This study examined the association between energy drink consumption and substance use among adolescents and tested whether sex and/or grade level (i.e., middle vs. high school) moderate the association. Data were derived from the 2017 Ontario Student Drug Use and Health Survey, a representative survey of students in 7th to 12th grade. Analyses included 10,662 students who self-reported information on energy drink consumption and substance use. Poisson regression models were used with adjustments for important covariates. Energy drink consumption was associated with tobacco cigarette smoking (incidence rate ratio (IRR): 3.74; 95% confidence interval (CI): 3.22–4.35), cannabis use (IRR: 2.90; 95% CI: 2.53–3.32), binge drinking (IRR: 2.46; 95% CI: 2.05–2.96), opioid use (IRR: 2.23; 95% CI: 1.85–2.68), and alcohol use (IRR: 1.31; 95% CI: 1.26–1.36). The associations of energy drink consumption with tobacco cigarette smoking, cannabis use, and alcohol consumption were modified by grade level (two-way interaction terms p
< 0.05). The association between energy drink consumption and substance use was generally much stronger among middle school students compared with high school students. The findings suggest that middle school students may be more vulnerable to the negative effects of energy drinks in relation with substance use.
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