Prescribed burn smoke and community health in the Ozark Mountains: A qualitative descriptive study.

BACKGROUND: Prescribed burns sustain the fire-adapted forests of the Missouri Ozarks, and the smoke they generate carries respiratory and cardiovascular risks that fall unevenly across rural communities. Little evidence describes how these communities understand or respond to that smoke, leaving nurses in rural settings with limited guidance. PURPOSE: The purpose of this study is to explore how rural community leaders perceive the effects of prescribed burn smoke on community health and well-being in the Missouri Ozarks. METHODS: In this qualitative descriptive study, we conducted semi-structured interviews with 19 rural leaders, from government and public agencies, private foundations, private landowners, and news media, in and around the Mark Twain National Forest between May and September 2024. Interviews were audio-recorded, transcribed verbatim, and analyzed using a codebook (team-based) thematic analysis. DISCUSSION: Three themes emerged. In Smoke Trade-Off, leaders weighed the ecological necessity of burning against smoke-related health burdens they saw as heaviest for children, older adults, and people with respiratory conditions. In Cultural Lens, leaders described tradition, occupational norms, and an ethic of self-reliance as shaping how residents and workers interpreted and responded to smoke. In Trust Currency, leaders described trust, rooted in local history, credible messengers, and face-to-face relationships, as the decisive factor in whether communities accepted burns and protective guidance. In leaders' accounts, protecting rural communities from burn smoke depended more on culturally grounded, trusted communication than on new technical information. CONCLUSION: Nurses can contribute through occupational symptom screening, patient education delivered via trusted local channels, and advocacy for air-quality monitoring and equitable burn planning.