Etiology and dynamics of poly-tobacco use among adolescents in rural communities

烟草使用造成了巨大的疾病负担，农村人口的烟草使用率高于城市人口，随着时间的推移，差距越来越大。由于绝大多数烟草使用者是在青少年时期开始吸烟的，因此这是集中开展预防和干预工作的关键时期。其核心是了解烟草使用和尼古丁成瘾的病因。然而，最近烟草使用趋势的变化（即电子尼古丁输送系统（ENDS）的使用急剧增加）阻碍了目前对尼古丁成瘾和预防工作的理解。目前的项目将推动关于农村青年吸烟问题的研究，并将这些研究结果转化为预防/干预战略。首先，将分析当前烟草使用趋势（多种产品） 在农村人口和美洲印第安人人口中使用最新的可用数据。其次，使用因果推理方法分析ENDS使用与传统吸烟的关系，这将告知ENDS对农村青年烟草使用趋势的影响。第三，系统动力学模拟方法将汇编这些研究结果，以及现有文献的研究结果，烟草使用的病因。这一系统动力学模型将专门针对农村青年，并将用于确定杠杆点和适合农村环境的相应干预或预防战略。将对该模型进行分析，以确定最有可能有效减少农村青年烟草使用的战略。最后，这些发现将导致桑福德健康的实施工作。具体而言，PI将与其组织的医疗保健提供部门合作，改善医疗保健环境中的烟草使用数据收集，并实施适当的干预措施，以减少农村地区的青少年烟草使用。

Tobacco use presents a large disease burden, and rural populations have a higher prevalence of tobacco use than urban populations, with a widening disparity over time. Since the vast majority of tobacco users initiate during adolescence, this is a critical period in which to focus prevention and intervention efforts. Central to this is understanding the etiology of tobacco use and nicotine addiction. However, recent changes in tobacco use trends (namely the drastic rise in the use of electronic nicotine delivery systems (ENDS) have thwarted current understanding of nicotine addiction and prevention efforts. The current project will advance research on tobacco use among rural youth and translate those findings into prevention/intervention strategies. First, current tobacco use trends (multiple products) will be analyzed among rural populations and American Indian populations using the most recently available data. Second, the relationship of ENDS use with conventional cigarette smoking will be analyzed using causal inference methods, which will inform about the implications of ENDS on tobacco use trends among rural youth. Third, a system dynamics simulation method will compile these findings, as well as findings from existing literature, on the etiology of tobacco use. This system dynamics model will be tailored for rural youth and will be used to identify leverage points and corresponding intervention or prevention strategies that are appropriate for rural settings. The model will be analyzed to identify the strategies that are most likely to be effective at reducing tobacco use among rural youth. Finally, these findings will lead to implementation efforts within Sanford Health. Specifically, the PI will work with the healthcare delivery arm of her organization to improve data collection of tobacco use among and to implement appropriate interventions in healthcare settings to reduce youth tobacco use in rural areas.