Rates Of Substance Use Research Articles

Prevalent Adverse Childhood Experiences Among Young Adults Returning Home From Jail: The Need for Trauma-Informed Reentry Services.

Prevalence of adverse childhood experiences (ACEs) and the extent to which they relate to health among young adults (ages 18-25) returning home from jail is underexamined. To build on the growing literature examining associations between ACE exposure among young people involved with carceral systems and health, we (1) measured ACE prevalence and (2) explored associations between ACEs and health/well-being indicators among young adults experiencing reentry. Using a telephone survey on reentry experiences, participants completed an ACE screening, single-item responses on health and social indicators, and five-item responses on substance misuse. Fisher's exact tests and t tests compared sociodemographic and health-related factors by the levels of ACEs. Among the 85 participants, 66 (78%) reported four or more ACEs and 48 (56%) reported six or more ACEs, including divorced parents (n = 69, 81%), witnessing violence (n = 63, 74%), and household member incarceration (n = 60, 71%). Higher exposure to ACEs was associated with mental health diagnoses, psychiatric medication prescriptions, psychiatric hospitalizations, drug dependence, binge drinking, and cannabis misuse. High ACE exposure among young adults experiencing reentry portends worse mental health and high rates of substance use. Findings signify an opportunity to apply a trauma-focused developmental framework to support emerging adults during the crucial reentry period.

What does international evidence tell us about the health of people with childhood social care (CSC) experiences?

Abstract International research into the health of people with childhood social care (CSC) experiences has found evidence of worse mental health and emotional-behavioural wellbeing, higher rates of substance use, neurodevelopmental conditions, and avoidable mortality. Lower vaccination rates and worse dental health among those in care has also been reported in few countries. However, research results have been more mixed with regard to some physical health conditions, with higher prevalence of asthma and respiratory ill health among foster children reported in the US but no obvious differences found in the UK. Are there countries where these inequalities are less pronounced, and can we draw such conclusions based on available evidence? When making international comparisons or aiming to give policy advice, we also need to consider the quality of our evidence. Has this been based on small sample sizes or without comparison to other children and adjusting for relevant (socioeconomic) confounders? Most of our current knowledge is also cross-sectional and we do not know if some health conditions precede entry to care and may even be risk-factors for entering social care. Recent longitudinal and cross-sectoral data linkage programmes in many nations (Australia, UK, Canada) have a potential to change this and provide a foundation for evidence-based recommendations for policy and practice.

Characterizing a syndemic: STI symptoms, substance use & violence among incarcerated Peruvian women

Abstract Background Despite increasing rates of incarceration and sexually transmitted infections (STIs) among women globally, STI epidemiological data for this vulnerable at-risk population is limited. We therefore characterized patterns of STI symptoms and explored covariates and drivers of STI symptoms among incarcerated women in Peru. Methods Among 249 incarcerated women surveyed on substance use, depression, sexual behavior, STI symptoms and violence, univariate and bivariate analysis informed a latent profile analysis (LPA) and logistic regression assessing for syndemic associations between violence, substance use, and STI symptoms. Results Most participants were Peruvian (93.5%), in their late 30s (median=37; range:18-70 years), sentenced to < 5 years (86.6%) and had completed high school (78.7%). 36.9 had ≥2 STI; A minority were pregnant (2.6%), had children residing with them in prison (7.2%); symptoms. The LPA model with the best fit revealed the largest (39%) group with a ‘syndemic’ profile involving co-occurrence of multiple STI symptoms, substance use, and experiences of interpersonal violence (IPV); 86.6% of this latent class were <50 years old. The substance use and violence ‘syndemic’ profile was associated significantly higher likelihood of having multiple STI symptoms (2+ symptoms: PR = 1.88 (95% CI 1.18, 2.99) or 3+ symptoms PR = 2.55 (95% CI 1.32, 4.93). Conclusions and Recommendations The syndemic of younger incarcerated women with substance use and IPV with STI symptoms portends a group at substantially higher risk for HIV and given the structured setting of prisons, should be routinely screened for and treated for STIs. Moreover, these settings can and should screen for and address substance use and IPV and intervene before these women are released to community settings to not only improve individual but public health needs. Key messages • In line with syndemic theory, incarcerated women presenting with multiple STI symptoms (≥2) were more likely to be engaged in substance use (illicit drug use and/or alcohol) and experience violence. • Post-hoc analysis also revealed the rate of substance use was higher among women who engaged in commercial sex work (CSW) pre-incarceration compared to those who were not engaged in CSW.

