Understanding higher substance use among early adolescent females: A decomposition analysis of adverse childhood experiences, bullying victimization, and depressive symptoms.

BACKGROUND

Historically, U.S. adolescent boys have reported higher substance use than girls, but this has changed in recent years with girls reporting more use. The reasons for this demographic shift are unclear, but girls may be more likely to turn to substance use as a way to cope with stress and internalizing problems.

METHODS

We used cross-sectional data from the 2023 Nevada Middle School Youth Risk Behavior Survey (YRBS) (grades 6-8;n = 6734). We estimated the adjusted prevalence ratios of girls versus boys past 30-day substance use (electronic vapor products (EVP), alcohol, marijuana, and non-medical prescription pain medicine (NMPPM)) and intervention-relevant factors (adverse childhood experiences (ACEs), bullying victimization, and depressive symptoms). To estimate how much of the potential substance use sex disparities were statistically accounted for by differences in the prevalence of risk factors, we conducted decomposition analyses.

RESULTS

Substance use was higher for girls versus boys: EVP (aPR:2.05, 95%CI:1.62,2.61), alcohol (aPR:1.76, 95%CI:1.39,2.21), marijuana (aPR:1.93, 95%CI:1.43,2.59), and NMPPM (aPR:1.91, 95%CI:1.44,2.54). Girls also reported higher prevalence of intervention-relevant factors. The factors that made the largest contributions to statistically accounting for the substance use sex disparities were depressive symptoms (range:44.9-64.0%), household substance abuse (range:31.0-44.7%), emotional abuse (range:28.4-43.6%), and household mental illness (range:26.9-41.5%).

CONCLUSIONS

Recent substance use was approximately twice as high among girls compared to boys. These sex disparities may be statistically accounted for by the higher prevalence of ACEs, electronic bullying, and depressive symptoms among girls. There is a need for sex-specific substance use prevention that is trauma-informed and includes healthy coping strategies.