Higher Substance Use Research Articles

Immigration Enforcement and Hispanic Youth Substance Use: Is Depression a Mediator?

Hispanic adolescents report earlier onset and higher substance use rates than their non-Hispanic White and Black peers. This study examines the associations between the immigration-related arrest of a family member and substance use among Hispanic early adolescents and explores the mediating role of depressive symptoms as the mechanism explaining the association. We apply a mediated multiple linear regression analysis on 661 Hispanic youth attending 7th grade in an urban school district in a south-central, new arrival state. We found that Hispanic early adolescents who experienced the immigration-related arrest of a family member reported significantly higher substance use than Hispanic youth who did not experience the arrest of a family member due to immigration enforcement. Moreover, we found this relationship to be fully mediated by depressive symptoms. Findings suggest that even though the majority of Hispanic youth in the U.S. are citizens, experiencing the immigration-related arrest of a family member is not uncommon and has critical implications for poor mental health and maladaptive coping behaviors.

A latent class analysis to identify socio-economic and health risk profiles among mothers of young children predicting longitudinal risk of food insecurity.

BackgroundThe purpose of the current study was to use a social determinants of health (SDOH) framework and latent class analysis (LCA) to identify risk classes among mothers with young children. The risk classes were then used to predict food insecurity severity and stability/change of food insecurity over time.MethodThe secondary data from the Fragile Families and Child Wellbeing Study (n = 2,368; oversampled for non-marital births) was used in this study. Household food insecurity was assessed using the 18-items USDA Food Security Survey. A seventeen-item inventory of educational, economic stability, incarceration (i.e. social context), neighborhood safety (i.e. neighborhood and built environment), health and health care, and substance use behaviors at baseline/Year-1 were included to identify SDOH risk indicators in the LCA. Covariate-adjusted multinomial logistic regression models were used to examine the relation between risk classes at Year-1 and the severity of food insecurity at Year-3 and stability/change of food insecurity between Year-3 and Year -5.ResultsLCA identified five risk classes: High utility and medical hardship (Class 1), high housing and employment hardship, high substance use, and incarceration (Class 2), high housing and medical hardship, poor health, and health care (Class 3), high employment hardship and low-income (Class 4) and low-risk (Class 5). The Class 1, Class 2 and Class 3 had greater odds of low food security and very low food security at Year-3 compared to Class 4. In addition, compared to Class 4, Class 1, Class 2 and Class 3 had greater odds unstable food insecurity and persistent food insecurity over time.ConclusionsLCA could be used to identify distinctive family system risk profiles predictive of food insecurity. The generated risk profiles could be used by health care providers as an additional tool to identify families in need for resources to ensure household food security.

Syndemic relationship of depressive symptoms, substance use, and suicidality in transgender youth: a cross-sectional study using the U.S. youth risk behavior surveillance system.

Syndemics are co-occurring epidemics that cluster within populations due to shared socio-structural factors and are often in populations with intersecting forms of vulnerability. Suicide, depression, and substance use all disproportionately affect transgender and gender diverse (TGD) youth. In this study, we test a syndemic model of the relationship between these three mental health conditions in the context of economic deprivation and interpersonal discrimination. We used data on substance use, depressive symptoms, suicidality, and social-structural factors from 2680 TGD youth captured in the 2017 and 2019 survey waves of the Youth Risk Behavior Surveillance System. We used a latent class analysis (LCA) to identify groups with distinct patterns of self-reported substance use and depressive symptoms, and regression models to characterize the relationship between substance-use, depressive symptoms, class membership, social-structural factors, and suicidality. A three-class LCA solution identified a subset of student respondents in a "high use" latent class characterized by high self-reported substance use frequency and depressive symptoms compared with other classes. Online bullying (aOR:1.58; 95%CI: 1.28-1.95) and housing insecurity (aOR:8.78; 95%CI: 4.35-17.71) were associated with increased odds of "high use" class membership relative to the "no use" class membership. "High use" class membership was associated with increased odds of suicidal ideation (aOR:2.26; 95%CI: 1.75-2.94), plans (aOR:2.59; 95%CI: 2.01-3.36), and attempts (aOR:6.85; 95%CI: 3.17-15.68). The co-occurrence of substance use and depressive symptoms is associated with socio-structural factors and may drive risk for suicidality among TGD youth. Meaningful suicide prevention efforts that address disproportionate risk in this population must be attentive to and mitigate the shared determinants of mood symptoms and substance use behavior.

