Self-Reported Discrimination, Mental Health, and Substance Use among Adolescents in Santiago, Chile

Background and Purpose

Evidence continues to grow worldwide of the positive association between self-reported discrimination and illness.  However, studies of discrimination and drug use are few and mostly conducted in the U.S.  These few studies have identified, as in the health field, a positive association between discrimination and substance use, potentially due to discriminatory experiences serving as key stressors. In this study we examined the correlation between reports of discrimination with lifetime use of alcohol, cigarettes, and marijuana and extent of problems with each substance among a large community sample of youth participating in the Santiago Longitudinal Study (SLS) in Chile.

Methods

Data are from an ongoing NIDA-funded study of drug use with over 700 13-17 year olds (M=14 years, 51% male) from municipalities of mid-to low-socioeconomic status. In 2008-2009, youth completed Wave 1 assessments that consisted of a 2-hr interviewer-administered questionnaire with comprehensive questions on drug use, drug opportunities, and a range of individual, familial, and contextual variables. Wave 2 assessments will be completed two years from now.  Discrimination was measured with the 9 items 6-point Likert scale “Every Day Discrimination” utilized in several U.S. surveys (Cronbach's α=0.82). Questions about drug use were taken from standardized instruments (i.e., Fagerstrom, CBCL-YSR) or from U.S. surveys (i.e., MTF, NSDUH) and from questions utilized in Chile's school based surveys. English Instruments were translated into Spanish, some of which were back translated into English and then back into Spanish. All measures were pilot tested, and revised prior to the study. Bivariate and multiple logistic regression analyses were conducted with STATA 10.0.

 

Results

Reports of discriminatory experiences were positively associated with ever use of alcohol (OR=1.05, p<0.0001), cigarettes (OR=1.05, p<0.0001), and marijuana (OR=1.04, p<0.05) and separately with the number of problems youth experienced with each of these substances, even after adjusting for age, gender, and SES. However, when the YSR variable ‘externalizing behaviors' was included in the models, the associations of discrimination with cigarettes and marijuana use became non-significant suggesting that externalizing behaviors could either be a confounder or a mediator of these relationships. The association with alcohol use remained significant (OR=1.03, p<0.05). Similar findings were observed when other mental health variables were entered. Youth reported experiences of discrimination were highly correlated with the YSR subscales, from a low of 0.13 for somatic complaints to a high of 0.34 with externalizing behaviors.

Conclusions and Implications

Studies of the potential association between discrimination and substance use are few and specific to U.S. populations.  To our knowledge, this study may be the first to document an association, between reports of discriminatory experiences and substance use among youth in countries other than the U.S. The study findings suggest that it is important to examine experiences of discrimination within the context of the youth mental health, the type of substance they consume, and their cultural background.  Finally, more research is needed to investigate whether youth mental health problems serve as confounders or potential mediators of the associations studied. The answer to this question will point to important intervention implications.