Public Health in the Rockies 2026

Public health professionals are increasingly called to address complex inequities rooted in systemic racism, trauma, and historical mistrust. Yet many professionals have not been given the tools to navigate conflict, build authentic trust across difference, or recognize how implicit bias and emotional responses impact communication with strategically undervalued populations. This skill-building session is designed to strengthen participants’ ability to practice equity-centered, trauma-informed, and empathetic public health engagement.

This interactive training will help public health professionals better communicate with and listen to QBIPOC communities while building empathy for the structural injustices that shape health outcomes and lived experiences. Participants will examine how conflict avoidance, defensiveness, implicit bias, and countertransference can interfere with effective communication, relationship-building, and equitable public health practice. The session will also explore how white supremacy shows up in workplace dynamics, systems, and patient care, particularly through urgency, perfectionism, and avoidance of discomfort.

Participants will develop practical emotional intelligence and communication skills that support stronger public health relationships, more responsive community engagement, and increased capacity to navigate difficult conversations with compassion and accountability. Through equity education, discussion, and real-world application, attendees will leave with tangible tools to strengthen their anti-racist public health practice and deepen trust with the communities they serve.

This session aligns with best practices in public health by centering cultural humility, trauma-informed engagement, equity-informed communication, and community-centered approaches to care. The training supports workforce development by equipping professionals with interpersonal and reflective skills necessary for effective collaboration, cross-sector partnership, and equitable patient care in increasingly diverse communities.

Instructional methods will include a lecture-style presentation with slides, facilitated discussion, reflective exercises, scenario-based application, and opportunities for peer learning and dialogue. Skill development will be measured through participant self-reflection, interactive discussion, applied practice exercises.

This session directly supports the conference theme, Stronger Together, by helping public health professionals build the empathy, communication skills, and relational capacity necessary to foster resilient communities, collaborative partnerships, and a more equitable public health future.

Traditional mental health research has often limited the involvement of underrepresented groups, including youth, in research development, limiting the applicability of findings and reinforcing inequitable power dynamics. Although evidence demonstrates that engaging youth in all phases of the research process improves relevance, youth participation remains limited to passive roles rather than active partners. Many initiatives sparingly involve youth, rather than full collaboration in all stages of the research process.

Youth Participatory Action Research (YPAR), a specific type of Community-Based Participatory Research focused on youth engagement, seeks to address these inequities. Project YAM (Youth-engaged Approaches to Mental Health) is a qualitative research study focused on using YPAR approaches to explore youth engagement frameworks for mental health settings. We took a unique youth-adult collaborative approach to qualitative YPAR by completely integrating youth researchers as team members in all project phases.

In this skill-building session, we will examine contextual barriers and facilitators to youth engagement in public health settings with a focus on integrating youth into qualitative research and evaluation teams. Attendees will gain experience in utilizing a bidirectional youth-adult partnership approach to co-create strategies for effective youth engagement. Our youth facilitators will support attendees in tailoring YPAR methodology to integrate youth in the projects and settings relevant to attendees.

Our study was co-developed with a youth co-PI, who formulated the research question and co-led the successful submission of a grant proposal. We recruited and hired a team of five youth researchers, and completed youth-focused research ethics and qualitative methods training. Youth-adult teams completed interviews, with youth facilitating and taking field notes. Data analysis utilized a co-led qualitative rapid matrix approach. By embedding youth voices, we enhanced and made significant modifications to our qualitative research procedures leading to more precise, youth-tailored results that have a better chance at improving youth engagement efforts. Consequently, we developed a “roadmap” for youth participation in all phases of the qualitative research process.

Throughout the presentation attendees will engage in small group discussion guided by reflective questions and interactive case studies intended to support application of skills learned in the session to real world situations. Each activity builds on presented knowledge and skills culminating in an actionable roadmap that can be implemented as a practical guide for incorporating YPAR in their organization. This roadmap outlines key stages, including detours highlighting common challenges along with strategies for navigating them and fast lanes, like existing partners/tools that can accelerate the process. Application questions will prompt attendees to reflect on how and why they want to engage in YPAR, helping them clarify purpose, readiness, and next steps for their team

By centering youth engagement and applying YPAR approaches, we were able to innovate a process for integrating youth into qualitative public health research. The roadmap presented and applied in this workshop provides infrastructure to embed and leverage youth’s lived experiences and insights to produce meaningful participation. Applying this roadmap and considering novel forms of youth engagement has the potential to co-create equitable and tailored solutions for youth.

