We evaluated the implementation of local coalitions led in partnership with citizen scientists, community-based organizations, and public libraries in four rural communities to lower exposure to radon in the home. The objectives were to (1) describe the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) of four radon coalitions, and (2) compare RE-AIM factors among citizen scientists who participated in the coalitions and those who did not. A larger community-engaged research project embedded coalition building using a citizen science approach. Three of the four coalitions focused on health and wellness more broadly (18-34 members); one focused solely on radon (10 members). Coalition membership and activities varied from marketing a radon detector Library Loan Program, community events, and in-library tabling events to working with government officials to sign National Radon Action Month proclamations. We used mixed methods to evaluate coalition-building using the RE-AIM framework. The coalitions were most likely to reach local health departments, hospitals, and schools. Although these partners were highly supportive, they provided few to no resources. Four in 10 citizen scientists were at least moderately involved in the coalition regardless of whether they had high home radon. Citizen scientists reported low awareness of both how frequently radon received local media attention and how favorably radon awareness, testing, and mitigation was portrayed in local media, particularly among those uninvolved in the coalition. Citizen scientists involved in the coalition had the most experience disseminating scientific information on radon and educating the public. The coalitions fostered radon mitigation as 82% of library loan participants with high radon were likely to hire a radon mitigation professional, and all said financial assistance would help them mitigate. Multi-issue health coalitions that engage citizen scientists and partner with public libraries can increase radon testing and build demand for mitigation in rural areas.

PURPOSE:To determine the association between adult tobacco/nicotine product use over time and residence location (urban, suburban, town, rural), controlling for demographics. METHODS:Data from Waves 4-7 (2016-2023) of the Population Assessment of Tobacco and Health (PATH) study (N = 18,590 adults) were analyzed using survey-weighted logistic regression to evaluate location and time differences in likelihoods of current, daily, and established use of combustible tobacco, electronic nicotine delivery systems (ENDS), smokeless products, and poly use (≥2 products). FINDINGS:Compared to those residing in urban locations, suburban residents were less likely to report current (adjusted odds ratio (aOR) = 0.88), daily (aOR = 0.73), and established combustible products use (aOR = 0.77); town residents were more likely to use these products currently (aOR = 1.20) and daily (aOR = 1.42), and rural residents were more likely to use daily (aOR = 1.25) and report established use (aOR = 1.33). Rural residents had a lower likelihood of current ENDS use (aOR = 0.90), compared with those in urban locations. Compared with urban residents, current smokeless products use was more likely among rural residents (aOR = 1.63) and less likely among those in suburban locations (aOR = 0.74). Participants living in suburban (vs. urban) locations were less likely to use ≥2 products currently (aOR = 0.89) or daily (aOR = 0.79), while rural residents were more likely to engage in daily poly use (aOR = 1.39). Time was a significant factor in all models, with fluctuating patterns across waves. CONCLUSIONS:These findings highlight nuanced geographic differences in tobacco/nicotine product use patterns beyond simple urban-rural comparisons, informing efforts to eliminate tobacco/nicotine use disparities.

ObjectiveThis study aims to build a rural Appalachian cohort to examine how US Food and Drug Administration (FDA) Center for Tobacco Products (CTP) regulatory policies influence tobacco and nicotine product use across levels of rurality.MethodsThe AppalTRUST (Appalachian Tobacco Regulatory Science Team) Cohort integrates four inter-connected Community-engaged Research + Technology (CEnRT) elements to support recruitment and retention: (1) building trust and cultural relevance; (2) addressing barriers to participation in research; (3) focusing on ethics and confidentiality; and (4) fostering ongoing and consistent collaboration between the scientific and field teams. The study uses a dual sampling design to recruit 1,000 quota-based non-probability sample participants and 1,000 address-based probability sample participants. Eligible adults (ages 18+) are recruited from two Appalachian Kentucky catchments spanning rural and peri-urban counties. A local field team combines culturally relevant engagement strategies with technology-enabled procedures, including virtual consent and participant tracking, to foster trust and relevance with an underserved population.Anticipated resultsRecruitment is ongoing. Feasibility indicators include enrollment of 985 non-probability sample participants and 209 probability sample participants, a 16% direct-mail response rate, and a 62% participant preference for text-based consent and survey reminders. Expected outcomes include guidance for applying CEnRT approaches in underserved populations, characterization of tobacco and nicotine use trends across the rural–peri-urban continuum, and description of marketing exposure and consumer choice among subgroups of young adults and daily users in Appalachia. Findings will inform FDA CTP regulatory decision-making in rural Appalachian communities.DiscussionThis integrated CEnRT approach shows promise for recruiting and retaining rural Appalachian adults by centering community voice, trust, confidentiality, and practical engagement strategies.

