Multilevel Correlates of Alcohol Use and Marijuana Initiation Among Hispanic Adolescents: Peer, Family, and Acculturation Influences

Background: Hispanic adolescents represent the most rapidly growing youth population in the United States. They report disproportionately high alcohol and marijuana use as well as disparities in accessing and benefiting from prevention initiatives during early adolescence with implications for health and development. School-based substance use education programs are typical across the U.S., though equitable benefit among Hispanic youth remains unclear. As Hispanic adolescent substance use is shaped by individual, social, family and cultural factors, there is a need for informing prevention before risk increases during mid-adolescence. This study examined attitudinal, social, and familial factors associated with alcohol use and marijuana initiation among Hispanic early adolescents and assessed the effectiveness of school-based substance use programs by English proficiency to inform future preventive efforts.

Methods: Using data from Hispanic adolescents aged 12-15 in the 2024 NSDUH (45% 12-13 years of age, 51% female, 69% attended school prevention programs, 4% reported monthly alcohol consumption), we modeled monthly alcohol use and marijuana initiation using survey-weighted logistic regression. Variables included approval of peer consumption, peer substance use, parental communication, exposure to school-based preventive programs, and English proficiency.

Results: Adolescents aged 14 to 15 presented higher odds of monthly alcohol use and marijuana initiation (OR = 4.36 and 2.58 respectively), while peer consumption presented positive associations (alcohol OR = 2.09, marijuana OR = 3.38). For monthly alcohol use, approval of peer consumption was positively associated (OR = 1.98), while talking to parents during difficulties was negatively associated (OR = 0.23). Marijuana initiation was positively associated with previous alcohol consumption (OR = 27.04) while also presenting a negative association with English non-proficiency and school-based prevention (OR = 0.42 and 0.12 respectively). Language moderated the association between school-based programs and marijuana initiation, where those with lower English proficiency benefit less (OR = 4.78).

Conclusions and Implications: Findings suggest that strengthening prevention for Hispanic youth may require attention to different social and contextual factors across substances. Alcohol and marijuana use appear to be associated with different social processes and cultural contexts among Hispanic youth. Alcohol use was also associated with peer approval of underage drinking and lower parental communication, highlighting the importance of peer norms and family support as key targets for early prevention. Marijuana use is more strongly associated with exposure to school substance use education than with peer and family dynamics. Differences in these associations across English proficiency suggest school substance use education may not be similarly associated with outcomes across linguistic groups. While youth with a lower English proficiency and exposure to substance use education in school had lower odds of marijuana usage, youth with lower levels of English proficiency did not. These differences in language proficiency may suggest language or acculturation barriers in youth access, engagement or effectiveness of prevention programs. These findings identify potential inequities in prevention delivery and highlight the need for culturally responsive approaches to substance use education to strengthen prevention efforts for Hispanic youth.