Factors For Substance Use Research Articles

Urbanization and substance use in left-behind children and adolescents: a systematic review and meta-analysis.

Inequalities in job opportunities between urban and rural regions have driven many parents to move from rural to urban regions with aims to improve household income. Financial and political barriers prevent children from moving with their parents, meaning that their children become left-behind in rural regions. This study aims to meta-analyse the risk of drinking, smoking, illicit drug use and drunk experiences in left behind children (LBC) and non-LBC. Previous studies have indicated the negative effects of prolonged parental separation on children and adolescent mental health. Parental separation and poor mental health have both been identified as proximal risk factors for substance use in adolescence. The results indicated that LBC were at significantly greater risk of drinking, smoking, using illicit drugs, and having drunk experiences. Positive psychology interventions are required to help provide LBC with positive coping strategies against psychological distress. Policy changes to reduce inequalities in job opportunities between urban and rural regions are required to reduce the prevalence of LBC.

RISK FACTORS FOR SUBSTANCE USE AMONG MALE SECONDARY SCHOOL STUDENTS IN ADEN GOVERNORATE, YEMEN

Substance use among secondary school students is a growing concern with significant implications for public health. This study aimed to identify the risk factors associated with substance use in a community of secondary school students in Aden Governorate, Yemen. A cross-sectional study was conducted among secondary school students in Aden governorate, using a structured questionnaire to collect data on potential risk factors for substance use. The questionnaire included measures of Peer Pressure, Academic Performance (GPA), Parental Monitoring, as well as self-esteem towards drug use. The Self-esteem among secondary students was measured using Rosenberg's Self-Esteem Scale. Descriptive and inferential statistical analyses were performed to identify significant risk factors. A total of 280 male students from 10 secondary schools (both section) of Aden governorate participated in the study, with a mean age of 17.37± 1.42 years. Risk factors associated with substance use included peer pressure (OR=2.34, 95% CI: 1.56-3.42), poor academic performance (OR=1.87, 95% CI: 1.23-2.81), lack of parental supervision (OR=1.62, 95% CI: 1.09-2.37), and low self-esteem (OR=1.45, 95% CI: 1.01-2.11). The findings highlight the complex interplay of social, familial, and individual factors in contributing to substance use among secondary school students. These results can inform targeted interventions and preventive strategies to address the identified risk factors in the community. This study identified several key risk factors for substance use among secondary school students in the community. Understanding and addressing these risk factors is vital for the development of effective preventive interventions and support systems to mitigate the impact of substance use on the health and well-being of young individuals.

Tribal Identity, Pain Interference, and Substance Use Among American Indian and Alaska Native Adolescents

Substance use is high among American Indian/Alaska Native adolescents. Pain interference is a risk factor for substance use, and identifying potential protective factors, such as Tribal identity, is important to help inform culturally grounded substance use prevention strategies. To examine the protective potential of Tribal identity as a moderator in the association between pain interference and substance use in American Indian/Alaska Native adolescents. This cross-sectional study of 10th-grade students self-identifying as American Indian/Alaska Native was conducted among students enrolled at 20 high schools on or near the Cherokee Nation Reservation. Data for this study were collected from the baseline assessments of a cluster randomized trial to prevent substance use among adolescents living on or near the Cherokee Nation Reservation. Inclusion criteria for high schools' participation included being located within counties that partially or fully fall within the Cherokee Nation reservation, a town population of 3000 individuals or fewer, and class sizes between 30 and 100 students. Exclusion criteria included high schools within metropolitan and micropolitan cores (per the US Census Bureau's Rural-Urban Commuting Area codes) and the existence of an established community drug prevention coalition. Student surveys were conducted from September 2021 to May 2024. Pain interference in the 7 days prior to baseline assessment. The primary outcomes were past 30-day alcohol use, marijuana use, and prescription opioid misuse. Generalized estimating equations Poisson models were used, with an exchangeable correlation structure clustered on the school level using baseline data from a cluster randomized trial to prevent alcohol and substance use among adolescents. For each substance, a separate multivariable model was fit, which included pain interference, Tribal identity, an interaction term between pain interference and Tribal identity, age, gender, food insecurity, anxiety symptoms, and depressive symptoms. Among 514 self-identified American Indian/Alaska Native students at 20 high schools on or near the Cherokee Nation Reservation, mean (SD) participant age was 15.59 (0.62) years, and 252 participants (49.0%) self-identified as female. Pain interference was associated with alcohol use and prescription opioid misuse in American Indian/Alaska Native adolescents, controlling for age, gender, food insecurity, anxiety symptoms, and depressive symptoms. Tribal identity significantly moderated the association between pain interference and alcohol use (coefficient, -0.13; 95% CI, -0.23 to -0.02). When Tribal identity was high, the adverse association of pain interference with alcohol use was significantly attenuated. This demonstrates a protective role of Tribal identity on alcohol use, which can inform future substance use prevention efforts among American Indian/Alaska Native adolescents. ClinicalTrials.gov Identifier: NCT04839978.