Employment and mental health for adults on probation, 2002-2021.

The 21st century has seen a decline in employment rates in the US at the same time that it has experienced a historically unprecedented rise in the numbers of adults under criminal justice system control. Both low employment and high incarceration have posed serious challenges for public health. Using data from the National Survey on Drug Use and Health from 2002-2021, we estimated employment rates by community supervision status. Variations by sociodemographic subgroups were explored as well as correlations between employment and a range of mental and behavioural health variables. Those on probation were twice as likely as those not to live in poverty. They experienced higher rates of poor mental and behavioural health, including three times the rate of substance use. Employment rates varied little by community supervision status. Health risk factors were associated with more risk and protective factors did less to mitigate risk for those under community supervision. Despite the range of adversities faced by individuals under criminal justice system control, their employment rates are remarkably close to those not. Despite near equivalent involvement in the labour force, this population has substantially poorer health and substantially reduced likelihood of escaping poverty.

Past-year substance use behaviors among university admission test-takers: insights from Bangladesh

University entrance test-takers are a vulnerable group of students transitioning from adolescence to youth, a peak time for adopting unhealthy behaviors. However, limited studies investigate substance use behaviors among this group. This study aimed to investigate the current (past 12 months) prevalence, associated risk factors, and geographic distribution of substance use behaviors, employing spatial analysis to identify regional disparities. A cross-sectional study was conducted utilizing convenience sampling in February 2024 among university entrance test-takers at Jahangirnagar University, Dhaka, Bangladesh (N = 1485). Participants provided information on socio-demographics, admission-related, depression (PHQ-9), anxiety (GAD-7), and substance use. Chi-square tests and logistic regression were employed to explore significant associations, with spatial analysis using ArcGIS to map substance use across districts. About 20.8% reported smoking, 10.1% reported drug use, and 9.9% reported alcohol consumption over the past 12 months. Males exhibited higher rates of smoking (23.1% vs. 17.6%) and alcohol consumption (10% vs. 9.7%), while females reported slightly higher rates of drug use (10.2% vs. 10%). Being female (AOR = 0.56; 95% CI: 0.40–0.79; p = 0.001), living in rural areas (AOR = 0.68; 95% CI: 0.49–0.94; p = 0.020), having a higher monthly family income (AOR = 1.72; 95% CI: 1.01–2.91; p = 0.042), a history of physical illness (AOR = 2.65; 95% CI: 1.87–3.76; p < 0.001), being a repeat test-taker (AOR = 1.49; 95% CI: 1.08–2.05; p = 0.014), and satisfaction with previous mock tests (AOR = 1.66; 95% CI: 1.20–2.28; p = 0.002) were significant risk factors for smoking. For drug use, belonging to a joint family (AOR = 1.71; 95% CI: 1.08–2.71; p = 0.021), having a history of physical illness (AOR = 2.57; 95% CI: 1.64–4.02; p < 0.001), and satisfaction with previous mock tests (AOR = 1.84; 95% CI: 1.20–2.83; p = 0.005) increased the risk. Additionally, a history of physical illness (AOR = 5.12; 95% CI: 3.27–8.02; p < 0.001) and satisfaction with previous mock tests (AOR = 1.78; 95% CI: 1.13–2.80; p = 0.013) were contributing factors to alcohol consumption. Spatial analyses indicated higher rates of substance use in border districts. The findings warrant targeted interventions, such as mental health support and substance use prevention programs, particularly in high-risk regions. By understanding the factors driving substance use, tailored strategies can be developed to reduce risk behaviors among university entrance test-takers, ultimately enhancing public health outcome in this vulnerable population.

