Integration of community-engaged research technology and methods to guide tobacco regulatory science in rural communities

Melissa H. Abadi, Stephen R. Shamblen, Mary Kay Rayens, Kirsten Thompson, Amy Wildman, Kathy Rademacher, William Wieczorek, Raphael Nishimura, Shyanika W. Rose, Mikhail N. Koffarnus, Seth Himelhoch, Ellen J. Hahn

Objective This study aims to build a rural Appalachian cohort to examine how US Food and Drug Administration (FDA) Center for Tobacco Products (CTP) regulatory policies influence tobacco and nicotine product use across levels of rurality. Methods The AppalTRUST (Appalachian Tobacco Regulatory Science Team) Cohort integrates four inter-connected Community-engaged Research + Technology (CEnRT) elements to support recruitment and retention: (1) building trust and cultural relevance; (2) addressing barriers to participation in research; (3) focusing on ethics and confidentiality; and (4) fostering ongoing and consistent collaboration between the scientific and field teams. The study uses a dual sampling design to recruit 1,000 quota-based non-probability sample participants and 1,000 address-based probability sample participants. Eligible adults (ages 18+) are recruited from two Appalachian Kentucky catchments spanning rural and peri-urban counties. A local field team combines culturally relevant engagement strategies with technology-enabled procedures, including virtual consent and participant tracking, to foster trust and relevance with an underserved population. Anticipated results Recruitment is ongoing. Feasibility indicators include enrollment of 985 non-probability sample participants and 209 probability sample participants, a 16% direct-mail response rate, and a 62% participant preference for text-based consent and survey reminders. Expected outcomes include guidance for applying CEnRT approaches in underserved populations, characterization of tobacco and nicotine use trends across the rural–peri-urban continuum, and description of marketing exposure and consumer choice among subgroups of young adults and daily users in Appalachia. Findings will inform FDA CTP regulatory decision-making in rural Appalachian communities. Discussion This integrated CEnRT approach shows promise for recruiting and retaining rural Appalachian adults by centering community voice, trust, confidentiality, and practical engagement strategies.