How social support shields teens from violence and substance use

Substance use (SU) and violence drive a significant proportion of adolescent mortality. Identifying shared protective factors is crucial. We aimed to characterize adolescent SU and violence typologies and examine associations with protective factors. Using cross-sectional surveys from 17 high schools, we assessed individual (psychological empowerment and future orientation), interpersonal (social support and school connectedness), and environmental (Child Opportunity Index) protective factors. We used latent class analysis to identify risk profiles across multiple forms of SU and violence. Multinomial regression assessed relationships between protective factors and latent class membership. Among 3,641 respondents, fighting was the most frequent violence type (20.2%). Marijuana use (20.0%) and vaping (17.6%) were common. Latent class analysis revealed five groupings: (1) low violence and low SU (72.7%); (2) low violence and high SU (10.3%); (3) sexual violence and moderate SU (5.7%); (4) high multiple violence and high SU (2.4%); and (5) fighting and marijuana/vaping (8.8%). Opioid use was highest (55.1%) in the high SU and high multiple violence class. Sexually diverse youth comprised most of the sexual violence and moderate SU (52.9%) and high multiple violence and high SU (50.6%) classes. Compared to the low violence and low SU class, high social support was associated with lower odds of membership in other categories. High future orientation was associated with lower odds of membership in the sexual violence and moderate SU class relative to low violence groups. Experiencing multiple types of violence tends to co-occur with SU, necessitating interventions for youth with compounding exposures.