Trends of Adolescent Substance Use by Type of Victimization: COVID-19 Interaction Effects in the United States Youth Risk Behavior Survey (2013–2023)

Background: Adolescent substance use remains a public health concern, particularly among youth exposed to interpersonal victimization. The COVID-19 pandemic has further disrupted social contexts, potentially intensifying disparities in substance use. Methods: We analyzed nationally representative data from the Youth Risk Behavior Survey (2013–2023), including 52,679 U.S. adolescents. Substance use outcomes included current cigarette use, alcohol use, marijuana use, and other drug use. Victimization types were categorized as school bullying, electronic bullying, sexual victimization, or multiple. Linear logistic regression models were used to assess temporal trends and victimization-by-year interaction effects. Difference-in-differences (DID) regression tested changes across pre-COVID-19 (2019), COVID-19 pandemic (2021), and post-COVID-19 (2023) periods. Results: Overall, 27.2% of adolescents reported at least one form of victimization. Adolescent with sexual victimization had higher odds of alcohol use (aOR = 2.79) and other drug use (aOR = 3.65) compared to non-victimized peers. Those reporting multiple victimizations had the highest risk across all substances, particularly for marijuana use (aOR = 3.53) and inhalant use (aOR = 6.45) during the pandemic. Victimization-by-year interactions were significant (p < 0.05), indicating widening disparities over time. While marijuana use declined in 2021, it rebounded in 2023 among multiple victimization group (aOR = 1.72). Conclusions: The COVID-19 pandemic exacerbated substance use disparities among victimized adolescents, especially those with multiple victimizations. Findings highlight the need for trauma-informed, targeted interventions beyond universal school-based approaches to address these behavioral vulnerabilities.