Predicting initiation to treatment for youth on probation: A multi-level approach

BackgroundPrevious research on youth involved in the juvenile legal system (JLS), who have higher substance use prevalence than other adolescents, has focused on treatment outcomes post-initiation. Scant research has examined factors affecting treatment initiation following JLS referral. The current work addresses this gap by estimating net impacts of state, site, and client attributes on initiating treatment. MethodsMixed effects logistic regression models analyzed data from the Behavioral Health Services Cascade framework of the JJ-TRIALS project for 5325 youth records from 22 sites across six states, using weighted hot deck imputation to address missing data. The analysis permitted estimating net impacts of individual factors while controlling for state variation factors and separating out within-state site variation. ResultsRates of treatment initiation varied significantly across sites. About 63% of outcome variation arose from site and state disparities. The odds of initiating treatment were 127% higher for youth under a higher supervision level compared to youth under low supervision. Race and ethnicity were significantly associated with initiation, with Black and Hispanic youth having 44% and 42% lower odds of initiating treatment, respectively. ConclusionIndividual factors, including race, ethnicity, and level of supervision, significantly differed in treatment initiation, controlling for between-state variation and allowing between-site-within-state effects to operate separately. A deeper understanding of factors shaping initiation may help behavioral health and JLS agencies to develop strategies to increase initiation for referred youth. This is the first study delineating individual, cross-program, and between-state variation in treatment initiation among referred youth.

Opioid Use Disorder and COVID-19: Treatment and Recovery Factors among Vulnerable Populations at the Intersection of Two U.S. Epidemics

ABSTRACT Social inequities made some sociodemographic groups – including those of older age, minoritized race/ethnicity, and low socioeconomic status – disproportionately vulnerable to morbidity and mortality associated with the opioid epidemic and COVID-19 pandemic. Given shared vulnerability to these public health crises, it is critical to understand how COVID-19 impacts substance use disorder (SUD) treatment and recovery among people with these characteristics. The current study examined COVID-19ʹs perceived impact on treatment factors and psychosocial outcomes by sociodemographic vulnerability. Patients receiving SUD treatment with a history of opioid misuse were recruited. Participants completed self-report questionnaires regarding the impact of COVID-19 on treatment indicators and mood and substance use symptoms. Most participants reported that COVID-19 decreased their treatment access and quality. There were no sociodemographic differences in treatment factors. Those with high sociodemographic vulnerability reported greater pandemic-related increases in depression and demonstrated greater mood symptoms. Post-hoc analyses demonstrated that unmet basic needs were significantly associated with lower treatment access and quality, greater mood symptoms, and higher substance use. Findings suggest pandemic-related stressors and barriers affected those across the sociodemographic spectrum. Treatment systems must address socioeconomic barriers to care exacerbated by the pandemic and bolster integrated treatment options for opioid use and mood disorders.

Substance use and individual assets in urban adolescents: Subgroups and correlates in emerging adulthood.

To investigate patterns of divergence in adolescent adjustment, this study examined the co-occurring patterns of adolescents' individual assets (e.g., school engagement, values) and substance use, and whether the co-occurring patterns were associated with later functioning in emerging adulthood. Participants were 358 (54% females), predominantly African American, urban adolescents, recruited at birth for a prospective study on the effects of prenatal substance exposure in the Midwest United States. Individual assets, using the Developmental Assets Profile, substance use (alcohol, tobacco, marijuana), via biologic assays and self-report, and substance use-related problems were assessed at age 15 years. High-school completion, substance use disorder, mental health symptoms, and legal problems were assessed at age 21 years. Latent class analysis identified five classes as follows: high assets with low substance use (C1, 10.2%); moderate assets with low substance use (C2, 28.7%); low assets with low substance use (C3, 32%); moderate assets with high substance use (C4, 9.4%); and low assets with high substance use (C5, 19.2%). Despite similar levels of assets, adolescents in C5 reported more life adversities (suboptimal caregiving environment, daily hassles, non-birth parents' care) than those in C3. C4 and C5 reported more substance use disorder at age 21 years than the three low substance use classes; adolescents in C5 were less likely to complete high school than those in C2. More females in C5 reported greater mental health symptoms than those in C1 and C3, and criminal justice involvement than those in C1. The current findings underscore the significance of substance use in adolescence in disrupting healthy transition to adulthood, especially among females in the context of low individual assets.

Qualitatively Exploring Mental Health Attitude Changes among Emerging Adult Motivational Interviewing after One Motivational Enhanced Interview.

