risk Factor Surveillance System (BRFSS). MEASURES: Individual-level demographics and smoking status from the BRFSS; county-level urban/rural status; quitline rates; and smoke-free policy status. ANALYSIS: Given the hierarchical structure of the dataset, with BRFSS respondents nested within county, multilevel modeling was used to determine the predictors of smoking status. RESULTS: For every 1-unit increase in the county-level call rate the likelihood of current smoking status decreased by 9%. Compared to those living in communities without a policy, those in communities with a smoke-free public policy were 18% less likely to be current smokers. Limitations include quitline call rate as the sole indicator of cessation demand, as well as the cross-sectional design. CONCLUSION: Communities with smoke-free policies and higher rates of quitline use have lower rates of adult smoking.