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Background Early adolescence is a challenging transition period where mental ill-health and experimentation with alcohol and tobacco often increases. Some foods and eating behaviours can be addictive in a way that is comparable to addictive substances. Few studies have examined the prevalence of food addiction in young people, and none have measured it with mental ill-health and substance-use. Methods 6,700 Year 7 students across NSW, WA and QLD completed the baseline questionnaire for “Health4Life” (Mage=12.7±0.5, 49%F). The prevalence of, and associations between, food addiction (YFAS-C), anxiety (PROMIS-A), depression (PHQ-A), psychological distress (K6), discretionary food/drink intake (SPANS) and alcohol and tobacco use were examined. Results Respondents who met diagnostic criteria for food addiction (5.2%, n = 272) were significantly more likely to screen positively for anxiety (X23=315.4, P &amp;lt; 0.001), probable major depression (X21=299.9, P &amp;lt; 0.001) and psychological distress at levels of serious mental illness (X21=238.885, P &amp;lt; 0.001). They were also significantly more likely to have consumed a full standard drink and smoked tobacco in the past 6-months (X21=53.8, P &amp;lt; 0.001 and X21=29.7, P &amp;lt; 0.001, respectively) and to consume high amounts of sugar-sweetened beverages (X21=15.2, P &amp;lt; 0.001), discretionary foods (X22=26.4, P &amp;lt; 0.001) and energy drinks (X25=28.4, P &amp;lt; 0.001). Relative risks ranged 1.29-4.35. Conclusions Findings suggest a strong link between food addiction, substance use, discretionary food and drink consumption and mental ill-health in early adolescence. Further analysis will model multivariable relationships whilst controlling for affluence, BMI and gender. Key messages Links between food addiction, substance use and mental ill-health are found in the largest sample of adolescents screened for these variables worldwide.

436Food addiction, mental health and substance-use during a transition period: Data from 6,700 Australian 12/13-year-olds