Effect of selective and family-based prevention on addiction susceptibility, affiliation with deviant peers, risk-taking, and risk and protective factors of substance use in high-risk adolescents: A randomized clinical trial

Effect of selective and family-based prevention on addiction susceptibility, affiliation with deviant peers, risk-taking, and risk and protective factors of substance use in high-risk adolescents: A randomized clinical trial

A Systematic Literature Review on the Predictors of Drug Abuse, Substance Use, and Opioid Misuse among Adolescents

Opioid misuse and dependence on prescribed opioids have strong link with drug addiction prevalence among adolescents. To gather evidence on the predictors of substance use, opioid abuse, and misuse of prescribed opioids, a systematic literature review was conducted covering articles published between 2016-2022. Of the 31 included articles, descriptively, substance use was considered as the dependent outcome in most of the studies (n = 15), compared to opioid misuse (n = 11), and prescription opioid misuse (n = 5). Resultantly, the common factors for substance use, opioid abuse, and misuse of prescribed opioids were broadly categorised into family-related factors, pain intensity and interference, comorbidity and psychopathology, demographic factors, substance use disorders and other drug addictive behaviours, and peer influence. Apart from the need to provide alternative pain management strategies, these factors should be considered by clinicians in identifying adolescents who are currently engaged in substance use or opioid abuse, and those likely to misuse prescribed opioids in the future.

Prevalence and determinants of risky behaviors: a comprehensive review of substance use and sexual risk behaviors among adolescents in the United States

Adolescents are often the most vulnerable to risky behaviors due to their quest for independence, experimentation, and identity development, resulting in deep-rooted patterns that affect health across the life course. This review examines the prevalence and determinants of substance use and sexual risk behaviors among adolescents in the United States. A systematic search of peer-reviewed literature published between 1980-2023 was conducted using multiple databases. Studies focusing on U.S. adolescents aged 12-19 and reporting on prevalence or associated factors of substance use (alcohol, tobacco, marijuana, or any illicit drugs) or sexual risk behaviors (early sexual initiation, multiple partners, or inconsistent condom use) were included. The review synthesized data from 40 studies meeting inclusion criteria. Results indicate concerning rates of substance use and sexual risk-taking, with variations by demographic factors. Alcohol and marijuana use were most prevalent, reported by 30-40% of adolescents. Nearly half of high school students reported having sexual intercourse, with 40% not using condoms consistently. Prevalence was generally higher among older adolescents, sexual minorities, and some racial minority groups. Key determinants of risk behaviors were reviewed based on socioecological models including individual, interpersonal, community and societal factors. The review highlights the multilevel nature of influences on adolescent risk behaviors. Findings underscore the need for tailored interventions addressing multiple determinants. Particular attention to vulnerable groups such as African American Adolescents and social determinants of health inequities is warranted. More research on risk and protective factors and effective interventions is needed. This synthesis can inform the development of evidence-based policies and programs to reduce substance use and sexual risk behaviors among U.S. adolescents.

Psychoactive substance use and associated factors among Mohammed first university students, Oujda, Morocco: a cross-sectional study