Rural public health systems across Colorado continue to navigate complex workforce challenges related to recruitment, retention, infrastructure, training capacity, and evolving community health needs. At the same time, rural communities, public health agencies, academic institutions, and community partners are developing innovative and relationship-centered approaches to strengthen workforce pathways and support sustainable public health capacity.

This showcase session will provide an overview of emerging insights and practice-informed lessons related to rural public health workforce development in Colorado from the perspective of academic and community partnership efforts. Drawing from ongoing collaborations involving workforce development initiatives, rural public health partnerships, student training programs, academic health department relationships, and statewide conversations with rural practitioners and leaders, presenters will highlight themes that are shaping current workforce needs and opportunities across Colorado’s rural public health landscape.

The session will explore topics such as workforce recruitment and retention, student development, training and mentorship needs, cross-sector collaboration, infrastructure challenges, rural practice-based learning opportunities, and the importance of relationship-building in sustaining rural public health systems. Presenters will also discuss how rural public health partners are navigating changing expectations, limited resources, and emerging opportunities for innovation and collaboration.

Rather than presenting a single program model or finalized research project, this session is intended to foster dialogue and shared learning around the evolving realities of rural workforce development in Colorado. Attendees will gain exposure to current partnership approaches, emerging strategies, and practical considerations for strengthening rural public health capacity through collaborative and equity-focused efforts.

This session aligns with the conference theme of “Stronger Together” by emphasizing the importance of partnerships, shared learning, and collective investment in the future of Colorado’s rural public health workforce.

Background/Purpose: Language Justice is the principle that all people have the right to communicate, understand, and be understood in their preferred language and that all languages should be valued equally. Within public health and environmental settings, effective language services are essential to equitable community engagement and meaningful participation in decision-making processes. At the Colorado Department of Public Health and Environment, particularly within the Office of Environmental Justice, staff have identified a growing need for culturally competent translation and interpretation practices that build trust and improve accessibility while navigating operational and funding constraints.

Methods: This session will present practices and lessons learned from implementing language access strategies within public health and environmental justice work. Presenters will discuss approaches used to improve translation consistency and quality, including shared glossaries, coordination with external vendors, and review processes that prioritize cultural and contextual appropriateness. The session will also examine interpretation practices such as advanced interpreter preparation, sharing technical materials before meetings, and supporting interpreters with subject matter context. Presenters will additionally discuss emerging technologies, including AI-assisted translation tools, and their appropriate role within language justice efforts.

Results: These practices have improved consistency across multilingual communications, strengthened interpreter preparedness, and supported more meaningful community participation in public health and environmental discussions. Presenters have also identified persistent implementation barriers, including limited funding, staffing capacity, and organizational misconceptions that language access can be fully replaced by automated tools.

Implications: Participants will leave with practical strategies for strengthening language services within their own organizations while critically assessing the opportunities and limitations of AI and other technologies in language access work. The additional 30 minutes requested for this session will allow for facilitated audience discussion, small-group reflection activities, and peer-to-peer sharing on implementation challenges and best practices in support of the conference theme, “Stronger Together.”

Colorado’s rural communities often face unique health care challenges, including provider shortages, longer travel distances for care, and limited access to timely, locally relevant data to support community health assessment and planning. Yet county-level health care data are frequently fragmented across multiple systems, making them difficult to access and interpret. To address this gap, the Center for Improving Value in Health Care (CIVHC) developed the Colorado County Profiles, a publicly available resource that draws on data from the Colorado All Payer Claims Database (CO APCD) to compile health care enrollment, access, utilization, and cost indicators for all 64 Colorado counties.