Purpose To evaluate change in home radon testing after initiation of a public library radon detector lending program (LLP) in four rural counties; and describe the impact of LLP promotions on check-outs. Design Longitudinal tracking of radon testing and description of LLP promotions. Setting Four rural Kentucky counties. Sample 14,697 radon tests pre-LLP (charcoal-based test kits); 12,707 radon tests post-LLP (detector check-outs plus charcoal-based). Intervention LLP and promotional strategies including direct mail, radio, newsletters, social media, and in-library promotions and training. Measures Radon detector check-outs (03/2023-11/2024) comparing counties with and without LLP. Analysis Examined change in radon testing pre- and post-LLP implementation using incidence rate ratios. Evaluated number of check-outs following promotions. Results There was a 2.5-fold increase in the rate of radon testing in the four study counties (RR=2.5, 95% CI: 2.27-2.76; p<.001), while the testing rate fell in non-study counties. Two study counties exceeded their check-out goals multiple months in a row following direct mail campaigns. Social media, in-library signage, and billboards were reported most effective at promoting the program. The proportion of county-level renter-occupied housing fluctuated, potentially affecting differences in library check outs. Conclusion LLPs show promise in maximizing access to population-based radon testing. Mailing postcards to residents had a sustained impact on detector check-outs over 3-5 months in some counties.

PURPOSE:We evaluated a Community Health Worker (CHW)-Tobacco Treatment Specialist (TTS) model for delivering tailored tobacco treatment counseling and support in a rural, low-resourced county. METHODS:This was an exploratory, prospective study of people 18 years or older who used any tobacco product including e-cigarettes or vapes in the past 30 days. The CHW assessed tobacco use, secondhand smoke exposure, and quit history; and collected an expired breath carbon monoxide sample and a brief health history before providing 4-6 in-person or phone-based sessions involving tailored tobacco treatment counseling and support. The CHW connected participants to a prescriber at a federally qualified health care center (FQHC) for cessation medications as needed and/or helped them obtain free or low cost medications as available. Six weeks after intake, the CHW conducted a final in-person assessment, carbon monoxide measurement, and tobacco treatment counseling. We then referred participants to the free Quit line and to their primary care provider or the FQHC for additional treatment. FINDINGS:Median cigarettes smoked per day decreased from 20 at intake to 4.5 at the final visit. Most participants reported at least one or more 24-h quit attempts, and 38% reported they had stopped smoking entirely after the final visit. There was a significant increase in participants' confidence in quitting from intake to final. CONCLUSIONS:Using a CHW-TTS-delivered tobacco treatment approach in a low-resourced rural community demonstrated promise in helping tobacco users quit.

