Research on the use of alcohol and other drugs suggests that although racial/ethnic differences in the epidemiology of alcohol and other drug use are not large, there are significant racial and ethnic dif- ferences in the experience of negative mental, phys- ical, and social health consequences associated with the use and abuse of drugs. Because substance-re- lated problems impact black and Hispanic adults disproportionately, black and Hispanic young peo- ple, particularly those who are children of substance abusers, are at elevated risk for myriad problems. Although researchers typically focus on differences in individual and interpersonal factors as explana- tions for racial/ethnic disparities in substance use
outcomes, recent research suggests that socioeco- nomic and contextual factors may be as important, if not more important, explanatory variables.
Although this article generally has taken racial/eth- nic differences in SES and exposure to contextual risk factors for substance use as givens, persons concerned with racial/ethnic disparities in health and well-being must question why these differences exist. Undoubt- edly, racial/ethnic differences in poverty and commu- nity-level living conditions are rooted in the historical and contemporary racialized nature of American soci- ety. The racialized nature of American society is dem- onstrated by the fact that it has in the past, and contin- ues to in the present, categorize, stereotype, prejudge, and differentially treat people based on their physiog- nomy—ie, physical features such as skin color, hair texture, and so forth.39The racialized nature of Amer-
ican society has systematically created and maintained significant differences in the social conditions and con- texts of the various people of African, Latin, and Euro- pean descent categorized as “black” and “Hispanic” and “white.”40
Historical and contemporary racialized practices and ideologies inherent in American society influence ra- cial/ethnic differences in substance use outcomes both directly and indirectly through their influence on the communities in which people of different racial/ethnic groups are placed, their influence on structure and process of people’s interpersonal relationships, and through the impact that they have on individuals’ psy- chology and behavior.41 And thus, although the em-
phasis of pediatricians’ and many other helping pro- fessionals’ work focuses on individuals and individual- level behaviors, these behaviors can be only properly examined, diagnosed, and treated when they are un- derstood in view of the community and societal con- texts in which they occur.
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