Clustering of substance use and its association with adolescents’ health and well-being: evidence from the Health Behaviour in School-aged Children (HBSC) Luxembourg study

Substance use during adolescence often persists into adulthood, with alcohol, tobacco, and cannabis use frequently clustering. These behaviors are associated with negative outcomes for self-rated health and well-being. This study analyzes the clustering of substance use (alcohol, cigarettes, e-cigarettes, and cannabis) among adolescents in Luxembourg and examines their association with sociodemographic factors, self-rated health, and well-being. Data were drawn from 5, 543 adolescents (50.7% boys; ages 13–18, secondary schools) who participated in the 2022 Health Behaviour in School-aged Children (HBSC) survey in Luxembourg. Substance use was assessed based on consumption in the past 30 days. Health outcomes included the WHO-5 Well-being Index and self-rated excellent health. A two-step cluster analysis identified substance use patterns. Binomial logistic regression and ANCOVA adjusted by sociodemographic variables examined associations with health outcomes. Three substance use clusters emerged: “No substance use” (56.4%), “Alcohol only” (18.8%), and “Other substance use” (24.8%; including cannabis, cigarettes, e-cigarettes, or multiple substances). Age, family structure, migration background, and perceived wealth were significantly associated with cluster membership. The “Other substance use” cluster reported the lowest well-being (M = 11.87) compared with the other 2 clusters. In addition, this cluster presented lower odds of excellent health (OR = 0.50), compared to “No substance use”. Substance use is negatively associated with adolescent health and well-being in Luxembourg. Distinct usage patterns suggest the need for tailored prevention strategies targeting specific risk groups to promote healthier lifestyles among youth.