Youth social media use, mental health, and substance use show interconnected links.

Youth social media use and internalizing symptoms link to later substance use risk.

Youth social media use links to greater odds of internalizing symptoms.

Substance-specific patterns vary across the four substances examined.

Mental health, substance use, and social media are three important, inter-related factors influencing youth development. This study examines the dynamic, reciprocal relationships among social media use, internalizing mental health symptoms, and substance use (e-cigarette, alcohol, cigarette, and marijuana) among U.S. adolescents.

Data were from restricted Population Assessment of Tobacco and Health (PATH) Study, Waves 4, 4.5, and 5 (2016–2019). The sample included 7759U.S. adolescents (weighted N = 15,032,305) who completed all three waves. Weighted generalized structural equation models with lagged dependent variables were performed to examine the reciprocal relationships between youth’s social media use frequency, internalizing symptoms, and use of substances. Each variable has a dual role as both a predictor and outcome across waves, with earlier waves predicting subsequent ones, to assess bidirectional influences over time.

Higher social media use and internalizing symptoms were associated with higher odds of subsequent e-cigarette, alcohol, and marijuana use. Higher social media use predicted higher odds of e-cigarette use (AOR=1.33, p < 0.001) and alcohol use (AOR=1.19, p < 0.001). Internalizing symptoms predicted higher odds of cigarette use (AOR=1.71, 95 % CI=1.15–2.53). Social media use also predicted greater odds of experiencing internalizing symptoms (AORs=1.05, all ps < 0.01). We found both similarities and differences in the patterns of the reciprocal pathways overtime across the four substances.

Our study reveals a complex and dynamic relationship among social media use, mental health, and substance use among youth. The findings support the need for integrative interventions that simultaneously address mental health, social media behaviors, and substance use risk.

Social media use

Internalizing mental symptoms

Substance use

Reciprocal relationships

Youth

© 2025 The Authors. Published by Elsevier B.V.