Using Agnew's general strain theory (GST) as a theoretical framework, we make an argument that health problems are sources of strain that influence substance use. Health strain's influence on the initiation and frequency of substance use is then empirically investigated using two waves of data from the National Longitudinal Study of Adolescent Health (Add Health). Results from logistic and zero inflated negative binomial (ZINB) regression models show that health related strains affect the initiation of marijuana, cocaine, and other drug use, but were inconsistently associated with the frequency of use of these substances. Adolescents with more frequent minor health problems experience greater levels of strain and may choose to cope with this strain through abusing both licit and illicit substances. In some instances negative affect mediates the effects of health strain on initiation and frequency of use. Study limitations and future directions for research on health strain are discussed.
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