Association of Reported Concern About Increasing Societal Discrimination With Adverse Behavioral Health Outcomes in Late Adolescence

Abstract

Importance: Public expressions of discrimination may generate stress and behavioral health problems, particularly in racial/ethnic minority or socioeconomically disadvantaged youths.

Objectives: To determine whether concern about increasing discrimination in society reported among adolescents during 2016 and the magnitude of increase in concern from 2016 to 2017 were associated with behavioral health outcomes by 2017 and to examine racial/ethnic or socioeconomic differences in associations.

Design, setting, and participants: This prospective cohort survey collected data at baseline from January 2 through September 28, 2016 (11th grade), and at follow-up from January 1 through August 10, 2017 (12th grade), at 10 high schools in Los Angeles, California, recruited through convenience sampling. A total of 2572 students completed both surveys.

Exposures: Reported concern, worry, or stress regarding "increasing hostility and discrimination of people because of their race, ethnicity, sexual orientation/identity, immigrant status, religion, or disability status in society" were scored as "not at all" (0) to "extremely" (4). Mean ratings were calculated in a 3-item composite (range, 0-4).

Main outcomes and measures: Self-reported days of cigarette, alcohol, or marijuana use in the past month (range, 0-30 days), number of substances used in the past 6 months (range, 0-27), mild to moderate depression (yes or no), and attention-deficit/hyperactivity disorder (ADHD) (yes or no) at follow-up.

Results: The sample of 2572 students (54.4% female; mean [SD] baseline age, 17.1 [0.4] years; 1969 [87.7%] had at least 1 parent with high school diploma) included 2530 with race/ethnicity data (1198 [47.4%] Hispanic; 482 [19.0%] Asian; 104 [4.1%] African American; 155 [6.1%] multiracial; 419 [16.6%] white; 172 [6.8%] other). Appreciable numbers of students reported feeling very or extremely concerned (baseline, 1047 [41.5%]; follow-up, 1028 [44.6%]), worried (baseline, 743 [29.7%]; follow-up, 795 [34.7%]), or stressed (baseline, 345 [13.9%]; follow-up, 353 [15.5%]) about increasing societal discrimination. Each 1-SD increase on the societal discrimination concern composite in 2016 was associated with more days of past-month cigarette (incidence rate ratio [IRR], 1.77; 95% CI, 1.42-2.20; P < .001), marijuana (IRR, 1.13; 95% CI, 1.01-1.26; P = .03), and alcohol (IRR, 1.11; 95% CI, 1.02-1.21; P = .01) use, more substances used (IRR, 1.07; 95% CI, 1.01-1.17; P = .04), and greater odds of depression (odds ratio [OR], 1.11; 95% CI, 1.01-1.23; P = .04) and ADHD (OR, 1.12; 95% CI, 1.01-1.26; P = .04) symptoms in 2017. The magnitude of increase in societal discrimination concern from 2016 to 2017 was also associated with several behavioral health problems in 2017; some associations were amplified among teenagers who were African American (IRR for cigarette smoking, 2.97; 95% CI, 1.45-6.09) or Hispanic (IRR for cigarette smoking, 1.30; 95% CI, 1.09-1.54) or had parents with less educational attainment (IRR for alcohol use, 1.41 [95% CI, 1.14-1.74]; OR for ADHD, 1.81 [95% CI, 1.13-2.89]).

Conclusions and relevance: Concern over societal discrimination was common among youths in Los Angeles in 2016 and was associated with behavioral health problems 1 year later. Adolescents' behavioral responses to recent societal expressions of discrimination may warrant public health attention.

Figure 1.. Behavioral Health Outcomes as Function of Change in Societal Discrimination Concern From 2016 to 2017, by Parental Educational Level

Graphs depict the estimated outcome value at follow-up as a function of magnitude of change from baseline to follow-up on the societal discrimination composite score (mean rating of concern, worry, and stress on scales ranging from 0 to 4, with 4 indicating extremely) derived from regression models in subsamples stratified by parental educational level. Marijuana (A) and alcohol use (B) are measured in the past 30 days; attention-deficit/hyperactivity disorder (ADHD) (C), as estimated prevalence of screening positive for ADHD symptoms on the Current Symptoms Scale–Self Report Form for Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)–defined ADHD. The solid lines indicate estimated alcohol or marijuana use frequency level or ADHD prevalence; shaded areas, 95% CI.

Figure 2.. Cigarette Smoking as Function of Change in Societal Discrimination Concern From 2016 to 2017, by Race/Ethnicity

Graphs depict the estimated number of days of cigarette use in the past 30 days at follow-up as a function of magnitude of change from baseline to follow-up on the societal discrimination composite score (mean rating of concern, worry, and stress on a scale of 0 to 4, with 4 indicating extremely) used to derive regression models in stratified subsamples of African American (A), Hispanic (B), and white (C) students. The solid lines indicate estimated cigarette use frequency level; shaded areas, 95% CI.