PURPOSE:This exploratory study described facilitators and barriers to reducing tobacco disparities in 2 small rural communities and identified ways to reduce tobacco use. METHODS:This was a descriptive design using qualitative methods. We created a resource database for 2 rural Kentucky counties, using a Culture of Health Framework. We recruited 16 organizational stakeholders serving low-socioeconomic populations and conducted focus groups and key informant interviews. We also completed key informant interviews with 7 tobacco users. Lastly, we tailored Community Action Plans for each county based on the data and then solicited feedback from the key stakeholders. FINDINGS:The 2 counties were similar in population size, but County A had fewer resources than County B, and the stakeholders expressed differences toward tobacco use and quitting. County A stakeholders talked most about the protobacco culture and that tobacco users accept the risks of smoking outweighing the benefits of quitting; they also expressed concerns about youth use and the influences of family, society, and industry. County B stakeholders described ambivalence about the health effects of use and quitting. County A's Action Plan identified an opportunity to build Community Health Worker-delivered tobacco treatment into a new school-based health center. County B's Action Plan focused on reaching tobacco users by providing incentives for participation and tailoring messages to different audiences. CONCLUSIONS:Tobacco control resources and stakeholder perspectives vary in small rural communities, implying a need for tailored approaches. Tobacco users in rural areas are a critical population to target with cessation resources.

Radon exposure is the second leading cause of lung cancer, yet few Americans test their homes for radon, particularly in rural areas. The academic team and community partners engaged the public library systems in four rural counties to offer digital radon detectors for check-out as a means of increasing the public's access to free radon testing. The check-out procedures and instructional materials were created through an iterative process, and library personnel were educated on radon and home radon testing prior to launching the lending program. Library patrons reported high usability, feasibility, and acceptability of the program. Library patron-staff interactions mainly included discussions about the logistics of radon testing. Given that public libraries are invested in making communities thrive and promoting health, providing library lending programs for radon detectors is a novel, feasible, and acceptable way to reduce the risk of lung cancer in the community.

During the COVID-19 pandemic, high-risk clients’ and caregivers’ access to essential personal protective equipment (PPE) was limited especially in many remote areas of Appalachia. A multidisciplinary team of community and university partners explored how to coordinate the use of community health workers (CHWs) and drone technologies to increase access to PPE in rural and remote Appalachian regions. CHWs recruited 10 Homeplace clients in an exploratory study of drone-based package delivery of PPE to assess importance and effectiveness of PPE self-efficacy related to PPE use, use of PPE, and ease and acceptability of drone delivery (following delivery only). CHWs educated each participant via in-person and Zoom meetings on the reasons for using PPE and proper use of PPE using Centers for Disease Control and Prevention guidelines. Most participants found the drone delivery of PPE easy and 80% were extremely satisfied with the drone delivery process. The frequency of mask-wearing increased from 60% at baseline to 90% at follow-up. On average, participants rated all types of PPE as effective in preventing the spread of disease. Drone officials used the findings of this pilot study to develop a waiver application to the U.S. Federal Aviation Administration to request permission to fly beyond visual line of sight in remote areas. Aerial drone technology could be a cutting-edge approach to health promotion in remote areas. The study results provide the proof of concept to assist investigators in designing future projects to promote healthy homes by collecting air and water samples and testing novel interventions deploying drone technology in remote Appalachian regions.

Exposure to tobacco smoke and radon cause lung cancer. Radioactive decay of naturally occurring uranium in bedrock produces radon. Seasonality, bedrock type, age of home, and topography have been associated with indoor radon, but the research is mixed. The study objective was to examine the relationships of geologic (soil radon and bedrock) and seasonal (warm and cold times of the year) factors with indoor home radon values in citizen scientists’ homes over time, controlling for atmospheric conditions, topography, age of home, and home exposure to tobacco smoke. We collected and analyzed indoor radon values, soil radon gas concentrations, and dwelling- and county-level geologic and atmospheric conditions on 66 properties in four rural counties during two seasons: (1) summer 2021 ( n = 53); and (2) winter/spring 2022 ( n = 52). Citizen scientists measured indoor radon using Airthings radon sensors, and outdoor temperature and rainfall. Geologists obtained soil radon measurements using RAD7 instruments at two locations (near the dwelling and farther away) at each dwelling, testing for associations of indoor radon values with soil values, bedrock type, topography, and atmospheric conditions. Bedrock type, near soil radon levels, home age, and barometric pressure were associated with indoor radon. Dwellings built on carbonate bedrock had indoor radon values that were 2.8 pCi/L (103.6 Bq m ^−3 ) higher, on average, compared to homes built on siliclastic rock. Homes with higher near soil radon and those built <40 ago were more likely to have indoor radon ⩾4.0 pCi/L (148 Bq m ^−3 ). With higher atmospheric barometric pressure during testing, observed indoor radon values were lower. Seasonality and topography were not associated with indoor radon level. Understanding relationships among bedrock type, soil radon, and indoor radon exposure allows the development of practical predictive models that may support pre-construction forecasting of indoor radon potential based on geologic factors.

