The Impact of Rurality on Substance Use and Adverse Mental Health Among High School Students in Vermont, USA: A Cross-Sectional Study

Introduction Rates of poor mental health among high school students in the United States are increasing. Both substance use and rurality are independently associated with poor mental health outcomes among adolescents. This study explores the impact that rurality may have on the relationship between substance use and poor mental health outcomes among Vermont high schoolers. Methods The 2021 Vermont Youth Risk Behavior Survey (YRBS) was used (N = 15,097). Multivariate logistic regression was used to assess the relationship between adverse mental health and substance use by rurality. Results Experiences of adverse mental health were associated with substance use behaviors among rural and non-rural populations. The associations between adverse mental health and substance use variables did not significantly vary by rurality. Conclusions Rural environments may not modify the relationship between adverse mental health and substance use. Future research is needed to understand the causal mechanisms between adverse mental health and substance use and how these may differ by rurality.