Association between early sexual initiation and forced sexual intercourse with polysubstance use among adolescents: Findings from a population-based study.

Substance use among adolescents in the United States is a significant public health concern. Despite the use of single substances among adolescents being rare, existing literature focuses on single, rather than the more common polysubstance use (PSU). Furthermore, the relationship between early sexual initiation (ESI), forced sexual intercourse, and PSU is underexplored. This study addresses this gap in the literature by examining this intersection. Data for this study came from the 2021 Youth Risk Behavior Survey (YRBS) and the sample was comprised of 17,033 adolescents aged 14-18. Models were built sequentially using descriptive, bivariate, and finally complementary log-log models to evaluate these associations, while controlling for symptoms of depression, poor mental health during COVID-19, parental monitoring, and demographic characteristics. Of the 17,033 adolescents examined, 18.7 % engaged in PSU, 21.6 % engaged in ESI, and 8.5 % also reported experiencing forced sexual intercourse. In the final model, adolescents who engaged in ESI had more than fourfold higher odds of engaging in PSU when compared to their counterparts who did not engage in ESI (AOR = 4.24, p < .001, 95 % CI = 3.75-4.79). History of forced sexual intercourse was associated with 1.34 times higher odds of engaging in PSU. These results underscore that ESI is significantly associated with increased risk of forced sexual intercourse and PSU. This study highlights the need of future research to uncover the psychological pathways linking ESI, forced sexual intercourse, and PSU.