Emerging adult military members and veterans (MMV) are experiencing many transitions (e.g., adulthood, military). The sum of these changes can cause stress, anxiety, and mental health challenges. Stigma of mental health and treatment exists, and military populations are often not seeking or engaging in appropriate care. Recent research emphasizes the need to uncover mental health attitudes and self-stigma barriers regarding help seeking. We evaluated the impact of a single motivational-interviewing enhanced interview with 26 MMV, all who reported high risk substance use. In 75-minute interviews with the primary focus of discussing their experiences regarding mental health, substance use, and identity development, the interviewer incorporated motivational interviewing strategies (e.g., affirmations, complex reflections). Participants shared their developmental experiences, stressors transitioning, and barriers and stigma around mental health treatment. Participants completed a survey which included a variety of standardized measures and open-ended questions two weeks before and after the interview. Qualitative follow-up data via open ended questions shows the session was well received by participants as they could share their stories, think critically about their military experiences, and brainstorm solutions for mental health care. We conclude that using individual, confidential interviews to discuss sensitive topics for data collection with MMV is an area to continue developing. Conducting qualitative research with motivational interviewing strategies has the potential to be twofold: advance scholarship and inform practitioners, but also serve as a therapeutic platform for some participants.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10615-022-00837-z.

Neural cognitive control moderates the longitudinal link between hedonia and substance use across adolescence

Hedonic dysregulation is evident in addiction and substance use disorders, but it is not clearly understood how hedonic processes may interact with brain development related to cognitive control to influence risky decision making and substance use during adolescence. The present study used prospective longitudinal data to clarify the role of cognitive control in the link between hedonic experiences and the development of substance use during adolescence. Participants included 167 adolescents (53% male) assessed at four time points, annually. Adolescents participated in a functional magnetic resonance imaging (fMRI) session where blood-oxygen level dependent (BOLD) response was monitored during the Multi-Source- Interference Task to assess cognitive control. Substance use and hedonia were assessed using self-report. A two-group growth curve model of substance use with hedonia as a time-varying covariate indicated that higher levels of hedonia predicted higher substance use, but only in adolescents with higher activation in the frontoparietal regions and in the rostral anterior cingulate cortex during cognitive control. Results elucidate the moderating effects of neural cognitive control on associations between hedonia and adolescent substance use, suggesting that lower cognitive control functioning in the brain may exacerbate risk for substance use promoted by hedonia.

Prevalence and Correlates of Illicit Substance Use Among Young Adults Experiencing Homelessness in Seven Cities Across the United States

Background Young adults experiencing homelessness (YAEH) engage in substantially higher substance use rates than housed young adults. This current study builds on previous research by investigating the prevalence of and salient correlates of illicit substance use across a seven-city sample. Methods This study used the Homeless Youth Risk and Resiliency Survey (HYRRS) dataset, n=1426 Young adults experiencing homelessness to study patterns and correlates of illicit substance use. Results Multivariate logistic regression analyses were used to assess correlates of substance use. Study site, age, gender identity, sexual orientation, history of suicidal ideation, use of specific substances, and trading sex for drugs were associated with five types of illicit substance use (ecstasy, cocaine, crack, methamphetamine, and injection drug use). Conclusion Findings indicate that substance use interventions for YAEH must be multifaceted, addressing illicit and multiple substance use, along with the myriad factors associated with substance use among this at-risk group.

Interruptions in Mental Health Care, Cannabis Use, Depression, and Anxiety during the COVID-19 Pandemic: Findings from a Cohort of HIV-Positive and HIV-Negative MSM in Los Angeles, California.

The objective was to examine the impact of the COVID-19 pandemic on mental health care, cannabis use, and behaviors that increase the risk of STIs among men living with or at high risk for HIV. Data were from mSTUDY — a cohort of men who have sex with men in Los Angeles, California. Participants who were 18 to 45 years and a half were HIV-positive. mSTUDY started in 2014, and at baseline and semiannual visits, information was collected on substance use, mental health, and sexual behaviors. We analyzed data from 737 study visits from March 2020 through August 2021. Compared to visits prior to the COVID-19 pandemic, there were significant increases in depressive symptomatology (CES-D ≥ 16) and anxiety (GAD-7 ≥ 10). These increases were highest immediately following the start of the pandemic and reverted to pre-pandemic levels within 17 months. Interruptions in mental health care were associated with higher substance use (especially cannabis) for managing anxiety/depression related to the pandemic (50% vs. 31%; p-value < .01). Cannabis use for managing pandemic-related anxiety/depression was higher among those reporting changes in sexual activity (53% vs. 36%; p-value = 0.01) and was independently associated with having more than one sex partner in the prior 2 weeks (adjusted OR = 1.5; 95% CI 1.0–2.4). Our findings indicate increases in substance use, in particular cannabis, linked directly to experiences resulting from the COVID-19 pandemic and the associated interruptions in mental health care. Strategies that deliver services without direct client contact are essential for populations at high risk for negative sexual and mental health outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-022-00607-9.

