This study examined correlates of co-occurring substance use and mental health symptoms.

School sports participation was associated with lower substance use and symptoms.

Physical activity and belongingness explained the associations found for sports.

Physical activity and belongingness had independent inverse associations.

Promoting adolescent sports participation and physical activity may be effective low-barrier prevention strategies for co-occurring adolescent substance use (SU) and mental health symptoms (MH). The objectives of this study were to: 1) explore associations between profiles of SU/MH and sports participation; and 2) determine whether physical activity and belongingness account for these associations.

Data came from a representative sample of 11,994 grade 9–12 Ontarian students (ages ~14–18) previously grouped into five SU/MH profiles based on patterns of use and symptoms. A series of multinomial logistic regressions, adjusted for socio-demographics and school clustering, were used to predict the risks of students belonging to SU/MH profiles based on: 1) school sports participation (>=weekly), 2) sports and physical activity (>=60 minutes; 0–7 days), and 3) sports, physical activity, and school belongingness.

Greater school sports participation, physical activity, and belongingness were each associated with reduced risks of belonging to most profiles with elevations in SU and/or MH symptoms relative to the low SU/MH profile (Relative Risk Ratios: sports=0.62–0.87, physical activity=0.78–0.98, belonging=0.75–0.83). Frequency of physical activity accounted for ~32–60% of the associations between sports and SU/MH profiles, while school belongingness accounted for the remaining associations. Physical activity and belongingness remained independently associated with SU/MH profiles.

Findings suggest possible indirect associations between school sports participation and SU/MH profiles through physical activity and school belongingness, which may be promising prevention targets that have independent associations over and above sports. School sports participation may be one of a number of ways to achieve these goals.

Adolescent

Physical activity

Sports

Mental health

Substance use

Belongingness

© 2023 The Authors. Published by Elsevier B.V.