Breaking barriers: Exploring collegiate recovery among black college students

The issue of substance use disorders among college students is a growing problem that has been widely studied and reported on in recent years. However, the experiences of black college students in recovery have been largely underrepresented. Although white college students tend to have higher rates of substance use, black college students face unique challenges in accessing resources that support recovery from substance use disorders. This article will highlight the experiences of black college students in recovery, the barriers they face, the importance of collegiate recovery community programs in addressing these barriers, and the need for more programs that cater to these experiences. Through an exploration of literature and current efforts, this article aims to emphasize the significance of collegiate recovery among black college students and a need for the implementation of culturally sensitive and responsive programs at historically black colleges and universities.

Using virtual reality technology to prevent substance misuse and violence among university students: A pilot and feasibility study.

Objectives: New prevention approaches that use engaging and innovative technologies are needed to reduce high rates of substance use and violence among university students. The present study developed and pilot-tested virtual reality (VR) technology that presented university students with immersive environments where they practiced skills with virtual peers. Methods: After viewing e-learning modules with prevention content, students engaged with immersive VR module prototypes to practice cognitive-behavioral skills for preventing risk behaviors, including assertive communication, negotiation, compromise, conflict resolution, and bystander intervention strategies. Results: Paired t-tests showed increases in life skills knowledge and anti-violence attitudes among students from the pretest to posttest assessments. Students and educators were enthusiastic about the VR prototypes, rating them as feasible, relevant, appealing, engaging, and innovative for prevention. Participants provided feedback on ways to improve the VR experience by including a greater variety of conflict situations, more nuanced branched scenarios and response options, and a more complete representation of all scenario outcomes. Conclusions: Findings suggest that VR scenarios are a promising strategy for enhancing life skills to help prevent health risk behaviors among university students.

Driving Under the Influence of Alcohol and Cannabis by Sexual Identity, Race, Ethnicity, and Gender: A Nationwide Analysis Using the 2016 to 2019 National Survey on Drug Use and Health.

Sexual minority populations experience higher rates of substance use and related problems, but little is known about their specific involvement in driving under the influence (DUI) of alcohol (DUIA) and cannabis (DUIC) incidents. Using data from the 2016 to 2019 National Survey on Drug Use and Health, we used logistic regression models to estimate the interactive effects of sexual identity, race/ethnicity, and gender on past-year DUIA among adults who used alcohol and DUIC among adults who used cannabis, accounting for covariates. Using model estimates and linear combinations, we calculated the predicted probabilities of each outcome and compared sexual identity differences within and across race/ethnicity and gender. With few exceptions, the predicted probabilities of DUIA and DUIC were significantly higher among sexual minority women than heterosexual women of similar race/ethnicity. The results were more variable among men with the probabilities of DUIA and DUIC being significantly higher for some groups of sexual minority men and some groups having probabilities equal to or lower than similar heterosexual men. Some of the largest sexual minority gaps in DUIA and DUIC were observed among Hispanic and Other lesbian women and Black gay men. Sexual minority individuals are more likely to report DUI than their heterosexual counterparts; however, the risk of DUI among sexual minority populations varies by racial/ethnic and gender subgroup. Our findings indicate the importance of applying an intersectional framework when addressing substance-use-related disparities and when designing effective DUI prevention interventions for sexual minority populations.

Firearm violence and associated factors among young adults presenting to emergency departments in three cities: Baseline results from Project SPARK

ObjectiveRecent shifts in U.S. violence dynamics call for updated violence epidemiology among general emergency department (ED) samples of young adults. Using baseline data from a multi-site longitudinal study of firearm violence prediction, we describe violence rates and associated factors. MethodsStaff approached age 18–24 entrants to Level-1 trauma centers in three cities (Flint, Seattle, Philadelphia; 7/2021–5/2023). Consenting participants completed a survey including validated measures of violence experience, firearm-related behaviors, substance use, mental health symptoms, peer/parental/familial behaviors, community violence, and attitudes/norms. We described the sample and examined factors associated with firearm assault (victimization/aggression, including threats). ResultsAcross sites, 1506 participants enrolled (41.7. % Black; 33.6 % White; 61.4. % female). Half of participants self-reported past-six-month violent victimization and/or aggression; non-partner violence, and violent victimization were most common. Over half of participants self-reported high-risk substance use, and over half screened positive for post-traumatic stress disorder, depression, and/or anxiety. About 14.4 % self-reported past-six-month firearm assault, and 5.9 % self-reported firearm violence (excluding threats). Adjusted analysis showed community violence exposure was most strongly associated with firearm assault; each one-point-increase corresponded to a 13.7 % (95 %CI: 10.4 %–16.9 %) absolute increase in firearm assault prevalence. Drug misuse, mental health symptoms, firearm carrying, retaliatory attitudes, prosocial attitudes, and family conflict were also associated with firearm assault. ConclusionsViolence, including firearm assault, is common among young adults entering urban EDs, and is associated with several psychosocial factors. High rates of substance use and mental health symptoms underscore this as a high-need population. Leveraging this information could help tailor interventions and optimize resource allocation.

