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The Role of Tobacco Cessation and Prevention to Combat COVID-19 Morbidity and Mortality in Rural Areas
1. Project Title: 
The Role of Tobacco Cessation and Prevention to Combat COVID-19 Morbidity and Mortality in Rural Areas
2. Problem Statement
a) Background
The coronavirus disease 2019 (COVID-19) outbreak has reached pandemic proportions with a large global footprint. In December 2019, COVID-19 was first reported in Wuhan, Hubei Province, China. On 28 January 2020, the National Health Commission of People’s Republic of China released national strategies for assisting prevention efforts for rural areas and the older adult population.  Nevertheless, this outbreak was not contained, and as of 04 April 2020, it has spread to 181 countries resulting in about 1,160,000 cases and 62,400 deaths worldwide.
To date, a total of 290,600 cases and 7,830 deaths have been reported in the United States (U.S.), with numbers climbing disproportionately on a day-to-day basis. New epidemiologic and clinical evidence is constantly evolving related to this infection while the pandemic is hastily progressing worldwide. Rapid efforts are needed to protect vulnerable populations including those living in rural areas. For example, before this pandemic, U.S. urban hospitals were over twice as likely to have growth in number of adult intensive care unit (ICU) beds available over a one-year period when compared to rural hospitals. Thus, rural hospitals are not as likely to have the higher level of resources and medical care needed for this crisis. Preventive and resource allocation strategies (e.g., ventilator availability) are needed to reach and care for 
b) What is its objective or goal?
This proposal will fill the current research-to-practice gap, by examining the role of tobacco cessation in combating COVID-19 morbidity and mortality in rural areas.  
3. Project Questions
a) Hypothesis, focusing areas or problems
We hypothesized that smoking behavior may be associated with adverse progression of COVID-19. This is characterized by more severe symptoms and the need for higher level care (e.g., intensive care), which is already inadequate in rural areas.
b) What do you expect to learn?
We assume that tobacco users living in U.S. rural areas may represent an additional subgroup at risk for higher COVID-19-related morbidity. Irrespective of COVID-19, individuals living in rural areas have high rates of tobacco use and related morbidity compared to individuals living in urban or metropolitan areas due to several factors including: low income, low educational attainment, higher social acceptability to tobacco use, permissive tobacco control policies, and lack of healthcare access.
4. Approach for the Project
a) Methodology
A secondary data analysis will be completed to ascertain the Role of Tobacco Cessation and Prevention in combating COVID-19 Morbidity and Mortality in Rural Areas. Data bases like PubMed, Medline, Scopus, EMBASE, PsycINFO, Google scholar, and Cochrane library are going to be used to complete data review. 
b) Required resources/data
Data will be assessed and analyzed from the quality secondary sources of data and the convenient sample collected. 
5. Expected Outcomes
a) Answers to the Project Questions
Irrespective of COVID-19, individuals living in rural areas have high rates of tobacco use and related morbidity compared to individuals living in urban or metropolitan areas due to several factors including: low income, low educational attainment, higher social acceptability to tobacco use, permissive tobacco control policies, and lack of healthcare access.
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