Changes of polysubstance use patterns and association with health risk behaviors among adolescents from 2007 to 2019

This study aimed to determine the changes in polysubstance use patterns among adolescents and their dynamic association with other health risk behaviors from 2007 to 2019.

The Youth Risk Behavior Survey data (2007-2019, N = 100,920) were collected biennially through national cross-sectional surveys of US school attending adolescents. Latent class analysis was used to identify polysubstance use patterns. Joinpoint regression was used to estimate biennial percentage changes (BPCs) of 11 substance use behaviors and 19 health risk behaviors over time. Survey-weighted logistic regression analysis with year-by-group interactions assessed dynamics association between polysubstance use patterns and health risk behaviors over time.

Three stable polysubstance use patterns-Low, Moderate, and High Polysubstance Groups-were identified from 2007 to 2019. There was an increasing trend in the Low Polysubstance Group (BPC = 1.60%[95%CI:0.35%,2.87%]), a decreasing trend in the Moderate Polysubstance Group (BPC = -3.21%[95%CI: -5.85%, -0.51%]) and a steady trend in the High Polysubstance Group from 2007 to 2019. There was a significant increase in suicide-related behaviors and self-reported depression specifically among the Low and Moderate Polysubstance Groups, and the disparities in suicide-related behaviors between Moderate/High Polysubstance Groups and Low Polysubstance Groups were smaller over time. The disparities in sexual-risk behaviors and violence-related behaviors between Moderate and Low Polysubstance Groups were widened over time.

Limitations include the cross-sectional design, self-reported data, limited applicability to out-of-school adolescents, and lack of substance use severity consideration.

As polysubstance use patterns and their link to other health risk behaviors evolve, policies and services must adapt with multifaceted strategies to address adolescent health risk behaviors.