LOUISVILLE, Ky., April 17, 2019 A new report recommends strategies that Appalachian communities can use to reduce the disproportionately high rates of smoking-related disease and mortality in the 420-county region. Included in the approaches are policy measures that communities and states can enact, such as raising the minimum legal age for access to tobacco products from 18 to 21, increasing the price of tobacco products through tax hikes, expanding smoke-free policies, fully funding quit lines, and reducing out-of-pocket costs for cessation programs.

The report, Health Disparities Related to Smoking in Appalachia: Practical Strategies and Recommendations for Communities, was released today by the Foundation for a Healthy Kentucky and the Appalachian Regional Commission (ARC), with funding from the Robert Wood Johnson Foundation (RWJF). The report recommends four approaches:

1. Prevent smoking initiation among youth.
2. Increase access to tobacco cessation interventions.
3. Launch anti-tobacco communication campaigns.
4. Reduce exposure to secondhand smoke.

"Most of the strategies recommended in the report are focused on preventing tobacco use and tobacco-related disease before it ever starts, but there are also policies proven to help current tobacco users quit successfully," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky. "These policies, programs and initiatives work. They have successfully reduced smoking rates and health disparities elsewhere in the country, as well as in parts of Appalachia. And the report gives practical advice for how to implement them in local communities as well as specific examples of Appalachian communities and organizations that have used them successfully."

The report recommends that communities begin by assessing their readiness to address tobacco use and offers tips and links for conducting such an assessment. It also provides multiple resources for state- and county-level data that can help communities understand tobacco use trends. The assessment will help communities determine which of the recommended approaches have the best chance of success.

One of the issues highlighted in the report is youth vaping, which has reached epidemic levels nationwide and also is prevalent in Appalachia. Educating parents, teachers, health professionals and youth; restricting youth access to tobacco products; and expanding smoke-free policies to include e-cigarettes are key approaches to address youth vaping, the report states.

"Student-led efforts are particularly successful in Appalachian communities" for decreasing youth tobacco use, it states.

The report also emphasizes the importance of building and mobilizing broad community coalitions that come together to educate community members, support policy changes and amplify the messages shared in media campaigns.

Another section in the Smoking: Practical Strategies report offers recommendations for funders, including leveraging well-connected community members who have strong ties and a shared culture and history.

"Here is a fresh set of evidence, practical advice, and local examples of the tactics and tools Appalachian communities have used to reduce tobacco use and improve health," Chandler said. "Some of Appalachia's most glaring health disparities are found in the central region that includes Kentucky and West Virginia, so the approaches can have an outsized benefit here."

Smoking: Practical Strategies is one of three capstone issue briefs released today by ARC and the Foundation for a Healthy Kentucky, with funding from RWJF. It is accompanied today by two additional briefs: Health Disparities Related to Obesity in Appalachia: Practical Strategies and Recommendations for Communities, and Health Disparities Related to Opioid Misuse in Appalachia: Practical Strategies and Recommendations for Communities. This series of briefs was developed as part of a health research initiative, Creating a Culture of Health in Appalachia: Disparities and Bright Spots. The first Bright Spots report documented the dramatic health disparities in Appalachia compared to the rest of the nation. The second report identified "bright spots" - Appalachian areas that scored much better than expected given the economic, resource and other challenges they face. The third report offered a deep dive into 10 representative bright spots counties. The Bright Spots project also includes an interactive website, healthinappalchia.org, where users can explore extensive county-level health data for the entire region.

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About the Foundation for a Healthy Kentucky
Funded by an endowment, the mission of the nonpartisan Foundation for a Healthy Kentucky is to address the unmet health needs of Kentuckians by developing and influencing policy, improving access to care, reducing health risks and disparities, and promoting health equity. Since the Foundation opened its doors in 2001, it has invested nearly $28 million in health policy research, advocacy, and demonstration project grants across the Commonwealth. Follow the Foundation on Twitter, Facebook and YouTube, and visit our website at www.healthy-ky.org.

About the Appalachian Regional Commission
The Appalachian Regional Commission (www.arc.gov) is an economic development agency of the federal government and 13 state governments focusing on 420 counties across the Appalachian Region. ARC's mission is to innovate, partner, and invest to build community capacity and strengthen economic growth in Appalachia to help the Region achieve socioeconomic parity with the nation.

About the Robert Wood Johnson Foundation
For more than 45 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are working alongside others to build a national Culture of Health that provides everyone in America a fair and just opportunity for health and well-being. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.
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