School Belonging and Racial Mistreatment: Association With Substance Use Among U.S. High School Students

INTRODUCTION: Alcohol, cannabis, and e-cigarettes are among the most commonly used substances among U.S. high school students. This study examines the associations between the intersection of school belonging, perceived racial mistreatment, and substance use. METHODS: Data were drawn from the 2023 Youth Risk Behavior Survey of high school students. An analysis was conducted using a novel composite measure combining school belonging (closeness to people at school) and perceived racial mistreatment (unfair treatment due to race/ethnicity). Multivariable logistic regression analyses, adjusted for demographics and sexual identity, examined associations between the composite score and past 30-day use of alcohol, cannabis, and e-cigarettes. RESULTS: Higher composite scores, indicating more school belonging and lower perceived racial mistreatment, were associated with lower odds of using alcohol (OR = 0.93, 95% CI = 0.88-0.99), cannabis (OR = 0.87, 95% CI = 0.83-0.92), and e-cigarette (OR = 0.87, 95% CI = 0.82-0.91). Sex-stratified analyses revealed that higher composite scores were significantly associated with protective odds for females across all substances (alcohol, OR = 0.91, 95% CI = 0.85-0.97; cannabis, OR = 0.87, 95% CI = 0.81-0.94; and e-cigarette, OR = 0.86, 95% CI = 0.81-0.92). For males, significant protective associations were observed for cannabis and e-cigarette use, though the association for alcohol use was not statistically significant. CONCLUSION: The findings suggest that greater school belonging and lower racial mistreatment are associated with lower odds of substance use among adolescents. Efforts to improve school climate and reduce racial mistreatment may be beneficial.