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Introduction: Anxiety disorders are the most common psychiatric disorder among adolescents, and African American youth are at greater risk for anxiety compared to whites. High anxiety is associated with low educational attainment and other adverse outcomes. Studies have also shown that marijuana use is associated with high school dropout. However, some youth in urban centers with elevated anxiety, including those who use marijuana to cope with anxiety, have positive life outcomes including high educational attainment, low exposure to community violence, and no criminal justice system involvement. We examine factors that may protect anxious African American youth from low educational attainment and the role of self-medication in this association.
Methods: This analysis utilizes data from the Woodlawn Study, a longitudinal study of an urban, African Americans followed since 1966 when they were in first grade, in adolescence (age 16), in young adulthood (age 32), and in midlife (age 42). We ran regression models for high school completion with the predictors: adolescent anxious mood, marijuana use, and their interaction, as well as confounders. In stratified analyses, we explored perceived teacher treatment regarding race and early childhood parent interactions as potential protective factors.
Results: Of 686 participants at adolescence, 10% had elevated anxious mood, 28% smoked marijuana 1-9 times, and 34% smoked 10 or more times. Controlling for gender and socioeconomic status, elevated anxious mood and marijuana use were independently and significantly associated with school dropout. Those with elevated anxious mood were 1.97 times (OR 0.51; 95% CI, 0.30, 0.87) less likely to graduate from high school than those with low anxiety. Those who smoked marijuana 10 or more times were 2.28 times (OR 0.44; 95% CI, 0.26, 0.73) less likely to graduate from high school than those who reported never smoking marijuana, however the interaction between marijuana and anxious mood was not significant. Among anxious youth, only being read to or played with several times a week in early childhood (first grade) was significantly associated with high school graduation and those individuals were 3.26 times more likely to graduate from high school than peers who were read to or played with less frequently (95% CI, 1.30, 8.13).
Conclusions: Understanding modifiable factors that protect those with anxious mood from low educational attainment and self-medication with marijuana will improve interventions aimed at reducing health disparities for African Americans. Understanding childhood behaviors that attenuate negative health outcomes from elevated anxiety such as adult-child interaction will provide new research avenues for helping children successfully manage their anxiety.