Interplay of Mental Health, Risk Behaviors, and Socioeconomic Factors in Lifetime Drug Use Among Korean Adolescents: A Nationally Representative Study Using KYRBS 2022-2024

Drug use among Korean adolescents is rapidly increasing and emerging as a critical social and public health issue. This study aimed to examine the prevalence of life time drug use among a nationally representative sample of Korean adolescents and to investigate the influence of mental health and risk behaviors on adolescent life time drug. This cross-sectional study analyzed data from the 2022-2024 Korea Youth Risk Behavior Survey (N = 159 383). Lifetime drug use was defined as any nonmedical use of sedatives, stimulants, analgesics, or narcotics. Sociodemographic, mental health, and risk behavior factors were examined using chi-square tests and multivariate logistic regression across 3 sequential models. Higher risks were observed among women, high school students, those living alone, and adolescents with significant anxiety (GAD ≥ 10), sadness or despair, or suicide attempts. Heavy drinking (aOR = 2.42, 95% CI = 2.03-2.91), lifetime smoking (aOR = 1.28, 95% CI = 1.03-1.58), heated tobacco use (aOR = 1.36, 95% CI = 1.10-1.68), sexual experience (aOR = 1.98, 95% CI = 1.67-2.34), and violence exposure (aOR = 2.99, 95% CI = 2.45-3.65) were also strongly associated with drug use. These findings indicate that adolescent life time drug use is influenced by overlapping sociodemographic vulnerabilities, psychological distress, and co-occurring risky behaviors. Adolescents experiencing anxiety, emotional distress, social disadvantage, or engagement in other high-risk behaviors are particularly susceptible to life time drug use. The results underscore the need for a multifaceted prevention framework that integrates mental health promotion, early screening for psychosocial risks, and concurrent prevention of high-risk behaviors.