Discrimination disproportionately affects socially marginalized groups, contributing to health disparities through psychological and physiological stress pathways. In particular, young adulthood is a critical developmental period marked by identity formation and transitions into new roles and environments, where experiences of discrimination may trigger maladaptive coping behaviors such as substance use. However, previous studies have typically examined discrimination in college students or focused on single forms of discrimination, failing to adequately capture the diverse experiences of the general young adult population. This study aims to examine how multiple forms of discrimination, as well as specific experiences of discrimination (race-, gender-, and sexual orientation-based), are associated with alcohol and cannabis use in a large, diverse sample of young adults. Additionally, it investigates how these associations vary by sociodemographic characteristics, offering important implications for the prevention of substance use and related harms among young people.
This study utilized data from 2,303 young adults in the United States who participated in Wave 14 (2021–2022) of an ongoing longitudinal survey. Discrimination was assessed using the 10-item Everyday Discrimination Scale, with participants indicating perceived reasons (e.g., race, gender, sexual orientation); responses were categorized by the total number of discrimination types and by specific forms of discrimination. Outcome measures included negative consequences of alcohol and cannabis use, substance use disorder symptoms (AUDIT and CUDIT-SF), and solitary use behaviors. Covariates such as substance use quantity, sociodemographic characteristics, and sexual and gender minority (SGD) status were included. All analyses were conducted using SAS 9.4, employing regression models to examine associations between discrimination and substance use outcomes.
The study revealed that various forms of discrimination were significantly associated with alcohol and cannabis use among young adults. Approximately half of the sample reported no or minimal discrimination, while the remainder experienced one (17%), two (12%), or three (10%) types. Race/ancestry-based discrimination was most common (27.0%), followed by gender (25.7%) and sexual orientation (5.1%). In adjusted analyses, individuals who reported one type of discrimination experienced alcohol-related consequences 1.43 times more frequently and had AUDIT scores 1.26 times higher than those reporting no or minimal discrimination. Regarding cannabis, participants reporting two, three, or five or more types of discrimination experienced cannabis-related consequences 1.70, 2.72, and 2.56 times more frequently. CUDIT-SF scores were also elevated: 1.68 times higher among those with one type, 1.70 times higher among those with three types, and 2.25 times higher among those with five or more types of discrimination. Notably, race-based discrimination was inversely associated with alcohol-related consequences (0.77 times lower), but positively associated with cannabis-related consequences (1.59 times higher). Gender-based discrimination was significantly associated only with greater odds of solitary cannabis use, while sexual orientation-based discrimination was not significantly associated with any outcomes.
Takeaway: Young adults who experience multiple forms of discrimination show significantly higher rates of problematic alcohol and cannabis use, with cannabis-related outcomes demonstrating a particularly strong relationship to the increasing number of discrimination types experienced.