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Background  Substance use among adolescents has caused worldwide public health concern in recent years. Overseas studies have demonstrated an association between adolescent self-esteem and substance use, but studies within a Chinese context are limited. A study was therefore initiated to: (1) explore the 30 days prevalence of substance use (smoking, drinking, and drugs) among male and female adolescents in Hong Kong; (2) identify the significant associations between multidimensional self-esteem and gender; and (3) examine the relationship between multi-dimensional self-esteem and substance use.    Methods  A self-esteem scale and the Chinese version of the global school-based student health survey were adopted. A total of 1,223 students were recruited from two mixed-gender schools and one boys’ school.    Results  Among females, there was a lower 30-day prevalence of cigarette, alcohol, and drug use. They also had significantly higher peer and family self-esteem but lower sport-related self-esteem. Body image self-esteem was a predictor of alcohol use among females, while peer and school self-esteem were predictors of drug use among males.    Conclusions  In summary, the findings demonstrated the influence of self-esteem to the overall well-being of adolescents. Schools could play a role in promoting physical fitness and positive relationships between adolescents and their peers, family, and schools to fulfill their physical and psychological self-esteem needs.

Multi-dimensional self-esteem and substance use among Chinese adolescents