Youth tobacco prevention: Context, capacities and community readiness for change

Background: Community context, capacities and level of readiness for change inform and guide strategies for prevention. The 3 counties in this study project include an urban county (C1), a rural county (C2), and a transitioning rural/suburban county (C3). Methods: The Tri-ethnic Center's Community Readiness Assessment was used in semi-structured interviews with 26 stakeholders in 3 Missouri counties to assess readiness for change in prevention of youth tobacco use. Level of readiness was scored according to the Tri-Ethnic Center's protocol. Transcripts were analyzed using the constant comparative method across all interviews and within groups of interviews (by county). Level of readiness scores and qualitative findings guided the development of community-specific prevention strategies. Results: Across-case findings suggest low community knowledge and concern, lack of consensus on who is responsible for tobacco prevention and connection between acceptability of tobacco use and access to tobacco. The readiness scores were similarly low on a scale of 1-10 (C1: Level 5 “Preparation”; C2 and C3: Level 3 “Vague awareness”). Qualitative findings provided guidance for developing programs for each county considering the context of local resources, capacities and concerns. Conclusions: Strategies were matched to the score of level of readiness, utilizing findings to target local initiatives for community tobacco prevention. County 1 (C1): city council ordinance–level intervention to expand the restriction of youth access to tobacco. County 2 (C2): a dedicated tobacco coalition with public health and other concerned stakeholders to promote smoke-free ordinances. County 3 (C3): school-based student group to promote tobacco-free lifestyle