Author ORCID Identifier

https://orcid.org/0000-0002-7002-0547

Date of Award

Summer 8-13-2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor

Claire Adams Spears, PhD

Second Advisor

Katherine Masyn, PhD

Third Advisor

Kim Ramsey-White, PhD

Fourth Advisor

Richard Rothenberg, PhD

Abstract

Compared to Whites, Blacks in the U.S. have lower rates of substance use in adolescence, but similar rates in adulthood and greater substance use problems, morbidity, and mortality. Discrimination contributes to substance use, poor mental health, and health disparities among Blacks. Theoretically, those experiencing discrimination may use substances to cope with discrimination-related stress. However, updated research is needed to understand the discrimination-substance use relationship, potential moderators, and mediators. The purposes of the dissertation are to 1) provide an updated assessment of the relationship between discrimination/allostatic load (i.e. physiological weathering) and substance use, 2) investigate the role of psychological distress and positive wellbeing as mediators of the discrimination-substance use relationship, and 3) investigate the role of race/ethnicity, sex, and attribution to discrimination as moderators of these associations.

For study 1, logistic regression was used to examine associations between allostatic load and current alcohol use, marijuana use, and cigarette smoking among adults aged 20-59 and moderation effects by sex and race/ethnicity. For studies 2 and 3, multiple group moderated mediated structural equation modeling was used to examine the role of psychological distress and positive wellbeing as mediators of the discrimination-substance use relationship (alcohol, marijuana, other illicit drugs, cigarettes, and electronic nicotine delivery systems; study 3 includes alcohol, marijuana, and tobacco use) among adults aged 18-28. For study 2, moderation effects by sex and race (Black/White) were explored. For study 3, participants included Blacks only, and moderation effects were examined by sex and attribution to the discriminatory experiences (e.g., race vs. other reasons).

In study 1, the non-linear, non-monotonic allostatic load-substance use relationship was moderated by sex and race/ethnicity, wherein Black and White males were more likely to be current substance users, Hispanics were least likely, and a strong sex effect was observed among Blacks and less strongly among Whites. In studies 2 and 3, discrimination was directly and indirectly (through psychological distress and positive wellbeing) associated with substance use among Blacks, especially males, and among Whites. Study 3 indicated that racial discrimination specifically contributes to substance use among Black males in particular. Additional research is needed to inform prevention efforts.

DOI

https://doi.org/10.57709/14881805

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