6571 Background: Persistent smoking after cancer diagnosis causes adverse clinical outcomes. ASCO and other organizations view smoking assessment and treatment as indicators of high-quality cancer care. Yet, adoption of clinical practice guidelines like the 3As (Ask, Advise and Assist) for smoking assessment and treatment has been slow and inconsistent in cancer care settings. Methods: Led by the American College of Surgeons Cancer Programs’ Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC), the “Just ASK” national quality improvement project focuses on enhancing smoking assessment and treatment in cancer care settings. All CoC/NAPBC programs (n~2000) were invited to participate, which consisted of educational webinars, online resources, and 3 online surveys (baseline, 6- and 12-month) collecting information on smoking assessment and treatment practices, plus other variables (e.g., organizational priority, implementation barriers). Program participation was incentivized by fulfillment of accreditation standards. Results: In total, 776 programs (731 CoC, 45 NAPBC), participated. At baseline, most programs strongly endorsed the importance of addressing smoking within cancer care and the majority of programs reported routinely assessing smoking (90%) and advising all patients reporting current smoking to quit (71%). However, routine delivery of evidence-based smoking cessation assistance (e.g., quitline referral, cessation medications, counseling services) was low (all < 30%). Program retention was excellent (91%). As shown in the table, the 12-month follow-up revealed marked improvements in evidence-based Ask, Advise and Assist, practices. Conclusions: At enrollment, the importance of addressing smoking was evident and high rates of smoking assessment were reported. At 12-month follow-up, marked improvement was reported in all quality indicators of the 3As. These findings guided the sharing of strategies for improving patient assessment, clinical workflow and documentation. Suboptimal delivery of smoking cessation assistance persisted despite overall improvements, which highlight persistent challenges and opportunities for implementing smoking assessment and treatment in cancer care settings. [Table: see text]

Introduction Science communication plays a crucial role in tackling pressing regional, national, and global health issues. Effective communication with various audiences is integral to dissemination of science findings. Purpose This study evaluates changes in self-efficacy and attitudes toward science communication skills over time and also assesses program outcomes and satisfaction with a Faculty Fellows in Science Communication (FFSC) program among faculty (N = 30) with interest in environmental health science and/or education in Appalachia Kentucky. Methods A mixed methods program evaluation was employed using longitudinal data on behaviors, attitudes, and program outcomes from three cohorts of Faculty Fellows who participated in the year-long UK-CARES Faculty Fellows in Science Communication (FFSC) program from 2018 to 2021. Repeated Measures Analysis of Variance was used to evaluate changes over time in self-efficacy and attitude scores. Results A total of 30 Fellows enrolled in the program. Participation in the FFSC program significantly increased self-efficacy in communicating with peers in one’s own department (F = 7.6, p = 0.002), outside department (F = 7.3, p = 0.002 ), and lay audiences (F = 5.8, p = 0.006) and evaluations of the program were positive. Qualitative feedback from participants offered insights into how program participation helped them communicate with different audiences, incorporate narratives or stories to engage audiences, and develop innovative methods of communicating with lay audiences. Implications The FFSC program provides a useful framework for other institutions and supports faculty as they build the communication skills necessary to effectively translate science with various audiences.

