Youth stress, anxiety, and depressive symptoms during the pandemic were all positively associated with the use of any substance (p < .001), including when covarying internalizing problems measured before the pandemic. Figure 3 shows youth use rates within quintiles of stress, anxiety, and depressive symptoms: Use rates were 2.2–2.4 times greater in the uppermost versus lowermost quintiles of each construct. No association varied significantly by youth sex. The association varied by youth age for stress and depressive symptoms (p < .001; Figure 4 ): Associations were stronger among older youth and negligible for the youngest youth.
