The Intersection Between Sex and Race in Understanding Substance Co-Use Patterns in Adolescents From the Fragile Families Study

DOI10.1177/00220426211041093
Date01 January 2022
Published date01 January 2022
Subject MatterArticles
Article
Journal of Drug Issues
2022, Vol. 52(1) 1530
© The Author(s) 2021
Article reuse guidelines:
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DOI: 10.1177/00220426211041093
journals.sagepub.com/home/jod
The Intersection Between Sex
and Race in Understanding
Substance Co-Use Patterns in
Adolescents From the Fragile
Families Study
Jamie M. Gajos
1
, Juliann B. Purcell
2
, and Sylvie Mrug
2
Abstract
The current study examined the prevalence of alcohol, cigarette, and cannabis co-use among a
longitudinal cohort of youth predominately born to single-parent families. Data were drawn from
wave six of the Fragile Families and Child Wellbeing Study (N= 2976; M
age
= 15.6; 49% female;
53% non-Hispanic Black, 27% Hispanic, 20% White). Adolescentsreports of their past 30-day use
of alcohol, cigarettes, and cannabis were used to construct eight mutually exclusive use groups.
Multinomial logistic regressions adjusting for sociodemographic factors revealed that Black ad-
olescents were at lower relative risk of using Alcohol Only compared to White adolescents. Black
males were at greater relative risk of using Cannabis Only than both White males and Black
females. Finally, Hispanic males were at a marginally increased relative risk of co-using Alcohol and
Cannabis compared to White males. Prevention efforts targeting Black and Hispanic malesuse of
cannabis (both alone and in combination with alcohol) may be benef‌icial.
Keywords
fragile families, substance co-use patterns, alcohol, cigarettes, cannabis, high-risk adolescents
Introduction
Rates of alcohol and substance use have been declining across the United States for the past
several years, but remain high for some substances. In recent years, nearly 60% of adolescents
have used alcohol, 24% have used cigarettes, and 44% have used cannabis by their senior year of
high school (Johnston, OMalley, Miech, Bachman, & Schulenberg, 2017,2019). However,
despite substantial information on the prevalence of single-substance use, recent research has
1
Department of Human Development and Family Studies, University of Alabama, Tuscaloosa, AL, USA
2
Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
Corresponding Author:
Jamie M. Gajos, Department of Human Development and Family Studies, The University of Alabama, 218 Child
Development Research Center, Tuscaloosa, AL 35487, USA.
Email: jmgajos@ches.ua.edu
begun to examine the co-use of alcohol and other drugs among adolescents (Tomczyk, Isensee, &
Hanewinkel, 2016). A greater understanding of substance co-use is essential, as co-use of multiple
substances is associated with poorer outcomes than single-substance use, including poor physical
and psychological health, increased risk of delinquency, and decreased educational attainment
(Bhalla, Stefanovics, & Rosenheck, 2018;Hoffman, Welte, & Barnes, 2001;Johnson & Richter,
2002;Kelly et al., 2015;Kokkevi et al., 2014;Neumann, Bühringer, H¨
of‌ler, Wittchen, & Hoch,
2018). Moreover, adolescents from single-parent households exhibit higher substance use risk
(Hemovich, Lac, & Crano, 2011), making it especially important to examine substance co-use
patterns in adolescents primarily born into single-parent households.
Prior investigations of single-substance use have also established consistent differences in
patterns of use based on sex and race/ethnicity. For example, male adolescents typically report
higher prevalence of alcohol, tobacco, and cannabis use than females (Chen & Jacobson, 2012;
Johnston et al., 2017,2019;Kann et al., 2018;Miech, Johnston, OMalley, Bachman, &
Schulenberg, 2017,2019), a pattern which tends to persist throughout the lifespan (Chen &
Jacobson, 2012). Additionally, prevalence of alcohol and substance use varies between different
racial/ethnic groups. Previous investigations have found that White adolescents are more likely to
report alcohol and tobacco use, while Black, and Hispanic adolescents are more likely to report
cannabis use (Chen & Jacobson, 2012;Hoffman et al., 2001;Johnston et al., 2017,2019;Kann
et al., 2018;Kokkevi et al., 2014).
Several recent investigations have focused on examining patterns of adolescent alcohol, to-
bacco, and cannabis co-use. Most of these studies f‌ind that males are more likely to be members of
all co-use groups compared to females (Banks, Rowe, Mpofu, & Zapolski, 2017;Kokkevi et al.,
2014;Moss, Chen, & Yi, 2014;Purcell et al., 2021). In contrast, there have been fewer in-
vestigations examining racial/ethnic differences in adolescent alcohol and substance co-use and
f‌indings have been variable. Some studies f‌ind that racial/ethnic minority youth are more likely to
use cannabis only or to co-use cannabis and alcohol (Banks et al., 2017;Moss et al., 2014).
However, a more recent investigation controlling for age and several sociodemographic factors
found that racial/ethnic minority youth were no more likely to use cannabis only than their White
peers (Purcell et al., 2021). Differences in study design, participant age, other sample charac-
teristics, and covariates included in analyses likely contribute to the heterogeneity of f‌indings
pertaining to racial/ethnic differences. Additional work is needed to clarify the results of prior
research and to elucidate relationships between sex, race/ethnicity, sociodemographic factors, and
patterns of adolescent alcohol and substance co-use.
Although many types of substance use show distinct patterns across sex and racial/ethnic
groups of adolescents (Amey & Albrecht, 1998;Choi, Lu, Schulte, & Temple, 2018), the in-
tersectional effect of sex and race/ethnicity has been largely unexplored. Intersectionality refers to
the idea that different identities (e.g., sex, race/ethnicity, sexual orientation, class, etc.) interact to
affect an individuals experience of the world (Crenshaw, 1991). For example, Black women, and
White women both have the same sex, but often experience the world differently due to their race.
Previous research has examined the role of racial differences in cultural expectations/perceptions
(e.g., parental and peer disapproval for substance use) on adolescent alcohol use (Mrug & McCay,
2013) and cannabis use (Lee, Kim-Godwin, & Hur, 2021). Indeed, prior evidence suggests that
Black and Hispanic adolescents are more likely to report greater levels of perceived peer and
parental disapproval for cannabis use (respectively) compared to White youth (Lee et al., 2021),
but also that Black and Hispanic youth are more likely to self-report lower risk perceptions of
cannabis use than White youth. However, an examination of the intersectionality of sex and racial/
ethnicity on substance co-use patterns is needed. Only one recent study examined the interactive
effects of sex and race/ethnicity in adolescent substance co-use. Although this study did not f‌ind
signif‌icant interactions between sex and race/ethnicity in a community sample of 16-year-old
16 Journal of Drug Issues 52(1)

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