Youth mental health and nicotine vape use: The moderating role of rural-urban/suburban school environments.

OBJECTIVE

To understand and compare the association between nicotine vape use and mental health among youth in rural and urban/suburban areas.

METHODS

This cross-sectional study included 146,489 high school students from the 2019-2020 California Student Tobacco Survey. Descriptive statistics were estimated with frequencies and percentages. Separate bivariate associations between each covariate/predictor variable and mental health were examined using linear regression. Multivariate linear regression models were used to examine the association between nicotine vape use and mental health for youth attending school in rural versus suburban/urban communities.

RESULTS

Findings showed that vaping nicotine was associated with poorer overall mental health (b = -0.307, SE = 0.019, p < 0.001), and that this association differed based on rural versus urban/suburban school environments (b = -0.135, SE = 0.046, p = 0.004). Specifically, the relationship between vaping and poor mental health was stronger for youth attending school in rural areas (b = -0.443, SE = 0.042, p < 0.001) than in urban/suburban localities (b = -0.307, SE = 0.019, p < 0.001).

CONCLUSIONS

Although differences in mental health were not shown based on rural versus urban/suburban school environments alone, findings showed that the relationship between nicotine vape use and mental health was stronger for youth attending high school in rural areas. Additional research is needed to understand the underlying social and environmental mechanisms that exacerbate this relationship. Future interventions might consider how to support and improve the mental health of rural nicotine vapers to better achieve health equity across different school environments.