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American Journal of Epidemiology Advance Access published online on August 13, 2007
American Journal of Epidemiology, doi:10.1093/aje/kwm180
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American Journal of Epidemiology © The Author 2007. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTION

Self-reported Racial Discrimination and Substance Use in the Coronary Artery Risk Development in Adults Study

Luisa N. Borrell1, David R. Jacobs, Jr2,3, David R. Williams4, Mark J. Pletcher5, Thomas K. Houston6,7 and Catarina I. Kiefe6,8

1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
2 Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN
3 Department of Nutrition, University of Oslo, Oslo, Norway
4 Departments of African and African American Studies and of Sociology, School of Public Health, Harvard University, Boston, MA
5 Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
6 Deep South Center on Effectiveness, Birmingham Veterans Affairs Medical Center, Birmingham, AL
7 Division of General Internal Medicine, University of Alabama, Birmingham, AL
8 Division of Preventive Medicine, University of Alabama, Birmingham, AL

Correspondence to Dr. Luisa N. Borrell, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032 (e-mail: lnb2{at}columbia.edu).

Received for publication December 22, 2006. Accepted for publication May 18, 2007.

The authors investigated whether substance use and self-reported racial discrimination were associated in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Smoking status, alcohol consumption, and lifetime use of marijuana, amphetamines, and opiates were ascertained in 2000–2001, 15 years after baseline (1985–1986). Most of the 1,507 African Americans reported having experienced racial discrimination, 79.5% at year 7 and 74.6% at year 15, compared with 29.7% and 23.7% among the 1,813 Whites. Compared with African Americans experiencing no discrimination, African Americans reporting any discrimination had more education and income, while the opposite was true for Whites (all p < 0.001). African Americans experiencing racial discrimination in at least three of seven domains in both years had 1.87 (95% confidence interval (CI): 1.18, 2.96) and 2.12 (95% CI: 1.42, 3.17) higher odds of reporting current tobacco use and having any alcohol in the past year than did their counterparts experiencing no discrimination. With control for income and education, African Americans reporting discrimination in three or more domains in both years had 3.31 (95% CI: 1.90, 5.74) higher odds of using marijuana 100 or more times in their lifetime, relative to African Americans reporting no discrimination. These associations were similarly positive in Whites but not significant. Substance use may be an unhealthy coping response to perceived unfair treatment for some individuals, regardless of their race/ethnicity.

adaptation, psychological; African Americans; alcohol drinking; amphetamines; cannabis; cocaine; prejudice; smoking

Abbreviations: CARDIA, Coronary Artery Risk Development in Young Adults; CI, confidence interval


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