Editorial: Long- and post-COVID syndromes: immune mechanisms and therapeutic strategies.

Rural populations, including those in Appalachia, use tobacco and nicotine products at almost double the national rate (). As of 2018–2019, KY had a tobacco product use prevalence among adults that was nearly 10 points above the national average (24.8 vs. 15.4%) (). And, more recently, the estimated use rate of any tobacco product was higher in rural (32.4%) vs. urban (26.4%) locations in the state. () Persons living in rural Appalachia may experience multi-generational tobacco use and pro-tobacco norms due, in part, to higher exposure to tobacco industry advertising, point-of sale marketing of emerging products, and price promotion strategies, () as well as weak tobacco control () and related policies (e.g., fewer smoke-free laws in public places, and lower taxes) (). These disparities in rural Appalachia contribute to high rates of tobacco-related disease, which are significantly higher compared to other areas of Appalachia (). Despite high tobacco use rates and related disparities, Appalachian populations have been largely overlooked in rigorous public health and tobacco research due to the challenges of engaging and surveying them through traditional recruitment and retention methods (). Such challenges include (a) lack of access to households and community members due to remote and hard to reach residences (–); (b) lack of or limited broadband internet and digital communications (, –); (c) low reading () and technology literacy (); and (d) mistrust of research and outsiders (–). Although these challenges are difficult and costly to address, failing to do so leaves rural populations underrepresented or misrepresented in public health research, which may lead to policies, programs, strategies, and services that are not well aligned with their communities. Federal tobacco regulatory policies enacted by the US Food and Drug Administration (FDA) are critical to curbing the tobacco epidemic in rural Appalachian communities. Rural communities have often been left behind in local tobacco control policies, with lower tobacco taxes and lower likelihood of living in an area with comprehensive smoke-free policy coverage. Therefore, national regulatory policies have great potential to reduce rural disparities. However, to best do so, it is critical to determine which tobacco regulations are beneficial or harmful for rural Appalachian populations and what impact they might have. The US FDA implements policies to regulate tobacco manufacturing, marketing, and distribution of all tobacco products. Regulatory policies include determining which new products are allowed to come onto the market, product standards (e.g., menthol bans or lowering nicotine content in cigarettes), and what types of marketing claims products can make, and they support relevant and foundational research through a variety of mechanisms including through tobacco centers of regulatory science (TCORS). This paper describes the sampling design and research methods our TCORS, AppalTRUST (Appalachian Tobacco Regulatory Science Team), used to build an Appalachian Cohort, engage rural residents in tobacco regulatory research, inform FDA regulations, and reduce rural tobacco use disparities.