The purpose of this study was to examine the impact of community smoke-free laws on incidence of preterm birth. A retrospective case-control study compared incidence of preterm birth via vital statistics birth records across communities with no, moderate/weak, or comprehensive smoke-free laws. A generalized estimating equation model was used to assess the effect of smoke-free community ordinance on preterm birth, with personal- and county-level variables included as covariates and pregnant women nested within county of residence. Data analysis was conducted using SAS, version 9.4, with an alpha of .05. A total of 863,790 mothers aged 18-44, singleton gestation and living in a county located in Kentucky from 2004 – 2020 were included in the analysis. Of the 120 counties, the average adult smoking rate was 24.3% (SD=5.3). The majority were between ages 25-34 (52%), White (83%), had a high school education (61%), married (61%) and had either public or no insurance (55%). History of preterm birth was low (4%) and one-quarter smoked prior to pregnancy (25%). Nearly three-quarters of counties were rural (71%) and almost one-quarter had a comprehensive smoke-free policy as of 2020 (24%). All personal-level variables were associated with preterm birth status (Table 1). Compared with pregnant women living in counties without a smoke-free law, those living in counties with comprehensive policies were 7% less likely to have a preterm birth (OR=0.93, p< .001). There was no difference in likelihood of preterm birth between those living in counties with moderate or weak laws compared with those with no law in their county of residence. This study is among the first in the US to demonstrate that comprehensive local smoke-free laws are associated with reduced risk for preterm birth, while moderate/weak laws are not. These findings have major implications for public health policy and underscore the potential impact of health care providers' advocacy for evidence-based health policy to support healthy pregnancies.

BACKGROUND:Smoking during pregnancy and prenatal secondhand smoke exposure increase the risk of preterm birth. As Kentucky has the second highest rate of smoking in the United States and no statewide smoke-free law, an examination of the effect of municipal smoke-free legislation on preterm birth is warranted. OBJECTIVE:This study used state-level live birth data and county-level municipal smoke-free legislation status to assess the association between the presence and strength of smoke-free laws and the likelihood of preterm birth. Moreover, this study hypothesized that pregnant persons living in counties with comprehensive municipal smoke-free laws prohibiting smoking inside all workplaces and enclosed public places would exhibit a lower likelihood of preterm birth than those living in counties with weak or moderate laws (ie, smoke-free laws with exemptions that do not cover all workplaces and enclosed public places) or no smoke-free law. STUDY DESIGN:Using live birth data from the Kentucky Office of Vital Statistics with birth years ranging from 2004 to 2020, a total of 894,372 live births were recorded that indicated that a childbearing person was between the ages of 18 and 49 years and a resident of Kentucky; these live births formed the sample for the study. Municipal ordinances implemented during a given calendar year were coded in the model as present starting with the following calendar year, as the birth records were time deidentified except for the year of birth. This lagged law convention maximized the likelihood that pregnant persons included in the study were exposed to the smoke-free policy for at least a portion of their pregnancy. Multilevel logistic regression was used to assess the effect of smoke-free ordinances on the likelihood of preterm birth, with personal- and county-level variables included as potential covariates and pregnant persons nested within the county of residence. Data analysis was conducted using SAS (version 9.4; SAS Institute, Cary, NC), with an alpha level of .05. RESULTS:Nearly all personal-level variables were associated with preterm birth status. Personal factors associated with an increased likelihood of preterm birth included being older (relative to 18-24 years old; odds ratios [95% confidence intervals]: 1.02 [1.01-1.04] and 1.27 [1.24-1.31] for ages 25-34 and 35-49 years, respectively); having a history of preterm birth (odds ratio, 4.65; 95% confidence interval, 4.53-4.78); and smoking before pregnancy (odds ratio, 1.14; 95% confidence interval, 1.12-1.16). Pregnant persons living in counties with comprehensive laws were 9% less likely to have a preterm birth than those living in counties without a smoke-free ordinance (odds ratio, 0.91; 95% confidence interval, 0.89-0.94; P<.001). There was no difference in the likelihood of preterm birth between those living in counties with moderate or weak laws and those unprotected by any smoke-free ordinance in their county of residence. CONCLUSION:This study demonstrated that comprehensive municipal smoke-free laws are associated with reduced risk of preterm birth and that moderate or weak smoke-free laws are not. The findings have major implications for public health policy and underscore the potential influence of healthcare providers' advocacy for strong smoke-free policies, prohibiting smoking in all workplaces (including restaurants, bars, and casinos), to support healthy pregnancies.