This session will present the development, structure, and early implementation of the Colorado County Profiles, including the integration of ongoing health care enrollment data with population, spending, and utilization measures. Particular emphasis will be placed on how county-level Medicaid and commercial enrollment data can help rural communities monitor coverage trends, identify emerging needs, and inform local planning efforts.

Presenters will highlight rural and regional variation in health care costs, utilization, and enrollment, demonstrating how the profiles translate complex data into concise, community-focused reports. The session will also explore how longitudinal enrollment tracking can help counties assess the effects of federal and state policy changes, including expected shifts in Medicaid and commercial coverage related to HR 1 and ongoing affordability challenges.

Early engagement demonstrates growing interest among local public health agencies and community organizations seeking practical tools to support Community Health Assessments and planning activities. Rural counties, which often have limited capacity for independent data analysis, may benefit in particular from accessible, regularly updated county-level information.

Attendees will leave with practical strategies for using county-level enrollment and population data to support rural health assessment, collaborative planning, and data-informed public health action.

Background / Purpose:
Access to preventative care and outbreak response remains a persistent challenge for underinsured, uninsured, newcomer, and geographically isolated populations across Colorado. Childhood immunization gaps—particularly MMR rates among kindergartners remaining below 90%—highlight the need for innovative, scalable delivery models. This project asks: how can mobile clinic infrastructure improve equitable vaccine access and strengthen public health resilience? We hypothesize that deploying independent, technology-enabled mobile clinics can expand reach, improve vaccination rates, and enhance outbreak responsiveness while fostering cross-sector collaboration—aligning with the conference theme, Stronger Together.

Methods:
We implemented mobile vaccination vans as fully independent clinic sites equipped with advanced cold-chain technology and data systems. Clinics were deployed in both urban and rural counties, targeting underserved populations. Operational improvements included streamlined registration systems, diversified staffing, and culturally responsive care practices. Data were collected on clinic frequency, geographic reach, patient demographics, and vaccines administered from September 2023 to January 2026.

Results:
The program delivered 40,664 vaccines to 15,427 individuals across 801 clinics in 44 of 64 counties. Over 65% of recipients were underinsured or uninsured. Transitioning to independent mobile units increased clinic frequency and capacity, particularly in rural areas, while improving workflow efficiency and access for diverse populations.

Implications:

Mobile public health clinics are a scalable, adaptable solution for improving healthcare access, addressing immunization gaps, and strengthening outbreak response. Key takeaways include the importance of operational flexibility, technology integration, and culturally responsive care to reduce barriers and advance health equity.

Background: Primary care practices often screen for food insecurity. However, short-term patient outcomes after screening are not well understood. We used a mixed-methods approach to examine satisfaction with screening and connection to resources among adults screening positive for food insecurity at two Western Slope federally qualified health centers.

Methods: Patients completed REDCap surveys on food assistance resource referrals and usage at three timepoints: identification of food insecurity, one, and three months later. Interviews were conducted with a subset of survey respondents using a semi-structured guide and were analyzed via rapid qualitative analysis.

Results: Thirty-four patients completed surveys and 18 also participated in interviews. Among survey respondents, 69% reported receiving a referral to food assistance programs. Of those referred, 75% rated referrals as ‘very helpful’ and 25% as ‘a little bit helpful.’ At baseline, 25% of respondents reported current use of the Supplemental Nutrition Access Program (SNAP) and 28% reported past use. At months one and three respectively, 39% and 36% reported current use of SNAP. At baseline, 34% reported current use of community food pantries and 34% reported past use, increasing to 40% at one month and 42% at three months. Topics emerging from key informant interviews included: limited recall of screening processes but no specific objections; few new resources received following screening; patients in acute medical or socio-economic crisis recalled attention to social needs more clearly; and inability of current community options to meet needs due to barriers such as pantry schedules, dietary needs, and transportation.

Implications: Screening for food insecurity can identify needs, but existing resources may be insufficient. Healthcare and community organizations may need to deepen collaboration and communication to advocate for policies and funding that increase availability and accessibility of food assistance resources.

