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

项目摘要 长期以来，受到种族歧视一直被认为是物质使用的关键社会决定因素 按种族/民族分层。从2020年开始，种族主义及其影响的表现有所加剧，最近 新冠肺炎大流行期间的动荡气候提供了一个独特的机会来评估 在药物使用方面存在种族/族裔差异的歧视和其他健康的社会决定因素，但没有 在这个主题上是理所当然的必备科学。关于歧视性物质使用的现有研究 关联性受到外部效度(即具有低概化能力的非代表性抽样)的困扰 (美国整体)和内部效度(即，从年度调查间间隔检测的低时间精度 预期的、潜在的因果关联)。此外，几乎没有证据可以指导临床医生和 政策制定者提出的干预措施可以破坏歧视对现代社会物质使用的影响， 经济和公共卫生背景。这是对具有国家代表性的理解的二次分析 美国研究(UAS，n~9000美国成年人)旨在阐明这种关联的性质和机制 物质使用中存在种族/族裔不平等的歧视。为了描绘大流行的广泛影响，这一点 研究将纵向协调双周(2020年3月至2021年7月)和每月(2021年8月/9月) 2022年6月)共38个时间点的调查波。时变测量包括1)频率 歧视经历、种族主义和新冠肺炎相关歧视，以及2)药物使用(过去一周使用 酒精、香烟、电子烟、大麻和其他毒品、多物质使用和酗酒) 关键的公共卫生(例如新冠肺炎疾病和疫苗接种)、经济(例如经济不安全、住房 不安全和就业不稳定)和行为因素(例如复原力和应对策略)。我们会 将个人级别的数据(38个调查波)与州级别的仇恨犯罪发生率地理编码数据相结合，法定 规定，以及其他公共卫生或经济背景。密集的纵向多层次建模将 旨在划分主体之间和主体内部的差异，并解决人与人之间的混淆，因此 克服其他年度间隔国家药物使用监测的固有偏见，时间较短 精确度和召回错误。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) 检查人内歧视的变化是否与物质使用有关，以及是否有关联 受到种族和民族的制约(目标1)，2)决定了加剧 或防止歧视与药物使用相联系的缓冲(目标2)，以及3)评估 解释歧视与药物使用之间的种族/族裔差异(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对可能扰乱 歧视在现代社会、经济和公共卫生背景下对物质使用的影响。

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.