Pediatrics · Medical Literature
Perceived Unfair Police Treatment and Recent Substance Use Among Male Youth Residing in Pittsburgh: Cross-Sectional Findings from a Randomized Control Trial.
Abstract
This study examined associations between race-based discrimination and substance use among a predominantly minority sample of male youth, ages 13-19, residing in under-resourced neighborhoods in Pittsburgh, Pennsylvania. Youth completed in-person, anonymous electronic surveys about their lifetime experiences with race-based discrimination and past 30-day tobacco, alcohol, and marijuana use. Logistic regression models examined associations between race-based discrimination, measured as a sum of each discriminatory experience endorsed and by each individual discriminatory experience, and past 30-day substance use. Models controlled for age, sexual orientation, school suspension history, parental education, and intervention status. Although most youth (85.6%) reported experiencing one or more forms of race-based discrimination in their lifetime, total discrimination scores were not significantly associated with past 30-day substance use. However, item-specific analyses revealed that unfair police treatment was significantly associated with greater odds of tobacco use (AOR = 2.18; 95% CI 1.39, 3.41) and marijuana use (AOR = 2.26; 95% CI 1.51, 3.39). Study findings highlight the importance of item-specific measurement since types of race-based discrimination have different consequences for youth (e.g., detention from an unfair teacher, police arrest). Study results suggest the need for healing-centered strategies and policy reforms to address the negative impact of policing on minority youth's well-being.
Clinical relevance
This study addresses the underexplored relationship between race-based discrimination—specifically unfair police contact—and substance use initiation among minority male adolescents in under-resourced urban environments, a population at disproportionately high risk for both exposure and adverse health outcomes. It highlights a critical gap in aggregate discrimination measurement tools, which may mask the differential health impact of specific discriminatory experiences such as law enforcement encounters. Pediatricians and adolescent medicine specialists caring for minority youth in high-poverty urban settings should consider policing-related trauma as a discrete, clinically meaningful social determinant of substance use risk.
Key findings
1. The sample comprised male youth ages 13–19 residing in under-resourced Pittsburgh neighborhoods, with 85.6% reporting at least one lifetime race-based discriminatory experience, underscoring the near-ubiquitous exposure burden in this population. 2. Aggregate (summed) race-based discrimination scores were NOT significantly associated with past 30-day tobacco, alcohol, or marijuana use in multivariate logistic regression models controlling for age, sexual orientation, school suspension history, parental education, and intervention status. 3. Item-specific analysis revealed that perceived unfair police treatment was independently associated with significantly greater odds of past 30-day tobacco use (AOR = 2.18; 95% CI: 1.39–3.41). 4. Perceived unfair police treatment was also independently associated with significantly greater odds of past 30-day marijuana use (AOR = 2.26; 95% CI: 1.51–3.39). 5. No statistically significant association was identified between unfair police treatment and past 30-day alcohol use (specific AOR not reported in abstract). 6. Findings demonstrate that item-level discrimination measurement captures clinically meaningful heterogeneity obscured by composite scoring, as different discriminatory experiences (e.g., unfair teacher treatment vs. police contact) carry materially different health consequences for youth.
Practice implications
Clinicians performing adolescent well-child and behavioral health visits in urban, minority-serving settings should incorporate targeted screening for law enforcement-related adverse experiences—distinct from generalized discrimination measures—as a discrete social determinant associated with a more than two-fold increased odds of tobacco and marijuana use. When unfair police contact is identified, providers should connect youth to healing-centered, trauma-informed interventions that specifically address policing-related stress, rather than relying solely on generic substance use prevention programs. At the systems level, pediatric providers and public health advocates should engage in policy reform efforts aimed at reducing harmful police-youth contact, given its independently documented contribution to substance use risk in this vulnerable population.