1. Are the proposed goals appropriate and relevant for addressing the needs of populations disparately affected by smoking? 2. Do the broad strategies capture the key components and aspects needed to drive

This means that attention is paid to the traditions and norms of local communities in rural America, which vary not only by the demographics of the populations (race, ethnicity) but also by long-established mores in the community (such as smokeless tobacco being most prevalent in rural communities in the Midwest and South, among those serving in the military, and employed in mining, utilities, and. [...] Programs to reduce tobacco use need to be integrated with programs to address the unmet behavioral health needs of rural populations. [...] Are there additional goals or broad strategies that should be included in the Framework? In addition to the strategies noted in the first two responses, we recommend payment strategies that incentivize both clinical providers and health plans to address tobacco cessation. [...] Lessons learned from the Centers for Disease Control and Prevention’s (CDC) 6|18 Initiative, which facilitated collaboration between state public health departments and Medicaid agencies to increase reimbursement for and uptake of evidence-based interventions related to tobacco cessation, could be leveraged in rural communities and other communities where tobacco use rates remain high. [...] Building robust data capacity in rural and underserved communities to understand and track tobacco use, which includes data access (e.g., medical records and tobacco sales), collection, (e.g., quantitative and qualitative data) and analysis, is an important strategy to include in the Framework.