Discrimination and Racial Inequalities in Drug Use in U.S. Adults: Associations and Mechanisms

美国成年人吸毒中的歧视和种族不平等：关联和机制

• 批准号: 10739180
• 负责人: Hongying Daisy Dai
• 金额: $ 38.5万
• 依托单位: UNIVERSITY OF NEBRASKA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-15 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10739180
• 关键词: Address; Adult; Alcohol consumption; Alcohols; Amplifiers; Anxiety; Asian population; Behavioral; Black Populations; Buffers; COVID-19; COVID-19 pandemic; COVID-19 vaccination; Cannabis; Characteristics; Cigarette; Climate; Coping Behavior; Coping Skills; Coronavirus; Crime; Data; Data Reporting; Data Set; Discrimination; Disease; Drug usage; Economics; Electronic cigarette; Employment; Employment Status; Environment; Ethnic Origin; Event; Exercise; Exposure to; Food; Frequencies; Friends; Hispanic Populations; Household; Housing; Incidence; Internet; Intervention; Life; Link; Measures; Mediating; Mediation; Mental Depression; Methods; Modernization; Nature; Not Hispanic or Latino; Outcome; Outcome Study; Patient Self-Report; Persons; Pharmaceutical Preparations; Police; Policy Maker; Probability; Public Health; Race; Research; Risk Factors; Sampling; Science; Surveys; Techniques; Testing; Time; Unemployment; United States; Vaccination; Volatilization; Vulnerable Populations; addiction; anti-Asian; anti-racism; anxiety symptoms; binge drinking; data modeling; depressive symptoms; ethnic difference; ethnic disparity; ethnic minority; ethnic minority population; experience; follow-up; hate crimes; health equity; killings; minority communities; multi-racial; multilevel analysis; pandemic impact; people of color; perceived discrimination; polysubstance use; prospective; racial difference; racial discrimination; racial disparity; racial minority; racial minority population; racial population; racism; recruit; resilience; secondary analysis; social; social determinants; social health determinants; substance use; theories

Project Summary Exposure to racial discrimination has long been identified as a key social determinant of substance use that stratifies by race/ethnicity. Starting in 2020, displays of racism and their impacts have intensified, and the recent volatile climate during the COVID-19 pandemic provides a unique opportunity to assess mechanisms that link discrimination and other social determinants of health with racial/ethnic disparities in drug use, but there has not been the requisite science on this topic as it deserves. Existing research on the discrimination-substance use association is plagued by both external validity (i.e., non-representative sampling with low generalizability to overall U.S.) and internal validity (i.e., low temporal precision from annual inter-survey intervals to detect prospective, potentially causal association). Additionally, there is little evidence to guide clinicians and policymakers on interventions that can disrupt discrimination’s impact on substance use in the modern social, economic, and public health context. This secondary analysis of the nationally-representative Understanding America Study (UAS, n~9,000 U.S. adults) aims to elucidate the nature and mechanisms of the association of discrimination with race/ethnicity inequalities in substance use. To chart the broad effects of the pandemic, this study will harmonize longitudinally bi-weekly (March 2020-July 2021) and monthly (August/September 2021- June 2022) survey waves with a total of 38 timepoints. Time-varying measures include 1) frequency of discrimination experience, racism, and COVID-19 related discrimination, and 2) substance use (past-week use of alcohol, cigarettes, e-cigarettes, cannabis, and other drugs, poly-substance use, and binge drinking) along with key public health (e.g., COVID-19 illness and vaccination), economic (e.g., economic insecurity, housing insecurity, and employment instability), and behavioral factors (e.g., resilience and coping strategies). We will combine person-level data (38 survey waves) with state-level geocoded data on hate crime incidence, statutory provisions, and other public health or economic context. Intensive longitudinal multi-level modeling will be conducted to partition between- and within-subject variance and address between-person confounds, thus overcoming the biases inherent in other annual-interval national substance use surveillance with low temporal precision and recall errors. Through three inter-related aims and theory-driven hypothesis testing, we will 1) examine whether within-person changes in discrimination are associated with substance use and if associations are moderated by race and ethnicity (Aim 1), 2) determine person- and environment-level factors that exacerbate or buffer against the association of discrimination with substance use (Aim 2), and 3) assess mechanisms that explain race/ethnicity differences in the association of discrimination with substance use (Aim 3). Findings from this study will provide timely evidence to guide clinicians and policymakers on interventions that can disrupt discrimination’s impact on substance use in the modern social, economic, and public health context.

项目概要 长期以来，遭受种族歧视一直被认为是药物滥用的一个关键社会决定因素， 按种族/民族分层。从 2020 年开始，种族主义的表现及其影响愈演愈烈，最近的 COVID-19 大流行期间不稳定的气候提供了一个独特的机会来评估将这些因素联系起来的机制 歧视和其他健康问题社会决定因素以及吸毒方面的种族/族裔差异，但并没有 是该主题应有的必要科学。关于药物使用歧视的现有研究 关联性受到外部有效性（即，普遍性较低的非代表性抽样）的困扰。 美国整体）和内部有效性（即，从每年的调查间隔中检测到的时间精度较低 前瞻性的、潜在的因果关系）。此外，几乎没有证据可以指导临床医生和 政策制定者采取干预措施，消除歧视对现代社会物质使用的影响， 经济和公共卫生背景。对国家代表性理解的二次分析 美国研究（UAS，n~9,000 名美国成年人）旨在阐明 物质使用方面种族/族裔不平等的歧视。为了绘制大流行的广泛影响， 研究将纵向协调每两周一次（2020 年 3 月至 2021 年 7 月）和每月一次（2021 年 8 月/9 月至 2022 年 6 月）总共有 38 个时间点的调查波。随时间变化的衡量标准包括 1) 歧视经历、种族主义和与 COVID-19 相关的歧视，以及 2) 物质使用（过去一周的使用情况） 酒精、香烟、电子烟、大麻和其他药物、多种物质的使用和酗酒） 与关键公共卫生（例如，COVID-19 疾病和疫苗接种）、经济（例如，经济不安全、住房 不安全感和就业不稳定）以及行为因素（例如复原力和应对策略）。我们将 将个人层面的数据（38 轮调查）与仇恨犯罪发生率、法定的州级地理编码数据相结合 规定以及其他公共卫生或经济背景。密集纵向多层次建模将 进行划分主体间和主体内差异并解决人与人之间的混淆，从而 克服其他时间较短的年度间隔国家药物使用监测中固有的偏差 精确率和召回率错误。通过三个相互关联的目标和理论驱动的假设检验，我们将 1) 检查人体内歧视的变化是否与物质使用有关，以及是否存在关联 受到种族和民族的调节（目标 1），2）确定加剧的个人和环境因素 或缓冲歧视与物质使用之间的关联（目标 2），以及 3) 评估机制： 解释歧视与药物使用之间的种族/民族差异（目标 3）。调查结果来自 这项研究将提供及时的证据，指导临床医生和政策制定者采取可能扰乱的干预措施 歧视对现代社会、经济和公共卫生背景下药物使用的影响。