Tobacco dependence is a prevalent, chronic, and complex addiction that often leads to long-term disease and death. However, few healthcare providers are sufficiently trained and feel comfortable in delivering tobacco dependence treatment. The purpose of the study was to examine the effectiveness of an accredited online Tobacco Treatment Specialist (TTS) training program that uses a novel, asynchronous approach. We compared the characteristics of participants who completed the program to those who did not complete the program. Changes in knowledge and attitudes in providing tobacco dependence treatment were measured, and satisfaction with the program and intent to pursue national certification were assessed. Participants who were more likely to complete the program were those who discussed quitting less frequently with patients prior to course enrollment. These participants had a significant increase in knowledge and high satisfaction with the course. Approximately half of participants who completed the program indicated that they would pursue obtaining a national certificate in tobacco dependence treatment in the next 2 years.

Purpose Determine associations of strength of local smoke-free laws and urban/rural location with cigarette and smokeless tobacco use among high school students in grades 10 and 12. Design Secondary data analysis from the 2004–2018 biennial Kentucky Incentives for Prevention Survey Setting Public high schools in Kentucky Sample N = 353502 10 th /12 th graders Measures County-level smoke-free law status from the Kentucky Center for Smoke-free Policy; Rural Urban Continuum Codes; self-reported last 30-day alcohol, marijuana, cigarette, and smokeless tobacco use Analysis Generalized estimating equations modeling assessed the association of law status and urban/rural location with tobacco use across cohorts, controlling for demographics and other substance use. Results Students in counties with a comprehensive smoke-free law were 23% less likely to smoke cigarettes and 16% less likely to use smokeless, compared to those in counties without a law. Students in counties with moderate/weak laws did not differ in likelihood of use for either product, compared to those in counties without a law. Students in urban counties were 14% less likely to smoke, but there was no difference in likelihood of smokeless use by urban/rural location. Conclusion Comprehensive smoke-free laws are associated with a lower likelihood of youth cigarette and smokeless use. Rural youth may be at increased risk of cigarette smoking relative to youth in urban areas.

Older adults in long-term care (LTC) facilities suffer disproportionately from health conditions caused or worsened by secondhand smoke. Long-term care facilities in many states and municipalities permit smoking. Americans for Nonsmokers' Rights compiles data on smoke-free policies only in institutional facilities (e.g., nursing homes), but not in transitional (e.g., independent living) or community-based settings (e.g., adult day). A cross-sectional, observational study was conducted of smoke-free policies using cluster random sampling in Kentucky to compare differences in policy location of coverage and strength of smoke-free policies in institutional, transitional, and community-based LTC facilities by rural/urban status. Online or phone surveys of LTC administrators representing 306 facilities were conducted. Of the facilities sampled, 35.5% were institutional, 33.4% transitional, 25.1% community-based, and 6.0% multi-type. Only one in five (19.6%) facilities restricted smoking indoors and outdoors. Only 17.3% of the policies were comprehensive (i.e., prohibiting use of all tobacco products by all persons living, frequenting, or working in LTC facilities). Compared to transitional facilities, institutional and community-based facilities were more likely to have comprehensive policies and restrict smoking indoors and outdoors. Facilities located in rural communities were less likely to restrict smoking indoors or outdoors and less likely to have comprehensive smoke-free policies, reflecting a disparity in policy protections. Strong, consistent smoke-free policies and policy enforcement are needed to reduce the disparity in smoke-free protections for older adults, LTC employees, and visitors. More research is needed to investigate the best strategies for implementing and enforcing policies that completely restrict smoking in all LTC facilities.