New study approach gives Appalachian communities a stronger voice in tobacco regulations
LEXINGTON, Ky. (Aug. 25, 2026) — A new research model developed by the University of Kentucky’s Appalachian Tobacco Regulatory Science Team (AppalTRUST) shows strong early success in engaging rural Appalachian adults in tobacco research. Published in Frontiers in Public Health, the study has created a pathway for more representative data that can inform tobacco regulations from the United States Food and Drug Administration.
Working with partner institutions like the Pacific Institute for Research and Evaluation Louisville Center (PIRE Louisville), UK researchers have developed a new approach that leverages trusted local relationships with user-friendly technology to recruit and retain Appalachian participants in research. Early results suggest the model can overcome long-standing barriers such as mistrust, geographic isolation and limited internet access.
Appalachian communities have tobacco use rates well above the national average but are often underrepresented in public health research. That means national policies may be developed and implemented without fully understanding how they affect these communities.
"When certain populations are missing from research, federal agencies are left with an incomplete picture,” said Mary Kay Rayens, Ph.D., professor in the UK College of Nursing and a lead researcher with AppalTRUST. “Communities deserve to see themselves reflected in the research that informs policies and regulations at both the state and national levels.”
Using a Community-Engaged Research + Technology (CEnRT) approach, the project set out to build a cohort of 2,000 Appalachian Kentucky adults. To date, it has enrolled nearly 1,400 participants across the region.
By working with local field teams, the researchers have helped build trust with participants. These field team members live in the region, are part of the local culture and already have strong relationships in the community. The study encourages participants to use their preferred communication methods, including texts, phone calls, email and direct response, to meet participants where they are.
Lead author Melissa Abadi, Ph.D., is a senior research scientist and center director for PIRE Louisville and adjunct faculty in the UK College of Nursing.
"People are much more likely to engage in research when they know who they're talking to and why the work matters, and respect for local culture is a core tenet of AppalTRUST,” said Abadi. “Our approach puts relationships at the center of the process and recognizes the expertise that community members bring to the table."
The team believes the CEnRT approach is one that can be applied beyond just research on tobacco to engage more underserved populations in public health studies.
"This work is about more than collecting data,” said Ellen Hahn, Ph.D., UK College of Nursing professor emerita, AppalTRUST co-investigator and faculty associate with the UK Markey Cancer Center. “It's about building relationships, earning trust and making sure rural Appalachian residents have a voice in future policy decisions.”
The study approach was led by Abadi in partnership with Hahn, Rayens and UK College of Nursing’s Kathy Rademacher.
AppalTRUST is funded through a 5-year, $19 million grant from the National Institute on Drug Abuse (NIDA) under the National Institutes of Health (NIH), the Office of the Director of the NIH and the U.S. FDA Center for Tobacco Products (CTP). As part of an interagency partnership, the NIH and FDA award Tobacco Centers of Regulatory Science (TCORS) grants that support studies across topics like toxicity, addiction, health effects and marketing. AppalTRUST is led by UK College of Medicine faculty and UK Markey Cancer Center researchers Shyanika Rose, Ph.D., and Mikhail Koffarnus, Ph.D.
