According to a study published in JAMA Pediatrics, teens whose concern over societal discrimination grew between 2016 and 2017 increased their cigarette and marijuana use. In addition, this change in concern was associated with behavioral health outcomes such as depression and ADHD, which were heightened among African American, Hispanic, and socioeconomically disadvantaged adolescents.

Investigators sought to determine whether adverse behavioral health outcomes in adolescents could be associated with their concern about increasing discrimination in society. Primary outcomes included substance use, depression, and ADHD, and the investigators further examined if certain associations were amplified in specific racial/ethnic minority groups or in teens with less educated parents.

The study sample included 2572 students from 10 high schools in Los Angeles who were recruited to complete 2 surveys: the first at baseline during 11th grade (2016) and the second 1 year later during 12th grade (2017). Participants rated their level of concern, worry, and stress regarding discrimination in society because of ethnicity, sexual identity, immigrant status, religion, and disability. Scores ranged from “not at all” (0) to “extremely” (4), and were used to measure the overall magnitude of societal discrimination concern and the change in concern from baseline to follow-up.

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The number of days of tobacco, alcohol, or marijuana use in the past month was self-reported, as was the number of substances used in the past 6 months. Students reported on the frequency with which they experienced 20 depressive and ADHD symptoms, including inattention, hyperactivity, and impulsivity. Negative binomial regression models were used to measure the rate of incidence among specific associations, whereas logistic regression models were used to calculate odds ratios.

Of the participants with available race/ethnicity data, 47.4% identified as Hispanic, 19% as Asian, 4.1% as African American, 6.1% as multiracial, 16.6% as white, and 6.8% as other. A large number of students reported feeling very or extremely concerned (1047 at baseline and 1028 at follow-up), worried (743 at baseline and 795 at follow-up), or stressed (345 at baseline and 353 at follow-up) about increasing societal discrimination. For students voicing concern, every 1-standard deviation increase was significantly associated with more days of cigarette, marijuana, and alcohol use; a greater number of substances used; and greater odds of reporting depression and ADHD symptoms. Cigarette smoking had a higher incidence rate ratio among African American teens (2.97; 95% CI, 1.45-6.09) and Hispanic teens (1.3; 95% CI, 1.09-1.54); participants with less educated parents had a higher incidence rate ratio for alcohol use (1.41; 95% CI, 1.14-1.74) as well as a higher odds ratio for ADHD (1.81; 95% CI, 1.13-2.89).

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One study limitation included the inability to infer causation from the observational nature of the study. The investigators could not verify substance use or clinical diagnoses of depression or ADHD, and although the societal discrimination items demonstrated high internal reliability, they were not evaluated psychometrically. Finally, it is unclear whether the study findings would generalize to different geographical locations or age groups.

“Recent societal increases in hostility and discrimination directed toward minorities may be a significant source of concern in youth that is associated with adverse behavioral health outcomes, particularly in teenagers of color or from socioeconomically disadvantaged families,” the researchers concluded. The authors suggested that exposure of a vulnerable population to discrimination and amplification of associated behavioral health problems may warrant public health attention.


Leventhal AM, Cho J, Andrabi N, Barrington-Trimis J. Association of reported concern about increasing societal discrimination with adverse behavioral health outcomes in late adolescence [published online August 20, 2018]. JAMA Pediatr. doi:10.1001/jamapediatrics.2018.2022.