Racial/ethnic differences in substance across the life course: an explanation of health disparities?

INTRODUCTION: Black and Hispanic individuals in the US have lower overall rates of substance use including smoking, alcohol consumption, and marijuana use, but higher rates of health consequences of use, compared with non-Hispanic Whites. This paradox has generated substantial interest in explaining racial disparities in health. Some have hypothesized that this is due to age-race interactions in substance use, with Whites more likely to use in adolescence but also more likely to desist in use during the transition to adulthood.

METHODS: Data were drawn from the National Longitudinal Study of Adolescent Health (N=20,705). Participants were interviewed at mean age 15.97, 16.37, 21.86, and 28.98. Measures of use and frequency for smoking, alcohol and binge drinking, and marijuana were assessed via self-report. Random effects models were used; control variables included age, parent education, parent income, use of public assistance, and urbanicity. Non-Hispanic Whites were the reference group in all analyses.

RESULTS: Smoking. Blacks/Hispanics were less likely to smoke and had significantly fewer mean cigarettes smoked among smokers, at all waves. Alcohol. Blacks were significantly less likely to drink at all and among drinkers, less likely to binge drink, at all waves. Hispanics either demonstrated no difference or reduced likelihood of drinking and binge drinking, at all waves. Marijuana. Blacks were less likely to use marijuana at Waves 1-3; no difference at Wave 4. No differences observed for frequency of marijuana use among users. For Hispanics, no differences in marijuana use, but lower frequency of marijuana use, at all waves.

CONCLUSIONS: There is no evidence for increased use of cigarettes, alcohol, or marijuana over the transition to adulthood among Black and Hispanic individuals compared with non-Hispanic Whites. Alternative explanations for racial/ethnic paradoxes in the epidemiology of substance use are needed.