Our global population is aging at an accelerated pace. While the average life expectancy has seen dramatic increases, chronic disease and disability have also increased, with rural America tending to be older, sicker, and poorer. This article examines the implementation and outcomes associated with the community engagement method of the world café that was instrumental in developing a "culture of health" aimed to reduce diabetes-related inequalities for older adults in rural counties of Kentucky. Older residents and the organizations that serve them participated in world cafés, which resulted in collective action due to the wisdom and capacity that evolve from the core element of the method, conversational sharing via multiple small group interactions. Four world cafés were held to explore the desires of the communities related to healthy eating, exercise, smoking cessation, and diabetes care. The world cafés brought a diverse group of community residents and governmental and business leaders to discuss topics that matter to their community, leading to the development of a strategic plan and a scorecard and, ultimately, community empowerment.

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