Commercial tobacco retail marketing in rural communities in Appalachian Kentucky, 2024

Objective To investigate heterogeneous commercial tobacco marketing patterns across rurality gradient. Methods We conducted audits in all retail stores ( n = 279) selling at least one commercial tobacco/nicotine product in eight U.S. Appalachian Kentucky counties in 2024, comprising rural and peri-urban catchments. Trained auditors assessed product availability, discounts, and advertising. Stores were linked to census tract demographics and Index of Relative Rurality (IRR) quartiles. Poisson models assessed prevalence rates of exterior and interior ads and discounts for cigarettes, nicotine vapes, and nicotine pouches (ONP) by IRR quartiles. Results Most stores carried cigarettes, cigarillos, and smokeless products, and over 50 % sold ONP, little cigars, and vapes. Lower proportions of stores in rural catchment carried ONP, little cigars, snus, and vapes. Stores in the least rural areas (Q1) had greater likelihood of exterior ads for vapes/ONPs. Stores across rural areas (Q1-Q3 vs Q4) had greater likelihood of interior vape ads. Stores in moderately-rural areas had greater likelihood of cigarette discounts inside (Q2 and Q3) and outside (Q3) stores (vs Q4). Conclusions Conventional combustible and smokeless products were widely available throughout Appalachian Kentucky. Newer non-combustible products were less available in the most rural areas. Exterior store marketing was less present in the most rural areas.