Buettner-Schmidt Kelly, Boursaw Blake, Lobo Marie L
Kelly Buettner-Schmidt, PhD, RN, FAAN, is Associate Professor, School of Nursing, North Dakota State University, Fargo. Blake Boursaw, MS, is an Instructor and Marie L. Lobo, PhD, RN, FAAN, is Professor Emeritus, College of Nursing, University of New Mexico, Albuquerque.
Nurs Res. 2018 Jul/Aug;67(4):324-330. doi: 10.1097/NNR.0000000000000286.
Rural populations have been identified as having tobacco use disparities, with contributing factors including less demand for policy change than in urban areas, resulting in higher age-adjusted death rates related to tobacco use. In 2012, the rural state of North Dakota enacted a statewide comprehensive law requiring all bars and restaurants to be smoke-free.
The purpose of this longitudinal study, performed in three phases, was to assess the continued effects of a statewide comprehensive smoke-free law in a primarily rural state, using a stratified random sample.
Particulate matter and compliance indicators were assessed in restaurants and bars 21 months after enactment of the comprehensive law. Results were compared with the findings from the Phase 1 and Phase 2 samples, in which venues were assessed before passage of the law and approximately 3 months after enactment, respectively.
The comprehensive, statewide, smoke-free law led to immediate, sustained, and substantial reductions in secondhand smoke and eliminated previous significant disparities in secondhand smoke exposure in rural communities. Although indoor smoke-free compliance with the law was generally high, compliance in required outdoor smoke-free areas was low. Compliance with signage requirements, both indoors and outdoors, was low.
The comprehensive statewide smoke-free law created a just distribution of smoke-free laws statewide, resulting in increased protection of rural populations from secondhand smoke. Targeted public health interventions to address compliance may reduce secondhand smoke levels in outlier venues that continue to have high levels of secondhand smoke.
农村人口被认为存在烟草使用差异，其影响因素包括对政策变革的需求低于城市地区，这导致与烟草使用相关的年龄调整死亡率更高。2012年，以农村为主的北达科他州颁布了一项全州范围的综合法律，要求所有酒吧和餐馆都实行无烟政策。
这项分三个阶段进行的纵向研究旨在通过分层随机抽样评估一项全州范围的综合无烟法律在一个主要为农村地区的州所产生的持续影响。
在综合法律颁布21个月后，对餐馆和酒吧的颗粒物及合规指标进行了评估。将结果与第一阶段和第二阶段样本的调查结果进行比较，在这两个阶段中，分别在法律通过前和颁布后约3个月对场所进行了评估。
这项全州范围的综合无烟法律立即、持续且大幅降低了二手烟水平，并消除了农村社区此前在二手烟暴露方面存在的显著差异。虽然室内无烟政策的合规率总体较高，但规定的室外无烟区域的合规率较低。室内和室外的标识要求合规率都很低。
这项全州范围的综合无烟法律在全州范围内实现了无烟法律的公平分配，从而加强了对农村人口免受二手烟危害的保护。针对合规问题的有针对性的公共卫生干预措施可能会降低那些二手烟水平仍然较高的异常场所的二手烟浓度。
