Perceived Racial/Ethnic Discrimination and Substance Use Among Yourh Living in Indian Country

Introduction: Racial discrimination is increasingly being recognized as an important social determinant of health for children and adolescents. Few studies have examined this relationship among American Indian youth, and no studies have examined the effects of racial discrimination on AI youth in a culturally diverse setting.  Additionally, there is a need to examine the effects of racial discrimination longitudinally; current literature relies heavily on cross-sectional studies, limiting the ability to make causal claims about the effect of racial discrimination on health outcomes.

Methods: The analysis sample included 1,421 American Indian (24.5%), White (53.1%) and American Indian and White (22.4%) high-school aged adolescents that completed two self-report surveys 6 month apart.  The sample was 50% male and 43% low income. We used regression analysis to examine the longitudinal relationship between the frequency and intensity of racial discrimination and substance use outcomes (alcohol use, tobacco use, illicit drug use).

Results: Twenty-two percent of the sample reported experiencing racial discrimination, and 8% of those experiencing racial discrimination reported high levels of discrimination intensity. After adjustment for potential confounders, a high frequency of racial discrimination was associated with an increased risk for heavy alcohol use (OR: 2.5 95% CI: [1.0, 6.1]), prescription drug misuse (OR: 4.7 95% CI: [1.9, 11.7]), and other illicit drug use (OR: 6.7 95% CI: [2.1, 21.6]). Among those experiencing racial discrimination, high intensity racial discrimination was associated with further increased risk of prescription drug misuse (OR: 5.3 95% CI: [1.4, 19.8]) and other illicit drug use (OR: 9.1 95% CI: [2.2, 37.5]).  Race/ethnicity was not a statistically significant moderator of the relationship between racial discrimination and substance use.

Conclusion: Experiencing racial discrimination likely contributes to substance use among adolescents, particularly non-normative substance use such as prescription drug misuse and other illicit drug use.  These risks do not appear to vary by racial/ethnic group. Particularly in culturally diverse settings, the implementation of interventions targeting racial discrimination should not be limited to any specific racial/ethnic subgroup.