Cross-sectional analysis reveals sex-divergent substance use patterns emerging at age 18 in adolescents, highlighting critical windows for targeted prevention.
Key Points
To assess the emergence and divergence of sex-specific substance use patterns across a broad range of substances during adolescence using a nationally representative sample.
Analyzed data from the 2019 Youth Risk Behavior Survey (n = 13,677), representative of U.S. high school students.
Evaluated 14 substance use outcomes across age categories using weighted logistic analyses of covariance adjusted for race and ethnicity.
Across all ages, males reported higher rates of illicit drug use and cigarette smoking, whereas females reported higher rates of prescription opioid misuse, synthetic cannabis use, recent alcohol use, and binge drinking.
Substance use patterns diverged primarily at age 18+ years, where males showed significantly higher odds of using most illicit substances compared to females (aORs 1.7–4.47).
At age 18+ years, sex differences were absent for electronic vapor product use, alcohol use, binge drinking, cannabis, synthetic cannabis, cigarette smoking, and prescription opioid misuse.