Adolescent-specific risk and protective factors of substance use among high school students in the United States: A cross-sectional study

<b>Objective:</b> Substance use among U.S. adolescents is a critical public health concern. This study evaluates risk and protective factors for substance use among high school students. <b>Methods:</b> Using data from the 2022 National Survey on Drug Use and Health, a cross-sectional analysis of 6,072 high school students was conducted. Multivariable logistic regression analyzed associations between substance use (alcohol, tobacco, illicit drugs) and adolescent-specific factors, adjusting for sex, grade, health insurance, and poverty status. <b>Results:</b> Overall, 35.6% of students reported using alcohol, tobacco, or illicit drugs in the past year. Antisocial behavior significantly increased the odds of alcohol (AOR = 2.54, 95% CI = 2.02-3.19), tobacco (AOR = 2.36, 95% CI = 1.92-2.89), and illicit drug use (AOR = 2.66, 95% CI = 2.22-3.19; <i>p</i> < .001). Religious involvement reduced the odds of alcohol (AOR = 0.79, 95% CI = 0.64-0.97, <i>p</i> = .026), tobacco (AOR = 0.71, 95% CI = 0.56-0.90, <i>p</i> = .006), and illicit drug use (AOR = 0.59, 95% CI = 0.45-0.77, <i>p</i> < .001). <b>Conclusions:</b> One in three high school students reported substance use. Antisocial behaviors increase risk, while religious involvement offers protection. Interventions targeting these factors may reduce adolescent substance use.