Adolescents who experienced multiple forms of victimization had 3.5 times higher odds of marijuana use during the pandemic, and the gap between victimized and non-victimized youth widened from 2019 to 2023.
School counselors, youth mental health providers, trauma-informed care practitioners, public health researchers
What the researchers found
Among 52,679 US adolescents from the YRBS (2013-2023), 27.2% reported at least one form of victimization. Those experiencing sexual victimization had higher odds of alcohol (aOR=2.79) and other drug use (aOR=3.65). Youth with multiple victimizations had the highest substance use risk overall, with marijuana use odds peaking at aOR=3.53 during the pandemic. While marijuana use declined broadly in 2021, it rebounded to aOR=1.72 by 2023 specifically among the multiple-victimization group. Victimization-by-year interactions were significant, indicating widening disparities over time.
Why it matters
The pandemic did not affect all adolescents equally. Youth who were already vulnerable through victimization experienced disproportionately worsened substance use outcomes, and these disparities persisted even after pandemic restrictions eased.
The numbers in context
52,679 adolescents; 27.2% reported victimization; multiple victimizations: marijuana aOR=3.53 during pandemic; sexual victimization: alcohol aOR=2.79, other drug aOR=3.65; marijuana rebounded to aOR=1.72 in 2023 among multiple-victimization group
How the study worked
Analysis of nationally representative Youth Risk Behavior Survey data (2013-2023, N=52,679). Victimization categorized as school bullying, electronic bullying, sexual victimization, or multiple. Linear logistic regression assessed trends and victimization-by-year interactions. Difference-in-differences regression tested changes across pre-COVID, pandemic, and post-COVID periods.
What this study cannot tell us
YRBS is school-based and excludes non-enrolled youth, who may have higher victimization and substance use rates. Self-report measures. Cross-sectional at each wave, though difference-in-differences approach strengthens causal inference. Cannot assess dose-response relationships.
How to read the evidence
Strong: nationally representative data across five survey waves with robust statistical methods including difference-in-differences analysis.
When this study was published
2025 publication using 2013-2023 YRBS data
The bigger picture
Universal prevention programs may not reach the youth at greatest risk. The widening substance use gap between victimized and non-victimized adolescents during and after COVID suggests trauma-informed, targeted approaches are needed alongside broader prevention efforts.
Questions still open
- Are post-pandemic prevention resources reaching multiply-victimized youth?
- Would trauma-focused interventions reduce the substance use rebound seen in 2023?
Read the original research
Trends of Adolescent Substance Use by Type of Victimization: COVID-19 Interaction Effects in the United States Youth Risk Behavior Survey (2013-2023).
Substance use & misuse, 1-11
Citation
Gu, Hyejin; Myong, Jun-Pyo. (2025). Trends of Adolescent Substance Use by Type of Victimization: COVID-19 Interaction Effects in the United States Youth Risk Behavior Survey (2013-2023).. Substance use & misuse, 1-11. https://doi.org/10.1080/10826084.2025.2597457
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