Oral health is a critical component of whole-person health, yet significant gaps in access, utilization, and affordability persist across Colorado, particularly in rural and underserved communities. To address the lack of accessible statewide dental data, the Center for Improving Value in Health Care (CIVHC) partnered with the Colorado Dental Association to develop Colorado’s first public Dental Health Dashboard, using data from the Colorado All Payer Claims Database (CO APCD). This project reflects the conference theme, Stronger Together: Public Health in the Heart of the Rockies, by demonstrating how collaboration among public health organizations, dental providers, and health care stakeholders can advance data-driven solutions to improve community health.

This session will present findings from 2022–2025 commercial and Medicaid claims data, examining dental utilization, procedure frequency, and out-of-pocket costs across rural and urban communities, payer types, and demographics (including age groups, sex, and race/ethnicity). Presenters will demonstrate the interactive Dental Dashboard, highlighting disparities in utilization and spending patterns, including lower rates of care among rural residents, younger adults, and some racial and ethnic populations, alongside higher treatment costs in rural communities and among older adults.

Attendees will learn how publicly available claims data can support oral health planning, outreach, policy development, and equity-focused interventions. Participants will leave with practical strategies for using the dashboard to identify disparities, inform local decision-making, and strengthen collaboration between oral health and broader public health initiatives. Time for attendee discussion and interactive dashboard exploration will encourage participants to share challenges, identify potential applications in their own communities, and provide feedback to inform future dashboard enhancements.

Background/Purpose: Functional Neurological Disorder (FND) is a common neurological condition associated with disability, psychiatric comorbidity, stigma, fragmented care, and high healthcare utilization. Despite growing evidence supporting FND treatment, inconsistent diagnostic communication and limited provider education remain major barriers to engagement and continuity of care. This project aimed to design a multi-sector communication strategy to improve diagnostic understanding, reduce stigma, strengthen referral pathways, and support sustainable care delivery within an academic FND clinic.

Methods: Using principles from the Health Belief Model, stigma theory, and implementation science, a multi-level communication intervention was developed for six stakeholder sectors: patients, caregivers, referring providers, behavioral health clinicians, administrators, and payers. Materials were designed to align with real-world clinical workflows and included standardized diagnostic scripts, patient-facing educational materials, provider referral guides, transition-of-care toolkits, executive briefs, and a proposed website redesign. A pragmatic evaluation framework was developed to assess patient-, provider-, and system-level outcomes using pre/post implementation measures.

Results: The intervention established a standardized communication ecosystem designed to improve diagnostic clarity, reduce stigmatizing language, increase treatment engagement, and support continuity of care following participation in a 12-week Multimodal Adapted Psychotherapy (MAP) program. Planned evaluation metrics include diagnostic understanding, provider confidence, referral appropriateness, treatment engagement, and healthcare utilization indicators.

Implications: This project positions communication as a scalable public health intervention capable of improving engagement and reducing fragmentation in complex neurological conditions. The model demonstrates how interdisciplinary communication strategies can strengthen integrated behavioral health systems, improve equity in access to specialty care, and support sustainable implementation within academic healthcare settings.

Community organizations know the importance of reliable, representative, local data, especially for smaller geographical areas and subpopulations. The landscape of local data is changing, and public health agencies need to adapt as well. Since 2007, the Weld County Department of Public Health and Environment (WCDPHE) has conducted a triennial household-based Community Health Survey (CHS) using scientific random sampling to obtain population-level metrics for Weld County adults. Over the past few survey cycles resident response rates have steadily declined (similar to national trends). Therefore, for the 2025 CHS WCDPHE collaborated with healthcare partners (who utilize WCDPHE’s local data), to launch an incentive program in the hope that it would boost the response rate.

Agreements were made with local healthcare partners for their financial support and in return preliminary findings were shared with them in advance of the public data release. The CHS was sent out to 20,000 randomly selected households with instructions to claim a “$5 reward for completing the survey”. As part of the program a reward platform vendor was selected to distribute the post-survey incentives.

The 2025 CHS response rate increased by 36% with the most improvement in Greeley/Evans and the Southwest regions of the county. Younger and lower income residents requested incentives more often compared to older and higher income residents. This indicates there is potential for incentives to boost response rates for the aforementioned hard-to reach groups. Overall cost of the incentive program was around $12,500.

