Demographic and psychosocial correlates of adolescent substance use: Analysis of the Canadian Student Tobacco, Alcohol and Drug Survey 2021-2022

Objectives Substance use in adolescence may have correlates that can inform prevention measures. We aimed to describe patterns of substance use among Canadian adolescents and explore related demographic and psychosocial factors. Methods Data came from the Canadian Student Tobacco, Alcohol and Drug Survey 2021–2022. We examined past 30-day use of alcohol, cigarettes, e-cigarettes, and cannabis and age of first use by grade level, province, rurality, ethnicity, gender identity, self-reported mental health, and having been bullied using weighted logistic and linear regression. Results The analytic sample included 59,230 students. Alcohol was the most commonly used in the past 30 days (26.2%), and e-cigarettes the most frequently used (11.6% weekly). The age of first exposure was 13–14 years. Girls reported higher 30-day prevalence than boys for alcohol, cannabis, and e-cigarettes. Higher prevalence was associated with higher grade level (OR = 5.27 (95% CI 4.73, 5.87) to 8.98 (7.88, 10.22)), Indigenous ethnicity (OR = 1.73 (1.41, 2.13) to 3.38 (2.58, 4.44)), poor mental health (OR = 1.69 (1.53, 1.87) to 2.99 (2.46, 3.64)), and frequent bullying (OR = 1.21 (1.03, 1.41) to 1.54 (1.23, 1.95)). Except for cigarettes, poor mental health and bullying showed higher point estimates in girls, while rural residence showed higher estimates in boys. Age of first use was inversely associated with poor mental health, bullying, and rurality. Conclusion Higher risk of substance use and younger age at first use were associated with several demographic and psychosocial variables. Policy interventions to address substance use should include education on harms, gender-sensitive mental health and bullying supports, and trauma-sensitive, culturally appropriate approaches for Indigenous adolescents.