Substance use among U.S. Black young adults: examining the influence of nativity, racial stressors and societal concerns.

Objective: There is increased ethnic diversity of Black Americans as a result of increasing migration. However, it is unclear whether the diverse sociocultural contexts and experiences of U.S.- and foreign-born Black young adults (YA) are similarly associated with substance use behaviors. With a rise in psychosocial stressors among YA in the U.S., this study examined whether there are nativity differences in the association of societal concern, experience of racist events, and discrimination with nicotine/tobacco, cannabis, and binge-drinking among U.S.- and foreign-born Black YA.

Methods: This pilot study used data collected in 2023 from a nationwide, non-probability sample of 484 young adults (182 foreign-born and 302 U.S.-born) aged 18-25 years. Nativity differences in demographic characteristics, study predictors, and substance use were assessed using two sample t-tests and chi-squared tests. Multivariable logistic regression analyses were used to examine the association of societal concern, racism, and discrimination with nicotine/tobacco use, cannabis use, and binge drinking overall and stratified by nativity.

Results: While foreign-born and U.S.-born Black YA had similar mean societal concern and racist experience scores, everyday discrimination was significantly higher among U.S.-born YA (p = 0.002). Societal concern was associated with reduced odds of nicotine/tobacco use in the overall sample (AOR = 0.90, 95% CI 0.83, 0.97) and among foreign-born Black YA (AOR = 0.79, 95% CI 0.66-0.94). Experience of racist events was consistently associated with increased odds of all substances assessed in the overall sample and among the sub-groups, with the exception of binge drinking among U.S.-born YA and cannabis and nicotine/tobacco use among foreign-born YA.

Conclusions: Despite similarities among foreign- and U.S.-born Black YA, exposure to these psychosocial stressors is associated with some distinct substance use patterns. These findings highlight the nuanced relationships between societal and discriminatory stressors and substance use, varying by nativity among Black YA.