Examining Risk and Protective Factors for Probable Youth Substance Use Disorder in a Diverse Statewide Sample
Rachel Pai BS1*, Mika D. Thompson MS2, Jane Onoye PhD3, John Valera MURP4, Trevor Lee PhD4
1University of Hawaiʻi at Ma noa, John A. Burns School of Medicine, Honolulu, HI, USA.
2Office of Public Health Studies, University of Hawaiʻi at Ma noa, Honolulu, HI, USA.
3Department of Psychiatry, University of Hawaiʻi at Ma noa, John A. Burns School of Medicine, Honolulu, HI, USA.
4Alcohol and Drug Abuse Division, Department of Health, State of Hawai‘i, Kapolei, HI, USA.
*Corresponding Author: Rachel Pai, 1356 Lusitana Street, 4th Floor, Honolulu, Hawai‘i, USA.
https://doi.org/10.58624/SVOAPD.2025.04.018
Received: October 16, 2025
Published: November 04, 2025
Citation: Pai R, Thompson MD, Onoye J, Valera J, Lee T. Examining Risk and Protective Factors for Probable Youth Substance Use Disorder in a Diverse Statewide Sample. SVOA Paediatrics 2025, 4:5, 116-126. doi: 10.58624SVOAPD.2025.04.018
Abstract
Objectives: The social-ecological framework of youth substance use posits that substance use arises from risk and protective factors (RPFs) on the individual, family, peer, school, and community levels. Less is currently known about protective factors compared to risk factors. The objective of this study is to examine a model for RPFs for probable substance use disorder (pSUD) in a large multi-ethnic sample of Hawaiʻi students.
Methods: A secondary analysis was conducted on a sample of students in grades 8, 10, and 12 from the Hawaiʻi Student Alcohol, Tobacco, and Other Drug Use Survey (n=2,794). RPFs across all social-ecological domains were selected for analysis based on existing literature. pSUD was based on the validated Car, Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) screener. Crude and adjusted prevalence ratios and 95% confidence intervals for pSUD were calculated using weighted Poisson regression models with a quasi-likelihood estimating method.
Results: Among protective factors, doing well in school, individual disapproval of substance use, and friends enjoying school had the highest magnitude of effect on pSUD. Of the risk factors, exposure to peer substance use, offers of substances by peers, and peer approval of substance use had the highest magnitude of effect on pSUD.
Conclusion: Although peer and community factors are known to increase risk for problem substance use, there are opportunities to reduce likelihood of pSUD by increasing protective factors, particularly within the school environment. Prevention and treatment programs should consider enhancing resources to provide at-risk students with academic, behavioral, and social support.
Keywords: Probable Substance Use Disorder, Adolescents, Risk Factors, Protective Factors