Clinical Screening and Assessment Considerations for Comorbid Substance Use Disorders in Adolescents With Mood Disorders

Although prevalence rates of substance use in adolescence have remained steady or declined in recent years, there is a concerning increase in overdose deaths in the last decade. Given the significant burden associated with substance use disorders, systematic screening and assessment are important to identify substance use risk and diagnose substance use disorders. Youth with mood disorders are at an increased risk of developing a substance use disorder. Understanding risk factors is critical to effective screening and assessment as well as early identification and intervention. In the present review, we discuss current research on risk factors of comorbid substance use disorders in youth with mood disorders and provide a brief review of commonly used screening and assessment tools for use with adolescents. Finally, we conclude with considerations for next steps following screening and assessment of comorbid substance use disorders in youth with mood disorders. [ Psychiatr Ann. 2024;54(9):e248–e252.]

Housing and supportive services for young mothers experiencing substance use disorder and homelessness: Cost-effectiveness analysis of a randomized trial

BackgroundMothers experiencing homelessness and caring for young children struggle with high rates of substance use and mental health problems. A comprehensive supportive housing intervention was implemented to assist young mothers experiencing substance use disorder (SUD) and homelessness. The cost-effectiveness of this intensive intervention could inform future dissemination. MethodsA cost-effectiveness analysis was conducted alongside a randomized controlled trial that lasted from May 2015 to October 2018. Mothers experiencing homelessness between the ages of 18–24 years with a SUD were randomly assigned to housing+support services (HOU + SS) (n = 80), housing-only (HOU) (n = 80), or services as usual SAU (n = 80). Using incremental cost-effectiveness ratios (ICERs), the study compared the costs of HOU + SS and HOU to SAU for three outcomes: housing stability (percent days of stable housing), substance use (percent days of substance use), and depressive symptoms (Beck Depression Inventory score). Direct intervention costs of HOU + SS and HOU from both payor and societal perspectives were estimated. Cost data were collected from detailed study financial records. Outcomes were taken from 6-month assessments. ResultsThe average societal cost of HOU + SS per participant was $5114 [CI 95 %, $4949-5278], while the average societal cost of HOU was $3248 [CI 95 %, $ 3,140–$3341] (2019 U.S. dollars). The calculated ICERs show that HOU was more cost-effective than HOU + SS and SAU for housing outcome. For illicit drug use, HOU + SS was more cost-effective than HOU. Finally, for depressive symptoms, neither HOU + SS or HOU were more cost effective than SAU. ConclusionWhile HOU is more cost-effective for increasing housing, HOU + SS is more cost-effective for reducing illicit drug use. However, housing without improvements in substance use may not be sustainable, and supportive services are likely essential for improved well-being overall beyond the housing outcome alone.

Reimagining Supportive Approaches at the Intersection of Mandatory Reporting Policies for the Mother-Infant Dyad Affected by Substance Use.

As rates of substance use during pregnancy persist, the health and optimal development of infants with prenatal substance exposure remain a key priority. Nurses are tasked with identifying and reporting suspected cases of child maltreatment, including abuse and neglect, which is often assumed to be synonymous with substance use during pregnancy. While policies aimed at protecting infants from child abuse and neglect are well intentioned, literature regarding the short- and long-term social and legal implications of mandatory reporting policies is emerging. In this article, we explore the intersections between the condition of substance use in pregnancy and policies related to mandatory reporting. We provide an overview of historical and current trends in mandatory reporting policies for nurses related to substance use in pregnancy and related ethical and social implications for mother-infant dyads. Nurses often function at the intersection of healthcare and social services, underscoring the important role they play in advocating for ethical and equitable care for both members of the mother-infant dyad affected by substance use. We offer recommendations for practice including the integration of respectful care and family-centered support for the mother-infant dyad affected by substance use. Cross-sectoral collaborations, inclusive of the family, are important to the advancement of evidence-based and equity-focused research, advocacy, and policy initiatives to support familial preservation and reduce mother-infant separation.