BackgroundThe use of psychoactive substances, including tobacco, alcohol, and others, remains a major public health problem. However, few studies have been conducted on Moroccan university students. This study aimed to assess the prevalence and associated factors of substance use among students at Mohammed First University, Oujda, Morocco.MethodsWe conducted this cross-sectional study with students enrolled at one of the Mohammed First University of Oujda’s institutes as part of the 2021–202 academic year. We used a self-administered survey to collect data anonymously. We cleaned the data and then entered it into IBM SPSS Statistics 21 for analysis. Data analysis involved descriptive statistics as well as univariate and multivariate analysis. We considered a P value < 0.05 as the level of significance.ResultsIn this study, out of 500 students we asked to complete the survey, 478 responded; the response rate was 95.6%. The average age was 21.1 ± 3.0, and the M/F sex ratio was 0.97. The lifetime prevalence of psychoactive substance use among Oujda University students was 28.7%. The most commonly used substances were tobacco (24.1%), alcohol (15.9%), cannabis (13.4%), sedatives (6.9%), stimulants (5.2%), and cocaine (4.4%). Male sex, age > 20 years, self-financing, school failure (one year repeated or more), the practice of a leisure activity, the presence of a personal medical or psychiatric history, and the presence of a family medical history were all significantly associated with the use of psychoactive substances.ConclusionOur study revealed a significant prevalence of psychoactive substance use among university students in Oujda, highlighting the need for interventions at various levels. Further analytical studies are necessary to better understand the initiation and maintenance of psychoactive substance use and to identify all associated factors to enhance prevention strategies against substance use disorders.

Posttraumatic stress disorder mediating associations between child sexual abuse and substance use among transgender adults in the United States.

Transgender people experience an excess burden of child sexual abuse (CSA), mental health concerns, and substance use compared to cisgender populations. Posttraumatic stress disorder (PTSD) has been found to mediate the association between CSA and substance use behaviors in cisgender populations, but this dynamic has not been previously examined among transgender adults. The aim of this study is to test if PTSD may mediate a relationship between CSA and substance use among transgender adults. Data were analyzed from the U.S. Transgender Population Health Survey (2016-2018), a national probability sample of transgender adults (N = 274). CSA was measured using the Adverse Childhood Experiences subsection for sexual abuse. Past-month PTSD was measured using the Primary Care-PTSD Diagnostic and Statistical Manual of Mental Disorders, fourth edition screening tool. Substance use was determined by lifetime binge drinking, polydrug use, and the Drug Use Disorders Identification Test. Baron and Kenny's approach was used to assess PTSD as a mediator between CSA and substance use. Within our sample, nearly half (45%) of the transgender adults experienced CSA. Lifetime binge drinking (40%), polydrug use (20%), and indications of drug-use-related problems (Drug Use Disorders Identification Test x¯ = 4.52) were frequently reported. Transgender adults who have experienced CSA had increased risk of PTSD and substance use, and PTSD was a mediator in all models. Results suggest that adult transgender CSA survivors are at increased risk of drug and alcohol use, and that PTSD may be an important contextual factor for substance use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Qualitative Exploration on Risk and Protective Factors of Substance Use Among Black Adolescent Girls

ABSTRACT Objective While Black adolescent girls use drugs at much lower rates than White and Hispanic girls, Black adolescent girls often have worse health outcomes due to drug use. This study seeks to highlight the voices of Black adolescent girls in order to understand their unique risk factors for substance use and misuse. Methods Utilizing the intersectionality and ecological systems theoretical frameworks, the research team conducted twelve focus groups among a sample of Black adolescent girls (N = 62) between the ages of 13–18 (M = 15.6 years SD = 1.50). Results Thematic analysis was conducted to analyze the participant narratives. Four main themes arose: 1) stereotypes of Black adolescent girls; 2) the role of the physical and social environment (feeling unsafe in neighborhoods where they reside); 3) using drugs as a coping mechanism; 4) input on prevention programming for girls with a sub-theme involving family as a protective factor. Discussion Study findings deepen our qualitative understanding of risk and protective factors for substance use among Black adolescent girls. These findings provide insight on girls’ lived experiences for researchers and intervention development to create and implement substance abuse prevention programs that are race- and gender-specific for Black adolescent girls.

Exploring the Abuses and Solutions of Students' Drug Addiction at the University Level

Drug addiction among university students has emerged as a critical issue, particularly in developing nations like Pakistan. This study explores the prevalence and factors contributing to drug abuse among university students, focusing on social, psychological, and economic influences. Peer pressure, socioeconomic status (SES), and mental health challenges have been identified as major risk factors for substance use in the university setting. Data were collected through interviews and focus groups with students and teachers using mixed methods, which provided a broader understanding of the topic. Findings indicate that students from low SES backgrounds are particularly vulnerable due to financial pressures and limited support. At the same time, peer influence generalizes drug use across social groups; the research emphasizes the need for targeted psychosocial intervention strategies aspects of addiction and emphasizes the importance of supportive resources and mental health resources in reducing drug abuse among students.

