Health-Related Determinants of Adolescent Drug Use in South Korea: A Cross-Sectional Study Based on the Korea Youth Risk Behavior Web-Based Survey

Background: Adolescent drug use is increasing globally, with nonmedical substance use becoming prevalent among South Korean youth. This study investigated the sociodemographic, health-related, and behavioral determinants of drug use in this group using nationally representative data collected during the coronavirus disease 2019 pandemic. Methods: This study analyzed data from the 2020–2021 Korea Youth Risk Behavior Survey, which included 109,796 adolescents. A complex sample design analysis was conducted with logistic regression and classification and regression tree analysis to determine various factors influencing drug use. Results: Adolescent drug use in Korea, while low in absolute prevalence, showed an increasing trend compared to pre-pandemic years. Key correlates consistently identified across analyses included psychosocial distress (such as suicidal ideation), engagement in other risk behaviors (e.g., alcohol, smoking, and sexual activity), and nonfamily living arrangements. Classification and regression tree analysis further identified suicidal thoughts as the primary node for drug use. For adolescents without suicidal thoughts, sexual intercourse was a determinant, while age was a determinant for adolescents with suicidal thoughts. Conclusions: This study highlights the significant association of individual, familial, and societal factors with Korean adolescent drug use. Effective interventions require understanding these dynamic interactions. Future strategies should integrate insights from multiple systems to address the complexity of youth substance use.