Racism-related experiences and substance use: A systematic and meta-analytic review

Examinations highlighting interpersonal racism-related experiences as risk factors for substance use are well documented, particularly for alcohol use. The associations between racism-related experiences across other levels of influence (e.g., historical trauma, online, internalized) and use of other types of substances, while emerging, have yielded mixed findings. The present systematic review and meta-analyses examined the associations between multilevel racism-related experiences and different types of substances including substance use overall, alcohol, binge drinking, tobacco/nicotine, cannabis, illicit drugs, and polysubstance use among ethnoracially minoritized adolescents and emerging adults (12-29 years old). A systematic literature search and the Newcastle-Ottawa Scale (NOS) were used to identify, assess quality, and bias of included articles. Random-effects meta-analyses estimated pooled effect sizes for seven substance use outcomes and by age, sex, and race/ethnicity. Out of a total of 3190 articles, 91 (N = 190,065 participants) met inclusion criteria, 79 of which were included in the meta-analysis. The studies included were predominantly cross-sectional, school-based samples, and focused on Black individuals. Most examined interpersonal racism and few examined online and historical forms of racism. Meta-analyses demonstrated a significant positive association, with a small pooled effect size, between racism-related experiences and each substance use outcome. Moderations by age, sex, and race/ethnicity were found. Racism-related experiences are a risk factor for substance use among ethnoracially minoritized adolescents and emerging adults. Interventions addressing racism-related experiences across multiple dimensions are critical for the prevention and treatment of substance use among ethnoracially minoritized communities.