Adolescent cyberbullying and polysubstance use: unpacking sex differences

The rise of social media platforms has heightened cyberbullying among adolescents, closely tied to negative mental health outcomes. Substance use, including alcohol, cannabis, and tobacco, also remains a significant concern for this population. This study examines the relationship between cyberbullying and substance use, exploring potential sex differences in these associations. We analyzed data from the 2021 Adolescent Behaviors and Experiences Survey (ABES) (n = 6,740 students in grades 9-12). We used multinomial logistic regression models to assess the relationship between past-year cyberbullying and current patterns of substance use (exclusive, dual, and poly), adjusting for sociodemographic factors, screen time, and mental health status. Stratified analyses examined effect modification by sex. Overall, 13.6% of the sample reported experiencing cyberbullying in the past year. Of these adolescents, substance use was reported by 16.4% (exclusive), 12.1% (dual), and 17.2% (poly). Experiencing cyberbullying was associated with increased odds of exclusive (OR: 1.45, 95% CI: 1.12-1.89), dual (OR: 1.87, 95% CI: 1.40-2.50), and poly (OR: 3.19, 95% CI: 2.16-4.71) substance use. Sex-stratified models indicated that among females, cyberbullying was associated with increased odds of dual (OR: 1.95, 95% CI: 1.31-2.92) and polysubstance (OR: 4.24, 95% CI: 1.14-2.98) use, which were slightly larger than the odds among males for dual use (OR: 1.85, 95% CI: 1.03-3.34) and significantly larger for polysubstance use (OR: 1.84, 95% CI: 1.14-2.98). This study highlights the importance of addressing both cyberbullying and substance use among adolescents. Sex-sensitive interventions that promote healthier coping mechanisms for emotional distress are essential to reduce the risk of substance use among cyberbullying victims. Further research is needed to explore causal pathways and inform effective prevention strategies. Implications and Contributions Statement: This study demonstrates the association between cyberbullying and exclusive, dual, and polysubstance use among adolescents, particularly in females. These findings emphasize the need for sex-focused interventions targeting both cyberbullying and substance use to mitigate compounded risks to adolescent physical and mental health within digital and social contexts.