Higher incentive request rates from hard-to-reach populations support the notion that incentive effectively promote survey participation. This successful partnership demonstrates that robust, high-quality data at a local level is still achievable in a time when data is getting harder to come by.

Background/Purpose: Public health professionals make complex decisions amid competing priorities, rapid change, limited resources, and expanding data. However, more data does not consistently lead to better decisions. Decision Intelligence (DI) is a framework that integrates data, human judgment, and context to improve decision quality. DI Maps relationships between actions and outcomes, enabling faster learning compared with testing one intervention at a time. This presentation introduces two DI interventions and their results. Methods: A DI framework was applied within two continuous quality improvement projects. Participants included public health staff and clinical partners. Procedures included elicitation sessions to develop Causal Decision Diagrams, a DI tool that maps decision-making by identifying goals, outcomes, external factors, actionable levers, and intermediates. One project focused on increasing referral capture within a practice, while the second examined conversion of referrals into scheduled visits. Data sources included referral volume, provider participation, and scheduling outcomes tracked over time. Analysis involved iterative PDSA cycles, trend monitoring, and refinement of decision levers to improve system performance. Results: The first of two DI projects is more mature, with initial results showing meaningful improvements in outcomes. Referrals increased from a baseline of 30% to 34% in Q4 2025 and was sustained at 33% in Q1 2026, with average monthly referrals increasing from 12.5 to approximately 14–14.25. The number of referring providers increased from three to six. These outcomes, alongside the associated Fussing Hard campaign, generated interest from Family Connects International for nationwide scaling. The second DI project, focused on conversion of referrals to scheduled visits, is newer, with preliminary results expected in September. Implications: DI helps public health professionals move faster and with greater clarity in complex systems. Rather than relying on slow, trial-and-error approaches, DI makes it possible to identify high-impact actions earlier and focus effort where it matters most.

Political rhetoric often stigmatizes immigrants as a drag on the U.S. health care system, but the Colorado Health Access Survey (CHAS) finds that immigrants use less health care than U.S.-born residents. The pattern is consistent for every form of health care use measured by the CHAS. It reflects a mix of interconnected factors, such as cost, access, and, more recently, fears about federal immigration actions that have led many immigrant community members to delay or avoid care altogether.

By combining data from the 2023 and 2025 CHAS surveys, CHI examined interactions with the health care system through the lens of insurance coverage, care utilization, employment, education, and food and housing security. One of our strongest findings shows a 12-point gap between immigrants and U.S.-born Coloradans who had at least one health care visit in the previous year. For immigrants who speak Spanish at home, the gap is twice as large.

The environment has shifted even since the survey was in the field. One multistate survey found that 84% of health care workers reported a significant or moderate decrease in immigrant patient visits following the January 2025 executive orders on immigration. Physicians have reported increased no-show rates among immigrant patients, and the presence of Immigration enforcement near health care settings has been driving care avoidance, including among people with legal status.

These fears carry real health consequences. When people avoid care, conditions go unmanaged, and outcomes worsen. This is an important issue for public health professionals because health care settings have long been understood as spaces where safety and care are guaranteed regardless of background. When patients fear that seeking care could lead to an immigration enforcement encounter, the result is a chilling effect that extends well beyond undocumented people and into mixed-status families and communities broadly.

Suicide continues to be a prominent public health concern in Colorado, even as the statewide age-adjusted suicide rate has stabilized in recent years. Because suicide is complex and isn’t caused by a single factor, suicide prevention requires multiple strategies and diverse, collaborative partnerships - which the National Strategy for Suicide Prevention calls community-based suicide prevention. Since 2019, the Colorado Office of Suicide Prevention has led and funded the Colorado-National Collaborative (CNC) to implement local community-based suicide prevention strategies in 15 Colorado counties with high counts and/or rates of suicide fatalities. Using a collective impact model, local CNC backbone organizations coordinate local partnerships and activities to reduce suicide by implementing and evaluating efforts to increase connectedness, education and awareness, access to economic supports, access to safer suicide care, lethal means safety, and postvention support. This presentation shares the following findings to date from the CNC implementation: 1) What are the key activities needed to implement a community-based suicide prevention program? and 2) How can a community-based comprehensive suicide prevention program be evaluated and monitored using a collective impact model? Using data from the CNC’s ongoing evaluation efforts, the presenters will also share findings on how the CNC’s six pillar strategies might be expanded into similar community-based comprehensive suicide prevention models in new communities.




