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.

INTRODUCTION

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.

OBJECTIVES

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.

METHODS

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.

RESULTS

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”.

CONCLUSIONS

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.