Cannabis use, social support and social engagement among working-age adults in rural America

•Previous work shows cannabis use is associated with negative health outcomes.•Low emotional support is linked to higher odds of cannabis use in rural adults.•Low social engagement is linked to higher odds of cannabis use in rural adults.•Emotional support and social engagement may serve as prevention mechanisms. Cannabis use has been linked to physical, psychological, and behavioral changes. Although research indicates separately that informal social support and formal social engagement – which are correlated measures – serve as protective factors in cannabis use, much of this research focuses on youth and more urban samples, limiting our understanding of if these findings are true for rural populations where social support and social engagement are particularly important for health and health behaviors. To fill the research gap, this study examines the effects of informal social support (tangible support and emotional support) and formal social engagement on cannabis use among rural working-age adults. This research analyzed 1,122 observations from a cross-sectional online survey conducted in 2022 of working-age adults (18–64) from rural America. Multilevel logistic regression models were used to predict cannabis use in the past 12 months using informal social support (tangible support and emotional support) and formal social engagement and other sociodemographic covariates and state legalization status. Multilevel logistic modeling indicates that low emotional support and low formal social engagement are associated with a higher odds of reporting cannabis use in the past 12 months among rural working-age adults, net of other sociodemographic variables and state legalization status. The study suggests that emotional support and social engagement may contribute to cannabis use prevention among rural working-age adults. These findings should inform future research as well as the development of tailored health interventions targeting rural working-age adults.