Purpose This study aimed to describe lesbian, gay, bisexual, and transgender (LGBT) friendly providers’ (1) smoking cessation recommendations to LGBT patients and (2) tobacco treatment practices for transgender patients. Design and Methods In‐depth, semistructured phone interviews were conducted with 13 healthcare providers. Findings Four overarching themes emerged: (1) providing tobacco treatment services for LGBT patients; (2) barriers to LGBT smoking cessation; (3) prescribing practices for transgender individuals taking estrogen hormone therapy; (4) provider community outreach to promote LGBT smoking cessation. Practice Implications Holistic tobacco treatment services are needed to address LGBT‐specific barriers to tobacco cessation, such as stress, identity‐related factors, and inadequate healthcare access.

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 = 353,502 10th/12th 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. Key Words: smoke-free policy; adolescent; tobacco use; outcome assessment; cigarettes; smokeless tobacco

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.