Perceived discrimination, depressive symptoms, and substance use in young adulthood

Highlights

• African Americans reported higher levels of substance use than African Caribbeans.

• African Americans reported higher levels of depressive symptoms than African Caribbeans.

• Full measurement and structural invariance was found across ethnicity.

• Depressive symptoms partially mediated discrimination and lifetime substance use.

• Depressive symptoms fully mediated discrimination and recent substance use.

Abstract

Perceived discrimination is an important health-related stressor. As suggested by the stress-coping model, substance use often serves as a means to reduce the negative effects of perceived discrimination. This study uses data from the National Survey of American Life—Adults to examine the structural relationship of perceived discrimination and depressive symptoms with lifetime and recent substance use among African American and African Caribbean young adults. Respondents (N = 1910) were 18–35 years old. Compared with African Caribbeans, African Americans report significantly higher levels of depressive symptoms and both lifetime and recent substance use. Multiple-group structural equation modeling is used to evaluate model fit and test hypothesized models. Results show good fit of the hypothesized models in both African Americans and African Caribbeans. Full measurement and structural invariance is found across ethnicity. Mediation models explain 18.5% and 47.4% of the variance in lifetime substance use for African Americans and African Caribbeans, respectively, and 23.5% and 35.0% of the variance in recent substance use for African Americans and African Caribbeans, respectively. Mediation tests indicate depressive symptoms partially mediate the relationship between perceived discrimination and lifetime substance use and fully mediated this relationship for recent substance use. This study is the first to demonstrate a positive association between perceived racial discrimination and substance use among African Caribbean young adults. Study findings illuminate the influence of perceived discrimination on substance use and the mechanisms of this relationship among African American and African Caribbean young adults.

Introduction

Despite ongoing prevention efforts, substance use continues to be a prevalent concern with persistent social and health consequences, especially the racial/ethnic disparities in substance use health outcomes. Research has consistently shown that as compared with White and Hispanic counterparts, Black adolescents and young adults generally report a greater number of negative substance-use related consequences (Gil et al., 2004, Mulia et al., 2009). For example, a longitudinal study with a representative sample of the U.S. population of adults who transitioned from abstainers during early adolescence to regular use of substances in young adulthood found that African Americans were 6.6 times more likely to experience a substance-use disorder compared to Whites (4.3) and Hispanics (2.8) (Gil et al., 2004).

During young adulthood, the advantageous lower rates of substance use found in Black adolescents are lost and their rates of substance-use become comparable to their White and Hispanic counterparts (Clark et al., 2013, Geronimus et al., 1993). Although the causes of this phenomenon, referred to as the “catch-up effect,” are unknown, perceived discrimination may be an important predictor of the catch-up effect. By adulthood and as compared to Asian Americans, Puerto Ricans, and Latinos, Black adolescents tend to report steeper increases of perceived racial discrimination (Greene, Way, & Pahl, 2006). Thus, for some Blacks the cumulative effects of discrimination can lead to new substance use in young adulthood, perhaps helping to explain the catch-up effect.

Indeed, discrimination is a powerful source of health-related stress for young adults (Whitbeck, Hoyt, McMorris, Chen, & Stubben, 2001), with its magnitude ranking alongside major negative events such as death of a loved one, divorce, and job loss (Kessler, Mickelson, & Williams, 1999). One pathway to poor physical health is through discrimination's effect on substance use. Research supports an association between perceived discrimination and substance use (Brody, Kogan, & Chen, 2012), including tobacco (Bennett, Wolin, Robinson, Fowler, & Edwards, 2005), alcohol (Terrell, Miller, Foster, & Watkins, 2006), and marijuana (Choi, Harachi, Gillmore, & Catalano, 2006). Several longitudinal studies have examined the direction of the relationship between discrimination and substance use, concluding discrimination causes substance use and not the reverse (Brody et al., 2012, Gibbons et al., 2004, Gibbons et al., 2010).

The stress-coping model, which has framed much of the research on discrimination, posits that perceived discrimination depletes coping resources and encourages avoidant coping strategies such as anger, frustration, sadness, and depression (Clark, Anderson, Clark, & Williams, 1999). Empirical studies support the stress-coping model by suggesting that discrimination leads to avoidance and internalizing symptoms such as depressive symptoms (Kessler et al., 1999). These findings are consistent with others who found that discrimination was indirectly related to substance use among African American adolescents and young adults and mediated by depressive symptoms (e.g., Brody et al., 2012).

Guided by the stress-coping model, this study proposed that African American and African Caribbean young adults turn to substance use as a means to reduce depressive symptoms stemming from perceived discrimination. Because country and culture-of-origin can contribute to variations in manifestations of discrimination, stress, and coping (Georgiades et al., 2007, Rong and Brown, 2002), such differences are expected between African Americans and African Caribbeans. The current study used data from the National Survey of American Life—Adult (NSAL) database and multiple group structural equation modeling (1) to investigate the process through which perceived everyday discrimination affects lifetime and recent substance use, and (2) to assess whether the mediated model is moderated by ethnicity.