Frequent Social Media Use Associated With Tobacco, Alcohol, and Drug Use Among US High School Students

OBJECTIVES: The purpose of this study was to examine the associations between frequent social media use and tobacco, alcohol, and drug use among US high school students in grades 9 through 12. METHODS: Data from the 2023 national Youth Risk Behavior Survey (N = 20 103) were analyzed to assess the associations between frequent social media use and current tobacco or nicotine use, current alcohol use, current binge drinking, ever marijuana use, ever prescription opioid misuse, and ever select illicit drug use. Frequent social media use was defined as using social media several times a day, about once an hour, or more than once an hour. Quasi-Poisson regression models estimated adjusted prevalence ratios (APRs) comparing substance use behaviors among students with frequent social media use versus infrequent or no social media use, overall and by sex. Models were adjusted for race and ethnicity and grade. RESULTS: Compared with students reporting infrequent or no social media use, students with frequent social media use were more likely to report current tobacco or nicotine use (APR = 1.88; 95% CI, 1.25-2.83), current alcohol use (APR = 2.07; 95% CI, 1.54-2.78), current binge drinking (APR = 2.55; 95% CI, 1.45-4.48), and ever marijuana use (APR = 2.09; 95% CI, 1.68-2.60). Associations were observed among female and male students. CONCLUSIONS: Frequent social media use was associated with several substance use behaviors among US high school students. Future research should examine mechanisms, including type of social media platform used, exposure to substance use-related content, and peer influences, to inform prevention strategies.