Polysubstance use and correlations with psychosocial and health risk behaviours: A latent profile analysis among more than 95,000 Norwegian adolescents during the COVID-19 pandemic

Background and aims: Polysubstance use represents a health risk for adolescents; however, large scale studies on this issue during COVID-19 pandemic are scarce. We aim to (i) characterise substance use profiles among adolescents, and (ii) identify predictors of such substance use profiles. Design: A Norwegian nationwide survey was analysed using Latent Profile Analysis in 2021.Participants: Adolescents (N = 97,429; ages 13 to 18 years). Measurements: We assessed current cigarettes, e-cigarettes and snus use, lifetime alcohol consumption, and cannabis and other illicit drugs use over a 12-month period. Predictors included psychosocial variables, health risk behaviours, and COVID-19 related problems. Findings: We identified three adolescent profiles; those who use no substances (n = 88,890; 92%); those who use snus and alcohol (n = 6,546; 6%); and those who use multiple substances (i.e., polysubstance users; n = 1,993; 2%). Boys, older adolescents, adolescents with lower socio-economic status, and those reporting low levels of parental control and higher parental alcohol use were most likely to be polysubstance users. Other significant predictors were to have easy access to cannabis, mental health problems, a high prevalence of pain, a low consumption of fruit, low levels of physical activity, and using over the counter painkillers. Adolescents with social and mental health issues related to COVID-19 were also more at risk of being in the polysubstance user profile. Adolescents who use snus and alcohol showed similar patterns of correlates compared to non-users, but associations were weaker than for polysubstance users. Conclusions: Adolescents who use multiple substances have an unhealthier lifestyle, are at a higher risk of experiencing psychosocial impairments, and report more negative problems related to the COVID-19 pandemic. Preventative strategies aimed at reducing polysubstance use might help to promote psychosocial wellbeing in adolescents in various life domains.