The Mediating Effect of Depression on the Relationship between Loneliness and Substance Use in Korean Adolescents.

Substance use among adolescents is a major emerging health problem worldwide. Although loneliness and depression are major risk factors for substance use, few studies have examined the relationship between loneliness, depression, and substance use in adolescents. This study aimed to determine the mediating effect of depression on the relationship between loneliness and substance use among Korean adolescents, based on the data from 53,310 adolescents from the 17th Korea Youth Risk Behavior Web-based Survey in 2021. Using a complex sample analysis module, hierarchical logistic regression analysis was employed to confirm the mediating effect of depression on the relationship between loneliness and substance use. The results showed that loneliness and depression have a significant effect on substance use (smoking, drinking alcohol, and drug use). Depression was found to have a partial mediating effect on the relationship between loneliness and substance use. Overall, the results suggested that loneliness and depression in adolescents increase substance use, and loneliness can affect substance use through depression. Therefore, proactive strategies to prevent and reduce loneliness and depression in adolescents can be effective in preventing substance use.

Multiple risk factors of substance use among lesbian, gay, bisexual (LGB) adults: A comparison study

ABSTRACT The aim of this study was to identify and compare risk factors of substance use between heterosexual and LGB adults. Using data from the 2020 National Survey on Drug Use and Health (NSDUH), Chi-square, t-test, and standard multiple regressions were employed to analyze the data. The findings showed that LGB participants had significantly higher experiences with substances and initiated substance use earlier than heterosexual participants. Some risk factors were related to experiences with substance use for both groups (i.e. depression, emotional distress, age of first alcohol and marijuana use), but these factors accounted for more of the variance for LGB participants. Additionally, overall health was uniquely associated with experiences with substance use for LGB participants. These results have important implications for the design of culturally appropriate substance use prevention and intervention services for LGB individuals.

Experiencing violence and other predictors of within-person same-day use of multiple substances in youth: a longitudinal study in emergency settings

ABSTRACT Background: Although experiencing violence is a risk factor for substance use among youth, its association with same-day use of multiple substances (a form of polysubstance use) and mitigating factors is less well understood. Objectives: To identify whether prosocial factors modified the effect of experiencing violence on the frequency of same-day use, and examine gender-specific risk/protective factors for same-day use. Methods: We analyzed longitudinal data from a cohort of youth who use drugs aged 14–24 (n = 599; 58% male) presenting to an urban emergency department between 2009–2011 and assessed biannually for two years. Using Poisson-generalized linear models with person-level fixed effects, we estimated within-person associations between self-reported experiencing violence and same-day use and analyzed gender and peer/parent support as effect modifiers. We adjusted for negative peer influence, parental drug and alcohol use, family conflict, anxiety and depression, and age. Results: Overall, positive parental support corresponded to lower rates of same-day use (rate ratio [RR]:0.93, 95% CI:0.87–0.99) and experiencing violence was associated with higher rates of same-day use (RR:1.25, 95% CI:1.10–1.41). Violence exposure was a risk factor among males (RR:1.42, 95% CI:1.21–1.66), while negative peer influences and parental substance use were risk factors among females (RR:1.63, 95% CI:1.36–1.97 and RR:1.58, 95% CI:1.35–1.83, respectively). Positive peer support reduced the association between violence exposure and same-day use among males (RR:0.69, 95% CI:0.57–0.84, p < .05). Conclusions: Tailored interventions may address gender differences in coping with experiencing violence – including interventions that promote parental support among males and reduce influence from parental substance use among females.

Prevalence, correlates, and reasons for substance use among adolescents aged 10–17 in Ghana: a cross-sectional convergent parallel mixed-method study

