Examining Community Engagement Strategies Used in the Climate Impact on Lung Cancer via Exposure to Radon (CLOVER) Study

Background: Residential radon exposure is a leading risk factor for lung cancer, and climate change may exacerbate this risk by increasing radon entry into homes. In North Carolina (NC), disparities in lung cancer outcomes and low radon awareness disproportionately affect racially and ethnically diverse and low-income populations. However, little is known about how use of conventional address-based sampling (ABS) compares with community-engaged recruitment strategies for enrolling historically underrepresented populations into such research. Community-engaged approaches are used to improve participation in environmental health research, yet few studies compare their effectiveness with traditional approaches in NC. This manuscript compares recruitment outcomes between ABS and community-engaged approaches within the CLOVER study to address this gap. Materials and Methods: The Climate Impact on Lung Cancer via Exposure to Radon (CLOVER) study is a cross-sectional study examining climate-impacted radon exposure and lung cancer risk in NC. Participants were recruited using either ABS through a commercial address database or targeted community-engaged approaches implemented through partnerships with community organizations and culturally responsive, in-person outreach events. After providing informed consent, participants completed a household survey and a 7-day home radon test. Recruitment outcomes—consent, survey completion, and radon test return—were stratified by race and ethnicity and compared across strategies. Results: Of 236 consented participants, community-engaged recruitment enrolled a higher proportion of Non-Hispanic (NH) Black, Hispanic/Latino, and American Indian participants than ABS (57.3% vs. 41.9%). Community-engaged recruitment also had a higher consent rate than ABS (10.2% vs. 1.3%). Of the 145 participants who completed the survey, ABS participants completed surveys at a higher rate than community-engaged participants (73.3% vs. 54.7%), while of the 86 who returned the radon test kits, community-engaged participants did so at twice the rate of ABS participants (44.7% vs. 22.1%). Conclusions: Community-engaged recruitment enrolled a more racially and ethnically diverse sample and achieved higher consent and return rates than ABS, though ABS participants completed surveys at a higher rate. These findings highlight the importance of community partnerships and in-person recruitment strategies to improve participation of historically underrepresented populations in environmental health research and support equitable approaches to radon mitigation and lung cancer prevention.