Reengaging Rural Research Participants After Two Decades: The NC Life Study's Recruitment Challenges in an Era of Funding Uncertainty

The North Carolina Life (NC Life, R01DA056264, MPI: O'Shea and Taggart) study is a 20-year follow-up to a groundbreaking adolescent study (R01DA013459, PI: Ennett), which examined the health behaviors of over 8,000 racially diverse adolescents in rural North Carolina communities during the early 2000s. This extension study aimed to leverage the initial R01 NIH investment by investigating health trajectories from adolescence through emerging adulthood, with a particular focus on how exposure to neighborhood-, health system-, social network-, and school-level structural racism influences these pathways. In April 2025, with one year of funding remaining, NC Life's NIH support was terminated because it "no longer effectuates agency priorities." This termination occurred after a considerable amount of time, effort, and funding had been invested into the complex process of re-contacting and enrolling thousands of rural participants, many of whom had relocated, changed contact information, or had no memory of their original study participation some twenty years prior. This paper presents an analysis of our recruitment methodology and outcomes including a variety of dynamic active and passive recruitment strategies to reengage research-hesitant rural communities. We conclude by detailing the cost of what has been lost by funding termination, reinstatement, and overall uncertainty. Our findings offer critical insights for the growing number of studies that may face similar reengagement challenges following termination or other extended study interruptions. The premature termination of NC Life represents a lost opportunity to advance understanding of how structural racism shapes health outcomes across the life course in understudied rural populations.