As adolescent substance use declines, internalizing symptoms increase: identifying high-risk substance using groups and the role of social media, parental supervision, and unsupervised time

Abstract Racial and ethnic differences in the prevalence of substance use as well as mood and anxiety problems among adolescents are shifting, prompting concern for rising inequality. While non-Hispanic white adolescents historically were at increased risk of substance use and mental health problems compared with most racialized minority groups, we and others have published recent evidence indicating rising rates of cannabis use, overdose, and suicide risk among young cohorts of Black, Asian, and Hispanic adolescents and young adults. These differences are widely variable across US states, a geographic entity that is critical for policy and intervention given allocation of resources. Addressing these emerging disparities requires assessment of the geographic and temporal sources of variation in order to recommend intervention and prevention efforts. In this supplement to R01-DA048853 to support research on health equity, we request additional funding to add two analytic aims to our project that both utilize the Monitoring the Future data in previously untapped ways, with scientific goals that fit appropriately with funded aims in a non-duplicative way. Indeed, our funded aims examine time trends and explanations for time trends in substance use and mental health among youth, but have not to date focused on racial/ethnic differences in those trends, or potential structural drivers of emergent disparities. Monitoring the Future is an ideal data source suited to accomplish the present aims, given the sample size of more than 530,000 youth; reliable mental health and substance use measures, and state-level variation. We begin our proposed investigation in 2008 as it is the inflection point for the increase in mental health symptoms and the emergence of disparities in substance use. Currently, we can conduct analyses through 2020, and will extend assessments into future years when possible to include assessment of whether COVID-19 has amplified existing inequalities Therefore we plan to: Aim 1) Examine race/ethnicity (including race/ethnic subgroups such Puerto Rican and Cuban youth) as effect measure modifiers of age-period-cohort effects among adolescents from 2008-2020 in alcohol, cannabis, other drug use, and vaping of nicotine and cannabis, mental health, and their co-occurrence; Aim 2) Assess state-to-state heterogeneity in age-period-cohort effects, by race/ethnicity, and moderation by state-level aggregated measures of structural racism in historical legacies, policies, attitudes, and social positioning of racialized minorities. These analyses are increasingly critical in the context of the COVID-19 pandemic; health disparities in the effects of COVID-19 on minority communities may amplify growing disparities in youth substance use, mental health, and their co-occurrence. As MTF data from 2020, 2021 and beyond are collected and released, assessing the consequences of the pandemic on adolescent health and health disparities will provide essential data for targeting intervention and prevention efforts to youth.