(30-minute session submitted for consideration, but addendum below addresses activity for 1-hour session. ) Presenters will lead an interactive session that guides attendees through a planning exercise to bring community-based suicide prevention efforts to their community. In doing so, this session will introduce how a collective-impact design can be used by local backbone organizations to effectively collaborate with community partner organizations to develop local suicide prevention strategies. This exercise will also show how a collective impact model informs data collection for program evaluation when resources are limited.

Background/Purpose: Rural Colorado communities continue to experience persistent health inequities influenced by social determinants of health (SDOH), including healthcare workforce shortages, transportation barriers, housing instability, food insecurity, limited broadband access, behavioral health service gaps, and geographic isolation. These challenges disproportionately affect older adults, agricultural populations, low-income families, and frontier communities. This presentation examines the question: How can public health professionals and community partners create sustainable, equity-focused approaches that improve health outcomes in rural communities? The session explores how cross-sector and community-driven strategies can address barriers while strengthening resilience and well-being.

Methods: This presentation draws upon community assessments, rural behavioral health initiatives, public health literature, and applied examples from Colorado communities. Participants will review population-level data related to rural health disparities and examine case examples of collaborative interventions. Methods highlighted include community engagement approaches, collective impact strategies, systems-level partnerships, and implementation frameworks designed to improve access and equity.

Existing research and practice demonstrate that integrated and community-centered approaches can improve access to care, strengthen service coordination, reduce barriers to behavioral and physical healthcare, and enhance community capacity. Emerging evidence suggests that partnerships involving healthcare systems, Extension services, community organizations, and local stakeholders can create more sustainable solutions for addressing SDOH and reducing disparities.

Participants will leave with practical tools for identifying key social determinants affecting their communities and strategies for designing collaborative, equity-focused interventions. Take-home messages include the importance of leveraging community assets, strengthening cross-sector partnerships, and implementing systems-level solutions that support long-term health improvement.

Additional time is requested to allow participants to engage in facilitated discussion and small-group activities focused on identifying local barriers and developing actionable strategies that can be adapted to their own communities. Interactive discussion will promote shared learning and peer-to-peer problem solving aligned with the conference theme of strengthening communities through collective action.

This session will both inform and assist public health practitioners and professionals regarding the current status of suicide rates in Colorado and assess the effectiveness of current programs to decrease its incidence. In this interactive presentation, attendees will be invited to participate in the conversation about suicide and how it is more prevalent among certain professions and occupations. QPR Training will be embedded in the presentation, providing attendees information they can use on both a personal and professional level.

Learning Objective:
To assess differences in health care utilization, documented social needs, and spending among Black populations in Colorado using Colorado All Payer Claims Database (CO APCD) data.

Background/Purpose:
Black populations in Colorado continue to experience disparities in health outcomes and health care utilization. This study evaluated differences in emergency department (ED) use, inpatient admissions, readmissions, follow-up care, documented social needs, and spending across insurance types and Black population subgroups.

Methods:
Researchers conducted a retrospective claims-based analysis using CO APCD data from 2018–2025 across commercial, Medicaid, Medicare Advantage, and Traditional Medicare populations. Outcomes included ED visits, inpatient admissions, 30-day readmissions, 7-day follow-up visits, ICD-10 Z-code utilization, and total health care spending. Measures were standardized as rates per member per year (PMPY).

