Perceived Racial Discrimination and Polysubstance Use Among Racial/Ethnic Minority Adolescents in the United States

Background and Objectives: Polysubstance use among adolescents remains a significant public health concern in the United States (U.S.). Polysubstance use refers to using two or more different substances over a defined period on separate occasions or simultaneously. Prevalence estimates of polysubstance use among adolescents in the U.S. vary between 8-16% depending on how polysubstance use is defined and the reporting period (i.e., past month use, past year use, or lifetime use). Most studies on adolescent substance use have focused on one substance. Yet, empirical studies and systematic reviews have found that single substance use among adolescents is less common than polysubstance use. Available research also shows that psychosocial stressors such as perceived racial discrimination (PRD) are associated with adolescent substance use. However, there is a dearth of research investigating the association between PRD and polysubstance use among racial/ethnic minority adolescents. Therefore, the objectives of this study are twofold: 1) to examine the prevalence of PRD and polysubstance use among racial/ethnic minority adolescents, and 2) to investigate the cross-sectional association between PRD and polysubstance use among racial/ethnic minority adolescents. We hypothesized that controlling for the effects of demographic characteristics, and psychosocial stressors, racial/ethnic minority adolescents who experienced PRD would have higher odds of reporting polysubstance use than their counterparts who did not experience PRD.

Methods: Data for this study were obtained from the 2021 Adolescent Behaviors and Experiences Survey. A sample of 4,145 racial/ethnic minority adolescents (52.8% female) was analyzed. The outcome variable examined was polysubstance use and was measured as a binary variable. Adolescents who used at least two of the following substances during the past 30 days: cigarette smoking, alcohol, electronic vaping products, marijuana, and prescription medication misuse were considered as having engaged in polysubstance use. The main explanatory variable examined was PRD, and was measured using an item from the Perceptions of Racism in Children and Youth (PRaCY) scale. Hierarchical binary logistic regression models were fitted to examine the cross-sectional association between PRD and polysubstance use among racial/ethnic minority adolescents.

Results: About 12% of racial/ethnic minority adolescents engaged in polysubstance use, and 23.4% reported experiencing PRD sometimes/most of the time/always. Controlling for other factors, experiencing PRD sometimes/most of the time/always was associated with 1.52 times higher odds of polysubstance use when compared to adolescents who never experienced PRD (OR=1.52, p=.044, 95% CI=1.01-2.30). Cyberbullying victimization, symptoms of depression, and being emotionally abused by a parent during COVID-19 were also associated with polysubstance use.

Conclusion: The findings of this study revealed a concerning association between experiencing PRD and engaging in polysubstance use among racial/ethnic minority adolescents. It is imperative for social workers to develop and implement interventions that address the root causes of PRD and provide support to adolescents who have experienced discrimination. Interventions that focus on the implementation of anti-discrimination policies in schools and providing culturally sensitive mental health services and substance abuse treatment for adolescents who have experienced discrimination may help reduce the harmful effects of PRD on polysubstance use in this highly vulnerable population.