Substance Use and Risky Sexual Behavior Among Adolescents: A Cross-National Clustered Analysis of 35 European and North American Countries.

Adolescents, comprising about 16% of the global population, experience unique challenges during their transition to adulthood, which can be marked by substance use and risky sexual behaviors. Two key gaps exist in previous studies investigating substance use and sexual behaviors among adolescents including: (1) lack of stratified analysis based on sex; and (2) the use of broader or composite term/variable 'substance use'. This study sought to address these gaps by investigating the association between specific substances, including alcohol, cigarette, and cannabis and risky sexual behavior for adolescent boys and girls in 35 countries across Europe and North America. Data were obtained from the 2017/2018 Health Behavior in School-aged Children (HBSC) survey, involving 10,060 adolescents aged 15 years, stratified by gender 5574 boys and 4486 girls, from 35 countries. Clustered binary logit models using the Generalized Estimating Equation approach were employed to assess the association between the use of alcohol, cigarette, and cannabis and adolescent risky sexual behavior status. Our results showed that alcohol use was statistically significantly associated with higher odds of risky sexual behavior for boys (AOR = 1.31; 95% CI = 1.16, 1.47) and not for girls (AOR = 1.07; 95% CI = 0.92,1.24). Cigarette smoking, however, was statistically significantly associated with higher odds of risky sexual behavior for girls (AOR = 1.58; 95% CI = 1.26,1.97) and not for boys (AOR = 1.26; 95% CI = 0.86, 1.84). Cannabis was not significantly associated with risky sexual behavior for both boys and girls. Findings from this study underscore the complex link between substance use and risky sexual behavior among adolescents. The results highlight the importance of understanding gender-specific differences in risk-taking behaviors, especially concerning substance use and its influence on risky sexual behaviors. These insights are crucial for designing effective interventions and promoting healthier behaviors among adolescents.