Rural–urban residence in relation to cannabis use influences and behaviors among a sample of US young adults reporting past‐month cannabis use

BACKGROUND AND OBJECTIVES: Despite growing cannabis use rates among US rural-residing young adults, less research has examined associations of rural-urban residence with cannabis use influences (e.g., harm perceptions, peer use) or behaviors (e.g., use frequency, driving under the influence of cannabis [DUIC]). METHODS: = 26.86 [standard deviation = 4.61], 14.7% rural-residing, 38.2% racial/ethnic minority, 59.2% female), multivariable regressions controlling for sociodemographics and state non-medical cannabis legalization examined associations of (1) rural-urban residence with cannabis use influences (motives, perceptions, mental/physical health, parent/peer use, advertising exposure); and (2) rural-urban residence and use influences with use behaviors (past-month days of use, past 6-month DUIC, consequences). RESULTS: Rural (vs. urban) residence was associated with three use influences (i.e., greater coping motives, lower perceived harm of cannabis use, higher odds of a mental health diagnosis), more frequent cannabis use and DUIC, but fewer use consequences. All three influences were associated with more frequent use and having a mental health diagnosis was associated with more frequent DUIC. Greater coping motives and lower harm perceptions were associated with fewer consequences, and having a mental health diagnosis was associated with greater consequences. DISCUSSION AND CONCLUSIONS: Rural (vs. urban) young adults reported more frequent cannabis use and DUIC, which may be associated with low cannabis-related harm perceptions and using cannabis to cope with stress/mental health symptoms. SCIENTIFIC SIGNIFICANCE: Interventions targeting rural young adults that address mental health symptoms and risk perceptions, including DUIC-related risks, may be needed.