BackgroundSubstance use among adolescents poses significant risks to their health, wellbeing, and development, particularly in low- and middle-income countries, including Ghana. However, little is known about the outlets and reasons for substance use among Ghanaian adolescents. This study examined the prevalence, correlates, reasons for substance use, and outlets of these substances among adolescents aged 10–17 in Ghana.MethodsData were obtained from the Department of Children, Ministry of Gender, Children, and Social Protection, Ghana, which employed a cross-sectional convergent parallel mixed-methods technique to collect quantitative and qualitative data from children aged 8–17, parents or legal guardians and officials of state institutions responsible for the promotion and protection of children’s rights and wellbeing. Overall, 4144 adolescents aged 10–17 were interviewed for the quantitative data, while 92 adolescents participated in 10 focus group discussions. Descriptive statistics, Pearson’s chi-square test, and multivariable binary logistic regression were used to analyse the quantitative data, while the qualitative data was analysed thematically.ResultsThe prevalence of substance use was 12.3%. Regarding the types of substance use, alcohol (56.9%) and cigarettes (26.4%) were the most common substances. Being a male and currently working are significant risk factors, whereas being aged 10–13, and residing in the Middle- and Northern-ecological belts of Ghana are significant protective factors of substance use. Peers, household members who use substances, drug stores, and drug peddlers are the major outlets. The reasons for substance use were fun, substance as an aphrodisiac, boosting self-confidence, dealing with anxiety, and improved social status.ConclusionsThere is a relatively high substance use among adolescents in Ghana, and this calls for a multi-sectoral approach to addressing substance use by providing risk-behaviour counselling, parental control, and effective implementation of substance use laws and regulations.

An examination of the protective role of internalizing symptoms in adolescent substance use.

Although psychological symptoms are broadly considered to be risk factors for substance use, internalizing symptoms may be associated with lower risk for adolescent substance use after controlling for co-occurring externalizing symptoms. The present study explored two potential mediators of this protective association between internalizing symptoms and adolescent substance use: popularity and harm avoidance. The study used data from the Colorado Longitudinal Twin Study (LTS) and Colorado Adoption Project (CAP). Annual assessments of internalizing and externalizing symptoms and social competence were completed by parents and teachers at participant ages 7 to 16. Harm avoidance and substance use were assessed at age 17. In this sample, internalizing symptoms were associated with less frequent substance use, controlling for externalizing symptoms. We did not find evidence that popularity or harm avoidance accounts for the protective association of internalizing symptoms with adolescent substance use. Teacher-reported popularity was associated with less frequent substance use, suggesting that social connectedness in the school context may be a protective factor for adolescent substance use. Harm avoidance was not associated with substance use after accounting for internalizing and externalizing symptoms.

Epidemiology of substance and opium use among adult residents of Tehran; a comprehensive report from Tehran cohort study (TeCS)

BackgroundThe prevalence and burden of substance and opium use have increased worldwide over the past decades. In light of rapid population changes in Tehran, we aimed to evaluate the prevalence of opium and other substance use among adult residents in Tehran, Iran.MethodFrom March 2016 to March 2019, we utilized data from 8 296 participants in the Tehran Cohort Study recruitment phase (TeCS). We calculated the age-sex-weighted prevalence of substance use and the geographic distribution of substance use in Tehran. We also used logistic regression analysis to determine possible determinants of opium use.ResultWe analyzed data from 8 259 eligible participants with complete substance use data and the average age of participants was 53.7 ± 12.75 years. The prevalence of substance use was 5.6% (95% confidence interval [CI]: 4.6- 7.1%). Substance use was more common in males than females (Prevalence: 10.5% [95% CI: 8.6- 12.6%] vs. 0.5% [95% CI: 0.2- 1.2%], respectively). The age-sex weighted prevalence of substance use was 5.4% (95% CI: 4.6-7.1%). Moreover, opium was the most frequently used substance by 95.8% of substance users. Additionally, we found that male gender (Odds ratio [OR]: 12.1, P < 0.001), alcohol intake (OR: 1.3, P = 0.016), and smoking (OR: 8.5, P < 0.001) were independently associated with opium use.ConclusionsWe found that the prevalence of substance use in Tehran was 5.6%, and opium was the most frequently used substance. In addition, male gender, lower levels of education, alcohol, and tobacco consumption are the main risk factors for substance use in Tehran. Healthcare providers and policymakers can utilize our results to implement preventive strategies to minimize substance use in Tehran.

