The Socio-Ecological Enablers of Smoking and Vaping in Rural Young Adults: A Mixed-Methods Study.

INTRODUCTION: Tobacco and vaping use among young people is a significant public health issue in Australia. Smoking rates are higher in rural areas of Australia compared to metropolitan cities. Research is needed to understand the factors that influence rural people to experiment and commence use of these products to inform evidence-based prevention and to reduce dependence and related morbidity and mortality. The study aim was to analyse the socio-ecological enablers of smoking tobacco and vaping use in young adults (18-30 years of age) in a rural Australian context with high rates of population tobacco use and to identify factors to improve prioritisation, design and implementation of place-based prevention interventions.

METHODS: The study setting was defined by three adjoining rural shires (all modified Monash 5 small rural towns) in [deidentified for peer review] Victoria, Australia. A mixed-methods approach was applied using an online quantitative descriptive survey (n = 51) and semi-structured qualitative interviews (n = 7) with young adults, and semi-structured interviews with health professionals (n = 10) working in the region. Quantitative and qualitative descriptive analyses were completed to describe the influences on smoking and vaping uptake and continued use, and recommendations for prevention-focused population health intervention.

RESULTS: Friends were the highest influence on smoking tobacco and vaping uptake and continued use for the survey participants. The next highest known influences on smoking tobacco and vaping uptake were classmates and sporting teammates, and the interrelationships with stress and mental health were also emphasised. The interview themes are presented in the socio-ecological frames and highlight how cultural change and policy and legislation interventions might prevent uptake.

CONCLUSIONS: The findings inform place-based prevention strategies for governments and community health organisations in similar rural contexts; further population survey research is needed in this area for more accurate data to inform rural population health planning. SO WHAT?: Rural young adults smoking and vaping was most strongly influenced by friends. Prevention is needed that focuses on peer-to-peer health promotion in schools, sports clubs and workplaces, and which considers interrelationships with mental health.