Physical Health and Adolescent Substance Use: An Analysis of Repeated Cross-National Associations

Drawing on General Strain Theory (GST), this study examined associations between health-related strains, health-promoting behaviors, and adolescent substance use across five waves of Health Behaviour in School-aged Children (HBSC) data from 18 countries. After adjustment for measured individual and contextual factors, poorer self-rated health and more frequent injuries were generally associated with higher probabilities of alcohol and cannabis use, whereas healthy eating was generally associated with lower probabilities. Physical exercise showed the least consistent pattern. Physical fighting exhibited the strongest and most consistent positive association with both outcomes. Average marginal effects indicated that associations were generally larger for alcohol than for cannabis use, while their magnitude varied across countries and waves. These findings suggest that health-related strains and behaviors are associated with adolescent substance use, but their strength and generalizability are context dependent.