Trends in Health Service Utilization After Enrollment in an Interdisciplinary Primary Care Clinic for Veterans with Addiction, Social Determinants of Health, or Other Vulnerabilities.

BackgroundModels of interdisciplinary primary care (IPC) may improve upon traditional primary care approaches in addressing addiction and social determinants of health.ObjectiveTo compare the trends in health care utilization in the year before and after enrollment in an IPC clinic model, and explore the variations in temporal patterns for patients with histories of high emergency department (ED) use, homelessness, and/or substance use disorders (SUDs).Design and ParticipantsInterrupted time series study of utilization among IPC patients.Main MeasuresQuarterly ED, inpatient, primary care, and behavioral health visits were abstracted from administrative data before and after IPC enrollment. Negative binomial segmented regressions estimated changes in health care utilization over time. We used interactions to test for statistical differences in temporal patterns for IPC subgroups.ResultsAmong IPC patients (n=994), enrollment was associated with overall reductions in ED, inpatient, and behavioral health visits (p’s<0.001) and increases in primary care (p’s<0.001). Temporal patterns of ED visits, hospitalizations, and behavioral health differed across IPC subgroups (interaction p’s<0.001). For those with histories of high ED use (n=265), ED, inpatient, and behavioral health visits decreased after enrollment (level change incidence rate ratios [IRRs]=0.57–0.69) and continued to decline over time (post-enrollment IRRs=0.80–0.88). Among other patients with homeless experiences (n=123), there were initial declines in hospitalizations (IRR=0.33) and overall declines in behavioral health visits (level change and post-enrollment IRRs=0.46–0.94). Other patients with SUDs had initial declines in hospitalizations (IRR=0.46), and post-enrollment declines in rates of specialty SUD visits (IRR=0.92). For all patients, primary care visits initially increased (level change IIRs=2.47–1.34) then gradually declined (post-enrollment IRRs=0.92–0.92).ConclusionsAn IPC model of care reduces acute care and behavioral health service use, particularly for patients with historically high ED use. IPC models may improve patient and system outcomes of vulnerable patient populations with social, clinical, and addiction morbidities.

Google Street View Images as Predictors of Patient Health Outcomes, 2017-2019.

Collecting neighborhood data can both be time- and resource-intensive, especially across broad geographies. In this study, we leveraged 1.4 million publicly available Google Street View (GSV) images from Utah to construct indicators of the neighborhood built environment and evaluate their associations with 2017–2019 health outcomes of approximately one-third of the population living in Utah. The use of electronic medical records allows for the assessment of associations between neighborhood characteristics and individual-level health outcomes while controlling for predisposing factors, which distinguishes this study from previous GSV studies that were ecological in nature. Among 938,085 adult patients, we found that individuals living in communities in the highest tertiles of green streets and non-single-family homes have 10–27% lower diabetes, uncontrolled diabetes, hypertension, and obesity, but higher substance use disorders—controlling for age, White race, Hispanic ethnicity, religion, marital status, health insurance, and area deprivation index. Conversely, the presence of visible utility wires overhead was associated with 5–10% more diabetes, uncontrolled diabetes, hypertension, obesity, and substance use disorders. Our study found that non-single-family and green streets were related to a lower prevalence of chronic conditions, while visible utility wires and single-lane roads were connected with a higher burden of chronic conditions. These contextual characteristics can better help healthcare organizations understand the drivers of their patients’ health by further considering patients’ residential environments, which present both risks and resources.