Perceived parent and peer substance use disapproval and perceptions of harm among youth before and after COVID-19 lockdowns

ABSTRACT Background Changes in substance use among adolescence from before to after the COVID-19 lockdowns have been noted in the literature with mixed findings. Yet, no study has examined potential changes in risk or protective factors for substance use in that same period. This study assesses whether perceived parental/peer disapproval, and perceptions of substance harm among adolescents, changed from before to after COVID-19 lockdowns. Methods The Rhode Island Student Survey was administered to 17,751 middle and high school students from January 2020 – May 2021. Perceived parental/peer disapproval, as well as perception of harm, was measured for cigarettes, vaping, alcohol, marijuana, prescription drugs, and illegal drugs. Changes were assessed pre-post COVID-19 lockdown implementation using multivariable logistic regression. Results Perceptions of harm increased for all substances other than vaping, alcohol, and marijuana, and perceptions of peer and parental disapproval for all substances increased after COVID-19 lockdown implementation. Conclusion COVID-19 lockdown implementation may have led to greater perceptions of substance harm and peer/parental disapproval among adolescents. These shifts may have been associated with increased parental exposure and limited peer influence, which should be considered in future programming to prevent and treat adolescent substance use.

A comparison of the substance use related risk and protective factor profiles for American Indian and White American youth: a mixed studies review.

American Indian youth are disproportionately impacted by substance use compared to White American youth in the United States. This mixed studies review focused on gathering data to examine the similarities and differences between the risk and protective factor profiles for substance use among American Indian and White American youth aged 10-21. A scan of the existing literature was needed to review substance use related risk and protective factors for American Indian and White American youth. Search phrases were created to ensure maximum relevant results from existing literature through 2021. After deduplication, an appraisal tool was utilized to review 343 records. A total of 19 articles were deemed relevant. Data from relevant articles was recorded and categorized into the levels of the Social Ecological Model. Significant and salient risk and protective factors of substance use for both American Indian and White American youth presented at the individual, interpersonal (family/non-family), and community levels of the Social Ecological Model. A total of 84 factors were found from relevant articles, 55 risk factors and 29 protective factors. When comparing the American Indian and White American youth profiles, a total of 29 unique differences between American Indian (n = 21) and White American youth (n = 8) were identified. Results from this review can be utilized to inform Tribal leaders, stakeholders, and policymakers, which will ultimately influence health intervention strategies and prioritizations. Given the limited evidence though, researchers should be responsive to Tribal communities' call to action for utilizing a culturally rooted approach.

Risk and protective factors for substance use and media addictive behaviors in adolescents during the COVID-19 pandemic.

This study examined the long-term effects of the COVID-19 pandemic on adolescents' substance use, digital media use, and symptoms of internet, gaming, and social media addiction. A nationally representative longitudinal cohort of 1665 Israeli teens and preteens, aged 9-16, completed questionnaires assessing substance use prevalence, daily screen time, symptoms of media addiction, and potential risk and protective factors. Data were collected before the pandemic (October 2019), after the second wave lockdown (November 2020), and after the fifth wave (April 2022) in Israel. The analysis documented significant increases in substance use, daily screen time, and social media addiction indices over time. Gratitude, life satisfaction, positive emotions, future orientation, grit, and secure attachment emerged as significant protective factors. Sensation-seeking, negative emotions, and mental health symptoms were identified as risk factors. These findings highlight the importance of educational and public mental health services in addressing the pandemic's long-term impact on the mental health and addictive behaviors of adolescents. They also emphasize the significance of enhancing protective factors and reducing risk factors to effectively mitigate substance and digital media abuse among adolescents.

Food hardship as a strong predictor of tobacco and cannabis use among youth in WA state

This brief report examines data from The Healthy Youth Survey to understand the likelihood of tobacco and cannabis use for students in Washington state who experienced poverty as measured by participating in the free and reduced lunch (FRL) program or reported food hardship. We conducted descriptive and exploratory statistics and trend analysis of the data to understand differences in substance use between ethnic/racial groups by poverty status. While historically research has documented that experiencing poverty and being from marginalized ethnic/racial minorities are risk factors for substance use among youth, our study is unique because few studies look at the intersection of racial/ethnic differences and poverty and their impact on substance use. Our results align with previous research when the intersectional analysis was by ethnicity and FRL – White students reported significantly higher tobacco and cannabis use, and Black and Mixed-race students had a significantly higher likelihood of cannabis use if they received FRL. However, when the intersectional analysis utilized perceived food hardship and cannabis and tobacco use there were significantly higher rates of use within all race/ethnic categories. Therefore, FRL status may not be a sensitive enough measure to predict tobacco and cannabis use and we recommend additional screening for food hardship.