Social media use and health outcomes as moderated by rurality among sexual minority young adults

Background and Objectives Social media use may influence substance use and mental health symptoms differently for urban versus rural sexual minority young adults (SMYAs). Methods SMYAs aged 18–25 in Oklahoma and surrounding states were recruited via social media for a two‐wave online survey study in 2023–2024. Among participants reporting any social media use, multivariable logistic regressions examined associations of social media use variables and rural‐urban residence with health outcomes. Multiple group regressions examined whether associations varied for rural‐ versus urban‐residing participants. Results The sample ( N = 493; M age = 21.68 [SD = 2.15]) was 35.7% rural‐residing, 72.1% female sex, 47.1% gender‐minoritized, and 41.6% racially and/or ethnically minoritized. Most participants (61.9%) had moderate‐to‐severe depressive and/or anxiety symptoms; 39.8% reported current tobacco use (49.7% cannabis, 74.6% alcohol). Rural‐urban residence moderated associations between social media use and substance use. Among urban participants only, social media use frequency was associated with tobacco and alcohol use. Among rural participants, community connectedness was associated with lower odds of mental health symptoms, tobacco use, and cannabis use and social media‐based social support was associated with lower odds of cannabis use. Discussion and Conclusions Urban SMYAs may experience negative effects of social media use, including increased risk of substance use. Rural SMYAs may benefit from supportive connection from SMYA peers on social media, reducing their substance use risk. Scientific Significance Prior research has identified benefits (e.g., social support) and harms (e.g., substance use) of social media use. This study found that associations of social media use with substance use among SMYAs differed by urbanicity.