Intersectionality in Adolescent Opioid Use: Understanding the Role of Race, Class, Sex, and Place

Introduction:  Nonmedical prescription opioid use in the U.S. has increased, with devastating consequences. Although opioids are often prescribed to adolescents for medical use, youth are at risk for abusing the drug. In this study we consider how multiple positionalities (e.g., membership in simultaneous groups based on race, class, sex, place) impact lifetime rates of adolescent opioid use in the United States.

Methods: Using data from the 2015 Monitoring the Future study, we quantitatively address this gap by examining adolescent opioid use by residential context, parental education, across race/ethnicity and sex/gender. Multi-group logistic regression analyses were used to explore whether associations in parental education, residential context, sex with opioid use differed within race/ethnicity.

Results:  Slightly more than half of our analytic sample (n=18,444) reported being female (51.0%) and while we do not have data on their age, 20.6% of our sample reported being in 8^th grade, 22.8% in 10^th grade, and 56.7% in 12^th grade.  Slightly more than 1 in 5 participants (20.6%) reported being Hispanic, 15.9% Black and 63.4% White. The majority (83.4%) of the participants in our sample described living in city/urban settings, 13.0% in country settings and 3.6% in farms. Although only 2.5% of this adolescent sample reported having used opioids, we found differential patterns of lifetime opioid use when we considered multiple positionalities in our analyses by adjusting for residential context and SES across race/ethnicity and sex/gender. Specifically, we found lifetime opioid use rates in adolescents that ranged from 1.2% among African American females living in country settings to a high of 4.1% among White males living in farm settings when rates are adjusted for parental education and grade in school.  We further tested within each racial/ethnic group how parental education and residential context were associated with lifetime opioid use rates. In multi-group logistic analyses adjusted for sex we found that White and African American adolescents living in families with low levels of parental education had higher opioid use rates than those living with parents with higher levels of education. Hispanic adolescents on the other hand had higher rates of opioid use when living in urban contexts.

Discussion: Together our results suggest that intersecting positionalities lead to different rates of opioid use among adolescents and that multiple positionalities should be considered when designing treatment interventions for adolescent opioid use as social context may influence opioid use rates differentially within race/ethnic groups. Findings also reveal a need to acknowledge racial/ethnic and gender heterogeneity among rural adolescents, as well as better understand aspects of the rural context and how they may relate to opioid use. We discuss implications for prevention and intervention and identify community-based approaches for addressing these inequalities and increasing access to care.