Tobacco use rates are elevated in rural and medically underserved areas (CDC 2019, RHIHub 2017),  where substance use disorders are often under-diagnosed and under-treated. One study found that only ~11% of patients with substance use disorders obtained care for their addiction/s (SAMHSA 2017). These areas, as opposed to their metropolitan counterparts, do not have equitable access to cessation services (Bowman 2017, Levesque 2017); as such, an effective way to reach communities living in these priority areas is by working with existing system (such as Federally  Qualified Health Centers [FQHCs] and substance use treatment centers) that already provide healthcare to these communities (Rosen 2010, Fiore 2008, CDC 2014). Through our PP210003 grant awarded by the Cancer Prevention Institute of Texas, TTTF is committed to expanding our tobacco control work to improve the use of evidence-based practices for tobacco cessation and bridging the research to practice gap in addressing tobacco use among healthcare patients who use tobacco and concurrently abuse and depend upon alcohol and other illicit drugs in rural  and medically underserved areas.