Youth with refugee backgrounds who resettle in the United States have often experienced pre-migration traumas including sexual violence, physical violence, and witnessing the death of family members. After resettlement, while many youth integrate quickly, others face barriers related to difficulties with school and family stressors. Both pre-migration trauma and post-migration stress are widely believed to contribute to elevated risk of harmful substance use. However, there is limited literature that explores risk and protective factors for substance use for refugee youth, in particular, and almost no prevention or treatment protocols specifically targeting refugee youth. The purpose of this study was to utilize a community based participatory approach to explore risk and protective factors for substance use in a Karen youth community with a refugee background.
This study utilized a community based participatory approach. A community advisory board (CAB) of Karen refugee youth, social service providers, teachers, doctors, and law enforcement provided guidance and oversight to the research design, data collection, analysis, and dissemination of findings. Data was gathered from semi-structured interviews with 20 Karen refugee youth, ages 16 to 24. Semi-structured interview guides were pilot tested by the CAB and elicited youth’s perceptions of patterns of substance use, causes and consequences of use, and other factors that impact use and decisions about seeking treatment. Data were analyzed using thematic content analysis with multiple rounds of inductive coding. Transcripts were read through once to generate codes which were then applied to the data. Matrices were then used to explore emerging themes across interviews. The CAB met regularly with the authors to contribute to the analysis.
Participants described a range of risk and protective factors. Some were similar to non-refugee youth such as social media, friendships, family histories of use, religious participation, and family. However, all categories had significant cultural nuances that were unique to this population. Other factors were unique to the refugee experience, such as pre-migration trauma, anti-immigrant sentiment and racism in the US, and resettlement stress. Overall, participants’ experiences were situated in the context of broader social and political contexts related to migration and resettlement. Specifically, they highlighted limitations and inadequacies of existing youth-specific programming within the US resettlement service system. Findings also revealed significant community-based strategies for prevention and intervention among Karen youth with refugee backgrounds.
Conclusion and Implications
The findings in this study surfaced critical insights about how youth with refugee backgrounds may engage with substance use as well as crucial supports for prevention and intervention, including insights into barriers to treatment seeking. These findings underscore the importance of considering the unique sociopolitical, cultural, and contextual contexts of youth with refugee backgrounds in developing prevention and intervention tools to reduce substance use. Implications for refugee resettlement programming, community-based prevention and intervention efforts, and adapting current treatment systems will also be discussed.