The purpose of this article was to examine the association between health risk behaviors (tobacco, alcohol, and drug use) and psychosocial distress indicators among high school students. The sample consisted of 4,210 adolescent students from public schools in Pernambuco State, Brazil. The Global School-based Student Health Survey was used to collect personal (demographic and socioeconomic) and behavioral data and to obtain measures of psychosocial distress indicators (outcome variables). Prevalence rates were observed for sadness, loneliness, suicidal ideation, sleeplessness due to worries, and suicidal planning. Self-reported prevalence rates for tobacco, alcohol, and drug use were 7.7%, 30.3%, and 6.9%. Psychosocial distress was more prevalent among girls, while health risk behaviors were more common among boys. The study concludes that drug use is directly associated with suicidal ideation and planning, and that among girls, alcohol consumption was associated with psychosocial distress.
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