Well-being, social support, and substance use beliefs in rural youth

Youth mental health and substance misuse are interlinked public health concerns, with rural youth facing heightened risks due to geographic, social, and service-related disadvantages. This study explores how emotional well-being and perceived social support shape beliefs about substance use harm among adolescents in rural communities. Using the Broaden and Build Theory within an ecological framework, we analyzed cross-sectional survey data from 494 adolescents (ages 13–20) in rural southeastern U.S. Mediation analyses assessed the indirect effects of social support (from family, peers, and significant others) on the link between emotional well-being and substance use beliefs. Support from family and significant others partially mediated the relationship between emotional well-being and perceived harm of substance use, while peer support showed no significant effect. These findings suggest key protective pathways relevant to youth mental health and behavioral risk. This study highlights that emotional connections with family and trusted adults may be essential protective factors in shaping healthy beliefs about substance use among rural youth. Findings inform rural youth-focused interventions that emphasize family resilience, adult mentorship, and well-being promotion to mitigate substance misuse.