E-Cigarette Use among Rural Military Veterans

Abstract

E-cigarette use is more prevalent among veterans with mental distress; however, no studies have examined the impact of rurality on the relationship between mental distress and e-cigarette use among veterans. We obtained nationally-representative data on veterans from 2016 to 2018 Behavioral Risk Factor Surveillance System (BRFSS) surveys in order to explore the aforementioned relationship (n = 62,884). Results of generalized linear mixed models, stratified by rural-urban status, indicated that the relationship between mental distress and e-cigarette use was moderated by current traditional cigarette use, especially in highly rural areas. Our 33-state study showed that the rate of e-cigarette use among veterans with 14+ days of mental distress and current cigarette use living in highly urban areas was 8.93% (compared to 0.89% for those with no mental distress and no cigarette use, p < 0.001), while in rural areas, the prevalence of e-cigarette use among veterans with 14+ days of mental distress and current cigarette use was 12.75% (compared to 0.77% for those with no mental distress and no cigarette use, p < 0.001). Behavioral health programs for veterans in rural areas should target those with mental distress and e-cigarette use.