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

Distress tolerance: prospective associations with cognitive-behavioral therapy outcomes in adults with posttraumatic stress and substance use disorders

ABSTRACT 74Distress tolerance (DT; perceived or actual ability to tolerate aversive physical or emotional states) is related to both posttraumatic stress disorder (PTSD) symptoms and substance use disorders (SUD). This investigation evaluates self-report and behavioral measures of DT as potential predictors of PTSD and SUD cognitive-behavioral therapy outcomes. Participants included 41 treatment-seeking adults (53.7% women; 73.2% African American; M age = 44.90, SD = 9.68) who met at least four symptoms of DSM-5 PTSD and DSM-IV substance dependence, assessed via structured interviews. At baseline (pre-treatment), participants completed the Distress Tolerance Scale (DTS), Mirror-Tracing Persistence Task (MTPT), Breath Holding task, and Paced Auditory Serial Addition Task. The Clinician-Administered PTSD Scale for DSM-5 severity scores and percent days of primary substance use, measured via Timeline Follow-back, were used as indicators of PTSD symptoms and substance use, respectively. Covariates included treatment condition, baseline PTSD symptom severity, and baseline substance use. Lower perceived DT at baseline (DTS total score) was associated with higher PTSD symptom severity at end-of-treatment. Lower behavioral DT at baseline (MTPT duration) was associated with higher substance use at the conclusion of treatment (i.e. proportion of number of use days to total number of days between two final treatment sessions).

Perceived Social Support and its Effects on Treatment Compliance and Quality of Life in Cardiac Patients.

Background: The benefits of social support are often overlooked in common management components of cardiovascular diseases. The Multidimensional Scale of Perceived Social Support (MSPSS) is self-administered and scores perceived social support (PSS). We sought to identify PSS among cardiovascular patients and the effects it may have on quality of life (QoL) and treatment compliance. Methods: A total of 96 patients were evaluated using the MSPSS in 3 categories: significant other (SO), family, and friends using a 7-point Likert scale. A supplemental lifestyle survey assessed various demographics, subjective QoL, and compliance with treatment plans. Results: Patients with high QoL reported a higher PSS Likert score in the family support category. Patients who were compliant with appointments and had high substance use avoidance (tobacco, alcohol, illicit drugs) had a higher PSS Likert score in the friend support and higher PSS Likert score in support from SO and family categories, respectively. No difference in PSS was found in compliance with medications, diet, and exercise. Conclusion: Various social support categories are directly associated with higher QoL, adherence to appointments, and substance abuse avoidance.

Party, Academic, or Prepped for College? School Norm Profiles and Adolescent Well-being using National Data.

The current study examined how schoolwide norms came together into distinct profiles and how norm profile membership was linked to adolescent well-being. Using school-level (N = 786) and student-level data (N = 174,587 12th grade students; 52% female; 64% White, 13% Latino, 12% Black, 12% other) from Monitoring the Future (MTF), we identified four distinct school profiles-average, academic, prepped-for-college, party-that had unique patterns of shared norms. Compared with average schools, academic schools (high academics and low substance use and social integration norms) were most advantageous for students, prepped-for-college schools (high academics, substance use, and social integration norms) had both benefits and drawbacks, and party schools (low academics and high substance use and social integration norms) were most detrimental.

Identifying the availability of recovery housing in the U.S.: The NSTARR project

BackgroundHome is essential to recovery, and recovery housing can play an important role for individuals seeking a supportive environment. The National Study of Treatment and Addiction Recovery Residences (NSTARR) Project constitutes the largest and most diverse study of recovery housing to date. We describe the development of a national sampling frame to study recovery housing, as well as findings on availability and distribution of recovery housing across the U.S. MethodsData from publicly available sources and lists maintained by entities tracking recovery housing were compiled. Residences for which locating information was available were geocoded and linked with U.S. Census data and drug and alcohol mortality data. We used hot spot analysis and multilevel models to describe the geographic distribution of recovery residences and assess whether residences are located in areas of high need. ResultsThe NSTARR database contains information on 10,358 residences operated by 3628 providers in all 50 states. Residences were more likely (p < 0.05) to be in urban areas and in counties with higher substance use mortality; they were less likely to be in economically disadvantaged areas. Recovery housing density also was greater in urban areas and areas with a greater proportion of non-White residents, but lower in economically disadvantaged areas. ConclusionsDespite a wealth of research on some types of recovery housing, critical gaps in the field’s understanding about the nature of recovery housing remain. The NSTARR Project represents an important first step to expand research on recovery housing across the country.

