The tobacco industry remains a formidable influence in thwarting tobacco control efforts, in part because they have raised concern about how tobacco control negatively impacts tobacco farmers. This concern has been a key obstacle in the passage of tobacco control policies at local, state and federal levels. This study will be conducted in North Carolina, where more tobacco is grown than in all other states combined (52 percent). In addition, due substantially to public and policy-maker concern about farmers, North Carolina lags far behind other states in tobacco control efforts. The study is a randomized intervention trial of 14 major tobacco-producing countries. Seven counties will be assigned randomly to receiver an intensive community organization and education intervention that helps farmers lessen their dependence on tobacco. The seven non-intervention counties will serve as a no-treatment comparison group. The efficacy of the intervention will be evaluated over four years among a cohort of about 1,000 tobacco farmers. The overall objective is to increase the proportion of tobacco farmers who supplement their tobacco enterprises. The investigators will also intervene on perceptions that economic devastation is inevitably tied to tobacco control and that tobacco farm diversification is infeasible. The Secondary outcomes are: (1) Proportion of farmers who request materials from the Rural Advancement Foundation International (RAFI) on diversification (2) Proportion of farmers who attend a RAFI-sponsored meeting on tobacco diversification; (3) Proportion of farmers who sign a RAFI petition supporting a policy change that would facilitate tobacco diversification; (4) Proportion of farmers who contribute at least 50 dollars to a RAFI fund to support the development of education programs for tobacco farmers; (5) Proportion of farmers who attend at least one RAFI- sponsored training forum on strategies for diversifying; (6) proportion of farmers who seek loans for alternative enterprises only, proportion of farmers who supplement with farm income with off farm income; The investigators suggest that farmer diversification and the subsequent economic development it produces will decrease public and policy-maker resistance to tobacco control. If farmers, elected officials, and the general public believed that diversification was desirable, achievable, and economically advantageous, a key obstacle to the passage of tobacco control policies would be lifted, leading to reduced tobacco use among the population. To ensure that the intervention is culturally appropriate to farmers, they have brought together a diverse team of investigators and consultants with expertise in tobacco policy, community organization, agricultural economics, and tobacco farming.
