Families flock to McDonald County in southwest Missouri each summer to float down the Elk River, visit the caves where Jesse James took refuge and stay in a rustic cabin.
The county is a vestige of old, wild Missouri charm — and a place where restaurants and bars still ask, “Smoking or non?”
People in McDonald County, like those in other rural places across Missouri and the country, smoke more. The U.S. Centers for Disease Control and Prevention says smoking runs even higher in rural Missouri than in rural America as a whole.
Groups that research and advocate for decreasing tobacco consumption connect that to Missouri’s cigarette taxes, the lowest in the country, and relatively weak rules backing smoke-free public places.
Some rural communities across the state, including McDonald County, are enacting their own smoke-free ordinances and in-restaurant policies to improve health outcomes and fall in rhythm with their urban neighbors.
“We want more people staying here, living here, coming here (for) tourism –– we just want to keep people coming back to McDonald County,” said Kayla Langford, the assistant director at the health department.