Psilocybin-assisted therapy and HIV-related shame

As a proposed mediator between stigma-related stressors and negative mental health outcomes, HIV-related shame has been predictive of increased rates of substance use and difficulties adhering to antiretroviral treatment among people with HIV. These downstream manifestations have ultimately impeded progress toward national goals to End the HIV Epidemic, in part due to limited success of conventional psychotherapies in addressing HIV-related shame. In a pilot clinical trial (N = 12), receipt of psilocybin-assisted group therapy was associated with a large pre-post decrease in HIV-related shame as measured by the HIV and Abuse Related Shame Inventory, with a median (IQR) change of − 5.5 (− 6.5, − 3.5) points from baseline to 3-months follow-up (Z = − 2.6, p = 0.009, r = − 0.75). A paradoxical exacerbation of sexual abuse-related shame experienced by two participants following receipt of psilocybin raises critical questions regarding the use of psilocybin therapy among patients with trauma. These preliminary findings carry potential significance for the future of HIV care.

Optimism, pessimism, and physical health among youth: a scoping review.

High levels of optimism (and low levels of pessimism) are associated with improved physical health in adults. However, relatively less is known about these relations in youth. The present study aimed to review the literature investigating optimism, pessimism, and physical health in children and adolescents from populations with and without health conditions. We conducted a scoping review up until February 2024. Studies were included if they sampled youth (average age ≤18 years) and treated optimism or pessimism as predictors of health behaviors or outcomes. Data on study and sample characteristics, health outcome, optimism construct, and findings were extracted from eligible papers and results were synthesized. Sixty studies were retained. Most studies were conducted in North America, with adolescents, and used cross-sectional designs and self-reported measures of health. Measures of optimism and pessimism differed across studies. Roughly one-third of studies sampled medical populations. Health categories included substance use, diet and physical activity, sexual health practices, medical adherence, other health behaviors, cardiometabolic health, subjective health/health-related quality of life, pain, sleep, and oral health. Generally, we observed adaptive associations between optimism and health. Higher optimism and lower pessimism were most consistently associated with lower rates of substance use and lower cardiometabolic risk. The presence of optimism or the absence of pessimism appears to be associated with various adaptive health outcomes among youth with and without health conditions. Developmental, methodological, and clinical considerations for future research are discussed, such as conducting longitudinal studies with objective measures of health and psychometrically validated instruments.

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.

Early vs. Later Experiences of Violence and Polysubstance Use Among Adults Who Inject Drugs

Background People who inject drugs (PWID) experience high rates of violence, especially in early childhood, increasing their likelihood of engaging in risky substance use behavior in adulthood. Additionally, complex trauma has been reported among PWID due to witnessing and experiencing an overdose, further highlighting the need to examine the role of multiple experiences of trauma on their vulnerability to substance misuse. Methods Our study of 350 PWID from rural Kentucky examined differences in polysubstance use between participants who experienced violence earlier (≤15 years old) versus later (≥16 years old) in their childhood. Results Findings highlighted a direct association between experiences of early childhood violence and polysubstance use in adulthood. Additionally, our sample of PWID who experienced violence early in their childhood reported higher rates of severe substance use disorder and mental health distress. Conclusions Tailored approaches that incorporate trauma-informed care may help to address the disproportionate rates of substance use and related adverse effects among PWID.

On the pathway to health equity: Creating a harm reduction strategy for a large academic acute care hospital.

