COVID-19 Worsened Substance Use Disparities Among Victimized Adolescents

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.

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.

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.

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.

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.