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This online survey explored comfort levels of 399 rural SMM in the Southern United States when responding to five sensitive health topics (sexual behavior, alcohol use, drug use, sexualized drug use, and mental health), as well as examined demographic and behavioral differences in these comfort levels. Multiple linear regression models were analyzed. More than 70% of participants reported being very or somewhat comfortable answering all five health topics. More politically liberal SMM reported higher levels of comfort with sexual behavior and drug use questions. SMM who had condomless anal sex reported more comfortability answering sexual behavior questions, whereas SMM who used alcohol reported lower comfortability levels answering alcohol use questions. Findings have implications for the conduct and approval of health behavior survey research.<\/jats:p>","DOI":"10.1177\/10901981251336231","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T06:37:17Z","timestamp":1746686237000},"page":"644-652","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Reactions to Sexual, Substance Use, and Mental Health Surveys Among Rural Sexual Minority Men"],"prefix":"10.1177","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3330-1323","authenticated-orcid":false,"given":"Benjamin N.","family":"Montemayor","sequence":"first","affiliation":[{"name":"Texas A&amp;M University, College Station, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2729-151X","authenticated-orcid":false,"given":"Christopher","family":"Owens","sequence":"additional","affiliation":[{"name":"Texas A&amp;M University, College Station, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,5,8]]},"reference":[{"key":"e_1_3_2_2_1","unstructured":"Centers for Disease Control and Prevention. 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