Sex and school type modified effects of depressive symptoms and screen use on substance use among adolescent in Taiwan: findings from a nation wide cross-sectional survey

Background: Among Taiwanese adolescent, how depressive symptoms, screen use affect on substance use remains unclear. This study aimed to examine (1) the cross-sectional association between depressive symptoms, screen use and substance use ; and (2) the modified effects of sex and school type on those mentioned associations. Methods: We analyzed 18,509 participants from the baseline survey of the Taiwan Adolescent to Adult Longitudinal Survey in 2015. The outcome was substance use including binge drinking, smoking, cigarette smoking and betel chewing. The main predictors were self-reported depressive symptoms and screen use. Multiple logistic regression was employed to estimate predictors, and a subgroup analysis was performed to assess effect modifications. Results: Among 18509 participants, 6.4% reported binge drinking, 5.6% reported smoking, 4.4 % reported e-cigarette smoking, 5.0% reported betel chewing. After adjustments for covariates including sex, school type, BMI, skipping breakfast and social determinants, the associations of depressive symptoms, screen use on substance use were significant. Stratified results indicated that depressive symptoms and screen use employed diverse effects on substance use across subgroups based on sex and school types. Conclusions: Depressive symptoms and screen use were notable factors positively associated with substance use among Taiwanese adolescents. The findings highlight the importance of strengthening public health interventions to monitor substance use, decrease depression, and screen use among adolescents.