Developmental Patterns and Social Determinants of Adolescent Polysubstance Use Among Connecticut Youth

Adolescent substance use continues to be a leading health concern in the United States. Although individual substance trends have demonstrated a decrease in use, it seems as if polysubstance use is on the rise among this population. Prior research into adolescent polysubstance use patterns tends to include only commonly used substances (e.g., alcohol, cannabis, tobacco) and neglects prescription drug misuse and illicit substances. Further, subanalyses by grade are typically not completed, leaving a gap in our understanding of developmentally appropriate prevention strategies. The present study utilized 13 substance use indicator variables to estimate substance use patterns among adolescents in grades 7 through 12 through multiple group latent class analysis (LCA) and the socioecological correlates of each class. Participants included 14,134 adolescents (47.4% male; 45.6% female; 7% gender diverse) drawn from a historical dataset (2021-2024) of Youth Survey questionnaires maintained by a Connecticut nonprofit organization. It was expected that 4 classes would emerge, ranging from nonusers to polysubstance users, and that these classes would differentially relate to socioecological risk and protective factors. Results of the LCA models yielded 4 classes as the best solution for the sample: Nonusers; Alcohol, Cannabis, E-cigarette Experimenters; Prescription Drug and Alcohol Users; and Polysubstance Users. The Prescription Drug and Alcohol Users class emerged as a potentially unique substance using class, capturing a novelsubstance use pattern among adolescents. A series of multinomial logistic regressions were completed to assess the odds of belonging to substance using classes based on various levels of risk and protective factors. Results were largely in line with hypotheses, although the Prescription Drug and Alcohol Experimenter class differentially related to the School Domain variables compared to other substance using classes, with only feelings of school safety emerging as a protective factor for this class. Further, parental use of cannabis emerged as a salient risk factor for polysubstance use among youth. The findings highlight the importance of including prescription drugs and illicit substances in investigations of adolescent substance use as well as underscores the importance of preventive strategies to mitigate consequences related to the changing landscape of cannabis legalization.