Applying an Intersectional Lens to Racial and Gender Identity Disparities In Adolescent Substance Use In Colorado

Background and Purpose: Adolescent substance use is associated with a variety of negative outcomes including low graduation rates, future physical and mental health problems, suicide, and death by overdose. Previous literature indicates that race and gender identity are both important individual factors influencing rates of substance use among young people, though little research examines the ways they intersect to impact substance use vulnerability. As such, this study explores the relationship between substance use (i.e., alcohol, cannabis, nicotine) and intersectional race and gender identities among high school students in Colorado, a state that is underrepresented in current literature.

Methods: Data consisted of the high school subsample of the 2023 Healthy Kids Colorado Survey (N=49,539). Most participants were White (52.3%) or Multiracial/Other race (18.9%) and a plurality were 9th graders (29.8%). Most youth identified as cisgender boys (47.9%) or girls (45.6%); 2.1% and 1.8% identified as transgender and gender nonbinary, respectively. Regarding sexual orientation, most were heterosexual (79.5%), followed by bisexual (8.2%) and gay or lesbian (3.0%). For analysis, an intersectional race-gender variable was created (e.g., White cisgender girls, Black nonbinary youth). Logistic regression models examined intersectional race and gender disparities in past 30-day cannabis use, cigarette use, and heavy episodic drinking (HED), controlling for grade level, sexual orientation, and maternal education level. All analyses were weighted for representativeness. Missingness was addressed using multiple imputation (M=60). The significance level was adjusted using Bonferroni correction to address false discovery rate (p < .0125).

Results: Substance use patterns varied significantly across intersectional race and gender identities. In general, transgender, cisgender, and nonbinary youth of color reported greater substance use vulnerability than their White peers. For instance, Multiracial transgender youth (aOR=2.8) and cisgender boys (aOR=1.2) were more likely to use cannabis than White cisgender girls, with absolute risks of 28.7% and 16.6%, respectively, compared to 13.0%. Similarly, Black (aOR=5.9; 16.0% absolute risk) and Multiracial (aOR=5.8; 15.6%) transgender youth were more likely to use cigarettes than White cisgender girls (3.2%). Notably, Asian nonbinary respondents had the highest absolute risk of heavy episodic drinking (29.6%), while Asian cisgender boys had one of the lowest (5.7%).

Conclusions and Implications: The results suggest that mono-racism, anti-Black racism, and minority stress experienced by transgender, nonbinary, and cisgender youth of color may contribute to substance use vulnerability. Furthermore, the impact of gender on substance use vulnerability varied across racial groups, further underscoring the importance of using an intersectional approach when evaluating substance use disparities. Social workers supporting the substance use related-health of adolescents should tailor culturally-responsive treatment approaches to address the needs of youth with intersectionally marginalized identities. Similarly, social work researchers should utilize intersectional approaches to better understand substance use vulnerabilities among adolescents.