An urban centre in southwestern Ontario continues to be faced with the extensive impacts of high rates of substance use. To more effectively meet the quintuple aim, in a way that authentically considers patients who use substances, the need for a cohesive, comprehensive organizational harm reduction strategy at the large academic acute care hospital providing community and regional healthcare services was clear. Community-based harm reduction expertise was leveraged to support the development work. Information gathered through literature review and interviews with patients, internal staff and leaders, partner healthcare agencies, and Canadian hospitals leading in harm reduction work provided key insights and supported the formulation of emerging recommendations that will be used to shape the acute care hospital's formal organizational harm reduction strategy.

Afrocentric Norms and Substance Use Behaviors Among Black Young Adults

ABSTRACT Despite not displaying higher overall rates of substance use compared to White Americans, the social consequences of substance use disorders for Black Americans, particularly among Black American men, are more damaging. Furthermore, recent data suggest an uptick in substance use-related deaths among Black Americans, raising serious concerns about a growing health disparity that warrants the need for studies to identify factors associated with prevention. For decades, Black cultural theorists have argued that Afrocentric norms are important buffers against maladaptive behaviors in Black Americans, but the association in the context of substance use is still an emerging area. The present study investigated the associations between Afrocentric norms, Afrocentric self-regard, internalized negative stereotypes, and substance use attitudes and behaviors among Black young adults. Self-report questionnaires were administered to measure internalized negative stereotypes, Afrocentric norms, Afrocentric self-regard, substance use attitudes, and substance use from a sample of Black young adults (N = 619). Favorable attitudes toward substance use were found to be positively associated with internalized negative stereotypes but were inversely associated with Afrocentric norms and Afrocentric self-regard. Similarly, substance use reports within the past 30 days were inversely associated with Afrocentric norms, but the relationship to cannabis use was non-significant. Gender differences between Black men and women were also found. Implications for social work are discussed.

Addressing Substance Use in the Adolescent Transplant Population.

Adolescence is a unique period of physical and psychosocial changes as youth transition, over many years, to adulthood. The psychosocial changes that accompany adolescence include emotional separation from parents, greater influence of peer groups, an interest in self-identification and autonomy, and increased risk-taking behaviors. Substance use is a common form of risk-taking behavior in the adolescent developmental stage. Alcohol, nicotine, and cannabis are the most common types of substances used in the United States. In the adolescent transplant population, rates of substance use appear to be at, or slightly below, their peer counterparts. Substance use can lead to deleterious health outcomes for adolescent transplant patients as a result of impaired decision-making, reduction in medication and clinic visit compliance, increases in mental health disorders, and risk for developing dependence and a substance use disorder. Given the close relationship that many pediatric transplant providers have with their patients and families, transplant care teams are in an excellent position to help their patients by addressing adolescent substance use. This narrative review describes how providers can use proactive standardized approaches to identify and intervene with substance use behavior.

Sex differences in age-varying trends of depressive symptoms, substance use, and their associations among South Korean adults: A Time-Varying Effect Modeling (TVEM) analysis of a nationwide sample

BackgroundThis study investigated sex differences in the age-varying trends of depressive symptoms, substance use, and their relationships throughout the adult lifespan. Using a nationwide sample from South Korea, this study aimed to confirm existing patterns and identify unique characteristics specific to the South Korean context. MethodTime-Varying Effect Modeling (TVEM) was applied to data from 17,484 participants (9987 women and 7497 men) in the Korea National Health and Nutrition Examination Survey. ResultsConsistent with global trends, the results revealed a higher prevalence of depressive symptoms among women and a greater prevalence of substance use among men. However, the findings also illuminated unique patterns within the South Korean context. Substance use among South Korean men peaked during their 40s, whereas South Korean women consistently exhibited lower rates of substance use. Additionally, a stronger association between depressive symptoms and substance use was identified in women compared to men. LimitationsThe study used cross-sectional data, limiting the analysis of temporal dynamics between depressive symptoms and substance use. Additionally, TVEM cannot distinguish between aging and cohort effects. Furthermore, the assessments of depressive symptoms and substance use were based on self-report. Finally, the study did not include adolescents or sex and gender minorities in its sample. ConclusionsThese results emphasize the need for targeted interventions, particularly among women in their 20s and older adulthood, where there is a heightened co-occurrence of depressive symptoms and substance use. These findings also highlight the importance of sex- and culture-sensitive approaches tailored to the South Korean context.