Abstract
Aims: To measure the associations between racial discrimination and distinct alcohol and other drug use outcomes in minoritised racial/ethnic groups and to explore the moderating roles of demographic and methodological characteristics.
Methods: Quantitative studies including racial discrimination as an exposure (both binary and continuous), an alcohol and/or other drug use outcome, and a minoritised racial/ethnic sample were identified via database, citation, and journal searching. 130 studies contributing 273 effect sizes, across seventeen distinct outcomes, were included in this analysis. Random-effects meta-analytic models were implemented. Moderation effects were explored using subgroup analyses.
Results: Racial discrimination was positively associated with sixteen alcohol and other drug use
outcomes. The strongest associations were observed for at-risk/hazardous alcohol use (r=.24, 95% confidence interval [CI]=0.17, 0.3, I²=94.8%, m=29, n=9445), at-risk/hazardous cannabis use (r=.24, 95%CI=0.18, 0.29, I²=0%, m=4, n=462) and substance use disorder (r=.25, 95%CI=0.14, 0.36, I²=97.7%, m=5, n=21051). Considerable heterogeneity was observed across fourteen outcomes (I²=69.5% - 97.7%). Concerning tobacco use, Indigenous North Americans had the largest effect (r=0.27, 95%CI=0.2, 0.35, I²=0%, m=2, n=529), followed by Black Americans (r=0.06, 95%CI=0.01, 0.12, I²=81.7%, m=7, n=5409). Little evidence for an association was found for Latinxs (r=0.06, 95%CI=-0.02, 0.14, I²=89.2%, m=3, n=5404) or Asian Americans (r=-0.18, 95%CI=-0.8, 0.43, I²=99%, m=2, n=572). Regarding composite substance use, Indigenous North Americans had the strongest associations (r=0.29, 95%CI=0.23, 0.35, I²=0%, m=3, n=778), followed by Black Americans (r=0.13, 95%CI=0.09, 0.18, I²=62.8%, m=7, n=5981) and then Latinxs (r=0.07, 95%CI=-0.17, 0.31, I²=91.3%, m=4, n=1646). Concerning alcohol use problems, younger samples produced stronger associations (r=0.28, 95%CI=0.17, 0.38, I²=38.8%, m=3, n=483), while older samples showed larger effects in six other outcomes (rs=0.13 – 0.26). Regarding at-risk/hazardous alcohol use and alcohol use problems/consequences, cross-sectional studies (rs=0.23 - 0.24) produced stronger associations than longitudinal studies (rs=0.13 - 0.14). Concerning tobacco and illicit substance use, the strongest associations were identified for lifetime exposure (rs=0.18 - 0.32).
Conclusions: Racial discrimination appears to be a consistent correlate of multiple alcohol and other drug use outcomes in minoritised racial/ethnic groups, predominantly based in the United States, yet the magnitude of these associations differs across outcomes. Demographic and methodological characteristics somewhat moderate these associations.
Methods: Quantitative studies including racial discrimination as an exposure (both binary and continuous), an alcohol and/or other drug use outcome, and a minoritised racial/ethnic sample were identified via database, citation, and journal searching. 130 studies contributing 273 effect sizes, across seventeen distinct outcomes, were included in this analysis. Random-effects meta-analytic models were implemented. Moderation effects were explored using subgroup analyses.
Results: Racial discrimination was positively associated with sixteen alcohol and other drug use
outcomes. The strongest associations were observed for at-risk/hazardous alcohol use (r=.24, 95% confidence interval [CI]=0.17, 0.3, I²=94.8%, m=29, n=9445), at-risk/hazardous cannabis use (r=.24, 95%CI=0.18, 0.29, I²=0%, m=4, n=462) and substance use disorder (r=.25, 95%CI=0.14, 0.36, I²=97.7%, m=5, n=21051). Considerable heterogeneity was observed across fourteen outcomes (I²=69.5% - 97.7%). Concerning tobacco use, Indigenous North Americans had the largest effect (r=0.27, 95%CI=0.2, 0.35, I²=0%, m=2, n=529), followed by Black Americans (r=0.06, 95%CI=0.01, 0.12, I²=81.7%, m=7, n=5409). Little evidence for an association was found for Latinxs (r=0.06, 95%CI=-0.02, 0.14, I²=89.2%, m=3, n=5404) or Asian Americans (r=-0.18, 95%CI=-0.8, 0.43, I²=99%, m=2, n=572). Regarding composite substance use, Indigenous North Americans had the strongest associations (r=0.29, 95%CI=0.23, 0.35, I²=0%, m=3, n=778), followed by Black Americans (r=0.13, 95%CI=0.09, 0.18, I²=62.8%, m=7, n=5981) and then Latinxs (r=0.07, 95%CI=-0.17, 0.31, I²=91.3%, m=4, n=1646). Concerning alcohol use problems, younger samples produced stronger associations (r=0.28, 95%CI=0.17, 0.38, I²=38.8%, m=3, n=483), while older samples showed larger effects in six other outcomes (rs=0.13 – 0.26). Regarding at-risk/hazardous alcohol use and alcohol use problems/consequences, cross-sectional studies (rs=0.23 - 0.24) produced stronger associations than longitudinal studies (rs=0.13 - 0.14). Concerning tobacco and illicit substance use, the strongest associations were identified for lifetime exposure (rs=0.18 - 0.32).
Conclusions: Racial discrimination appears to be a consistent correlate of multiple alcohol and other drug use outcomes in minoritised racial/ethnic groups, predominantly based in the United States, yet the magnitude of these associations differs across outcomes. Demographic and methodological characteristics somewhat moderate these associations.
| Original language | English |
|---|---|
| Journal | Addiction |
| Publication status | Accepted/In press - 12 Jun 2025 |
Keywords
- racial discrimination
- substance use
- alcohol use
- racism
- substance use disorder
- alcohol use disorder
- ethnic minority
- health inequality