School Health Predictors of the School-to-Prison Pipeline: Substance Use and Developmental Risk and Resilience Factors

PurposeThe purpose of the study is to establish prospective relationships among school mean levels of substance use, developmental risk and resilience factors, and school discipline. MethodsWe linked 2003–2014 data from the California Healthy Kids Survey and the Civil Rights Data Collection, from more than 4,800 schools and 4,950,000 students. With lagged multilevel linear models, we estimated relationships among standardized school average levels of six substance use measures; eight developmental risk and resilience factors; and the prevalence of total discipline, out-of-school discipline, and police-involved discipline. ResultsSchool mean substance use and risk/resilience factors predicted subsequent prevalence of discipline. For example, a one–standard deviation higher school mean level of smoking, binge drinking, and cannabis use was associated, respectively, with 16% (95% confidence interval [CI]: 14%, 18%), 18% (95% CI: 16%, 20%), and 21% (95% CI: 19%, 23%) higher subsequent prevalence of total discipline. A one–standard deviation higher mean level of community support and feeling safe in school was associated, respectively, with 21% (95% CI: 18%, 23%) and 9% (95% CI: 7%, 11%) lower total discipline. Higher violence/harassment was associated with 5% (95% CI: 4%, 7%) higher total discipline. Peer and home support, student resilience, and neighborhood safety were not associated with total discipline. Nearly all associations remained, attenuated, when we restricted to out-of-school and police-involved discipline. ConclusionsSchools with students who, on average, have higher substance use, less school and community support, and feel less safe in schools have a higher prevalence of school discipline and police contact. The public health implications of mass criminalization extend beyond criminal legal system settings and into schools.

Substance Use, PTSD Symptoms, and Suicidal Ideation Among Veteran Psychiatry Inpatients: A Latent Class Trajectory Analysis

In this study, we aimed to inform clinical practice by identifying distinct subgroups of U.S. veteran psychiatry inpatients on their alcohol and drug use severity, posttraumatic stress disorder (PTSD) symptoms, and suicidal ideation over time. Participants were 406 patients with co-occurring substance use and mental health disorders. A parallel latent growth trajectory model was used to characterize participants' symptom severity across 15 months posttreatment intake. Four distinct classes were identified: 47% "normative improvement," 32% "high PTSD," 11% "high drug use," and 9% "high alcohol use." Eighty percent of the sample had reduced their drinking and drug intake by half from baseline to 3 months, and those levels remained stable from 3 to 15 months. The High PTSD, High Drug Use, and High Alcohol Use classes all reported levels of PTSD symptomatology at baseline consistent with a clinical diagnosis, and symptom levels remained high and stable across all 15 months. The Normative Improvement class showed declining drug and alcohol intake and was the only class exhibiting reductions in PTSD symptomatology over time. High substance use classes showed initial declines in suicidal ideation, then an increase from 9 to 15 months. The reduction in frequency of drinking and drug use for 80% of the sample was substantial and supports the potential efficacy of current treatment approaches. However, the high and stable levels of PTSD for more than 50% of the sample, as well as the reemergence of suicidal ideation in a sizable subgroup, underscore the difficulty in finding and linking patients to effective interventions to decrease symptomatology over time.

Does substance use by family members and community affect the substance use among adolescent boys? Evidence from UDAYA study, India

BackgroundSubstance use among adolescents is risky behavior that had emerged as a concern in both developed and developing countries. Evidence revealed that substance use is more frequent among those adolescents whose immediate family members (parents, siblings and grandparents) also indulge in such consumption; however, scarce literature is present in the Indian context. Therefore, the present study examined whether substance use among family members and in the community is associated with the substance use behavior of adolescent boys in Uttar Pradesh and Bihar.MethodWe used the data for 5969 adolescent boys aged 10–19 years from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey conducted in 2016. A three-level random intercept logit model was utilized to understand the association of adolescent substance use behavior with familial and community context.ResultsWe found that 16% of adolescent boys were using any substance (tobacco or alcohol or drug). The substance use was significantly higher among adolescent boys who were school dropouts (40%) than those who were currently in school. The prevalence of substance use is also high among those who were working (35%). Moreover, 19, 24 and 28% of the adolescents come from families where at least one of the family members consumed tobacco, alcohol and drugs, respectively. The odds of substance use were 2.13 times [CI:1.44–3.17] higher among those adolescent boys whose family members also indulged in substance use. Moreover, the likelihood of substance use was 1.24 times [CI:1.01–1.68] higher among the adolescent boys who come from a community with high substance use. Additionally, the risk of substance use is more likely among adolescent boys belonging to the same household of the same community.ConclusionIt is evident that exposure to substance use in the family and community increases the likelihood of substance use among adolescent boys. There is a need for household- and community-level programmatic interventions to alleviate the risk of substance use among adolescents.