We found that stress, depression, and anxiety were robustly associated with youth substance use, even when adjusting for the prepandemic level of internalizing problems. Thus, these effects may reflect pandemic-related escalations in emotional difficulties. Associations were stronger among older youth (Figure 4) and were stronger in the upper range of stress and depressive symptoms than in the lower range (Figure 3), consistent with an affect-regulation-based explanation [13,35]. Monitoring teens' stress and emotions and providing support as necessary is likely a fruitful path for parents to reduce substance use and promote health and safety [24,39] during the pandemic.
