Kentucky leads the nation in adult smoking prevalence (CDC, 2001). The effects of tobacco cessation treatment factors, and environmental, structural, and client factors on adults' participation in tobacco cessation programs, quit attempts, and smoking prevalence at the local level in Kentucky were examined using Meier's Theory of Morality Policy (1994) and the Logic of Governance Model (Lynn et al., 2000). Tobacco cessation treatment factors are the financial resources and interventions implemented by local health departments that promote quitting, and include funding allocations for tobacco control programs, counter-advertising expenditures, and type of tobacco cessation treatments. The environmental, structural and client factors are those at the local level that encourage or impede the public to quit or reduce tobacco use. Environmental factors include the percent of smoke-free food establishments and pounds of tobacco produced. Structural factors include the single or multi-county format of health departments and tobacco coordinator employment status (full or part-time). Client factors include demographics such as age, gender, education, and race.
A pooled time series cross-sectional research design was used to analyze the primary and secondary data collected at the population level and obtained from state and local agencies. Bivariate and multivariate analyses using fixed effects modeling were used to test the research hypotheses. Treatment factors of number of programs and counter-advertising and the client factor of age contributed the most toward participation in tobacco cessation programs. There were no significant predictors of quit attempts. The client factors of age and race, and the environmental factor of tobacco production contributed the most toward smoking prevalence. It is recommended that all local health departments initiate or increase counter-advertising, targeting younger adults and health department service areas (HDSAs) with higher tobacco production per capita. It also is recommended that HDSA's enhance marketing efforts for cessation and increase the number of cessation programs offered by HDSA's to as many as is feasible and affordable. By providing cessation programs including counter-advertising, health departments in Kentucky will continue to positively effect the participation of adults in cessation programs. With increased funding for counter-advertising, the expectation is that smoking prevalence may eventually decline in Kentucky.
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