Health equity and e-cigarette use among young adults in rural areas: A social determinants of health framework

Young adults (YAs) aged 18 to 24 in rural areas are increasingly using Electronic Nicotine Delivery Systems (ENDS), commonly known as e-cigarettes, in the United States. Rural communities already face significant health disparities due to higher tobacco use, contributing to worse health outcomes, including increased mortality from heart disease, cancer, and respiratory diseases. Using the adapted World Health Organization's Social Determinants of Health framework, this paper examines how structural and intermediary determinants shape ENDS use among rural YAs. Special attention is given to how policy and societal contexts, sociocultural norms, and rurality influence rural ENDS use. The paper also highlights intermediary factors like the availability of cessation resources and the role of psychosocial stressors in ENDS use behaviors. Nurses can play a vital role in addressing ENDS-related health inequities by providing culturally congruent and environmentally relevant care and advocating for intersectoral policies that promote health equity. This framework informs targeted public health interventions and nursing efforts to reduce the health disparities associated with ENDS use in rural communities. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.