Results:
The largest differences were observed in ED utilization. In Traditional Medicare, Black, Hispanic or Latino members experienced 1.99 ED visits PMPY compared to 0.74 among All Other Public Health Fields Race populations. Similar patterns were observed across Medicaid, Medicare Advantage, and commercial coverage. Inpatient admissions were also higher among Black populations, reaching 0.21 PMPY in Traditional Medicare compared to 0.14 among All Other Public Health Fields Race populations. Thirty-day readmission rates reached 0.09 PMPY among Black, Hispanic or Latino members compared to 0.03 among All Other Public Health Fields Race populations. Documented social needs, measured using ICD-10 Z-codes, were consistently higher among Black populations across insurance types.

Implications:
Findings highlight consistent, system-wide differences in health care utilization across Black populations in Colorado and support collaborative, community-based outreach, care navigation, and prevention strategies to advance health equity statewide.

Background: Tetrahydrocannabinol (THC) concentrations in recreational cannabis have risen dramatically with some products routinely exceeding 72% THC. Evidence links use of today’s THC products among adolescents to increased risks for cannabis use disorder, psychosis, and neurodevelopmental harm. Traditional public health channels are less likely to reach young people. To close the gap, Tea on THC, a cannabis-focused public health education campaign, developed a unique strategy to provide authentic messages through trusted teen and young adult messengers on social media.

Methods: Tea on THC deployed a multi-channel social media strategy across TikTok, Snapchat, Meta, YouTube and Twitch. This approach combined authentic youth voices and vetted influencer partnerships. Research was translated into creative assets, with messaging optimized using real-time performance data. Evaluation tracked reach, engagement, sentiment, and awareness using real-time metrics.

Results: Preliminary findings indicated that a diversified strategy combining authentic youth voices, influencer partnerships, and campaign content extended prevention messaging to young people, particularly teens aged 13 – 17 years old. Sentiment analysis revealed favorable reception of creator-driven content. Final reach, engagement, and awareness data will be presented. Using TikTok in Year 2 has generated over 8.4 million impressions just in 2026, driving engagement amongst 13-18 year olds. In February 2026, Tea on THC expanded to new platforms to reach more youth: Snapchat, Twitch, and Reddit, already generating over 5 million impressions. These metrics represent a significant change over previous year.

Implications: Effective youth cannabis prevention requires more complex approaches, especially given the contemporary social media environment. . By combining authentic youth voices and digital creators together with evidence-based content across multiple social media platforms, the Tea on THC campaign expanded youth access to prevention information, . This model offers a novel, replicable framework for multi-channel youth health communication.

Background / Purpose
Rural populations carry a disproportionate tobacco burden, and recent surveillance data suggest the gap is widening. Declines in rural tobacco use have slowed markedly relative to urban populations; among rural women, the decline has stalled entirely. This presentation argues the moment is critical: as a policy penetration gaps limit rural progress, evidence indicates the tobacco industry is intensifying its focus on rural communities through retail channel expansion and targeted product development.

MethodsT
his presentation synthesizes peer-reviewed literature and national surveillance data (NSDUH, BRFSS, PATH) to examine: (1) rural–urban tobacco prevalence disparities and their trajectory; (2) the role of differential policy penetration in explaining diverging trends; (3) tobacco industry retail channel expansion into rural markets; and (4) nicotine pouch use patterns disaggregated by sex, geography, and smokeless tobacco history.

Results
Rural tobacco prevalence remains substantially higher than urban rates across most product categories. Among rural women, use declines have stalled entirely. Nicotine pouch use, while low in overall national prevalence, is concentrated among young rural men with smokeless tobacco histories — consistent with deliberate industry positioning. The tobacco industry's expansion into discount retail has structurally amplified rural tobacco access: a 2023 study in the American Journal of Preventive Medicine analyzing FDA inspection data from 2015–2020 found Family Dollar had the highest rate of tobacco sales to minors among major retailers studied, at 12.1% of inspections, a pattern reflecting lax enforcement in the outlet formats most prevalent in rural communities.

Implications
Rural tobacco control is at an inflection point. Stalling declines, industry retail targeting, and the emergence of smokeless-adjacent nicotine products in rural male markets demand a coordinated public health response. Attendees will leave with a framework for understanding who is most at risk and what evidence-based policy and cessation responses are available.