Unpacking the Harmful Effects of Exposure to Neighborhood Violence on Substance Use Among Adolescents: Findings from a Population-Based Study

Background and objectives: In the United States (U.S.), substance use has been identified as a major public health concern and is one of the leading causes of preventable illness and death among adolescents. Substance use during adolescence has been found to increase the risk of risky sexual behaviors, poor academic performance, conduct problems, as well adverse health outcomes such as mental health problems. As a result, identifying factors that increase the risk of substance use among adolescents is crucial and could help prevent future substance use behaviors. Although research shows that adolescents who are exposed to neighborhood violence (NV) are more likely to use substances to cope with the trauma associated with NV, most of these studies are from small and unrepresentative samples that often lack diversity. Drawing on a large nationally representative sample of adolescents and guided by the stress-coping model, the objectives of this study were to examine the prevalence of exposure to NV, and the cross-sectional association between exposure to NV and different types of substance use.

Methods: Data for this study were obtained from the 2023 Youth Risk Behavior Survey. An analytic sample of 19,928 adolescents aged 14–18 (50.4% male) was analyzed using binary logistic regression. We hypothesized that controlling for demographic, risk, and protective factors, adolescents who were exposed to NV would have a greater likelihood of using different substances. Outcome variables investigated were current cigarette smoking, alcohol use, electronic vaping products (EVP) use, marijuana use, and prescription opioid misuse (POM). The main explanatory variable examined in this study was exposure to NV, and was measured as a binary variable based on response to the question, “Have you ever seen someone get physically attacked, beaten, stabbed, or shot in your neighborhood?” . Missing data were handled using Multiple Imputation using Chained Equations (MICE)

Results: Current use of substance use among adolescents are as follows: alcohol use (21.7%), EVP use (18.5%), marijuana use (17.5%), POM (4.9%), and cigarette smoking (4%). About one in four adolescents (23.4%) were exposed to NV. Controlling for demographic factors and other covariates, adolescents who were exposed to NV had 1.94 times higher odds of smoking cigarettes (AOR=1.94, 95% CI=1.42-2.65), 2.02 times higher odds of using EVP (AOR=2.02, 95% CI=1.68-2.43), 2.01 times higher odds of drinking alcohol (AOR=2.01, 95% CI=1.73-2.35), 2.18 times higher odds of using marijuana (AOR=2.18, 95% CI=1.83-2.59), and 1.91 times higher odds of POM (AOR=1.91, 95% CI=1.46-2.51) when compared to their counterparts not exposed to NV. Cyberbullying victimization and not school bullying was associated with adolescent substance use.

Conclusion: The findings of this study demonstrate an association between exposure to NV and use of different substances among adolescents. Understanding the association between exposure to NV and substance use could contribute to early identification of adolescents who are likely to engage in substance use. Such an understanding could also help in prevention and intervention efforts to reduce substance use behaviors and negative mental health consequences.