Human Capital Development Factors and Black Adolescent Tobacco and Cannabis Use

Abstract

Introduction

This study examined the association of four domains of human capital development (cognitive development, social and emotional development, physical health, and mental health) and exclusive and concurrent tobacco and cannabis use (TCU) among black youth.

Aims and Methods

Nationally representative annual cross-sectional data for black adolescents (12–17 years; N = 9017) in the National Survey on Drug Use and Health 2015–2019 were analyzed. Analyses examined the influence of human capital factors (cognitive development, social and emotional development, physical health, and mental health) on exclusive and concurrent TCU.

Results

In total, 50.4% were males; prevalence of 12-month tobacco use fluctuated insignificantly between 5.6% and 7.6% across survey years. Similarly, prevalence of 12-month cannabis use remained relatively stable around 13%, with no significant linear change. Prevalence of concurrent TCU also fluctuated insignificantly between 3.5% and 5.3%. Investment in cognitive development decreased the odds of tobacco (aOR = 0.58, p < .001), cannabis (aOR = 0.64, p < .001), and concurrent tobacco and cannabis (aOR = 0.58, p < .001) use. Similarly, investment in social and emotional development reduced the odds of tobacco (aOR = 086, p < .001), cannabis (aOR = 0.83, p < .001), and concurrent tobacco and cannabis (aOR = 0.81, p < .001) use. Good physical health reduced the odds of tobacco (aOR = 0.52, p < .1), cannabis (aOR = 0.63, p < .05), and concurrent TCU (aOR = 0.54, p < .05). Major depressive episodes increased the likelihood of cannabis use (aOR = 1.62, p < .001).

Conclusions

Investment in cognitive, social, and emotional aspects of human capital development, and physical health among black youth is protective against TCU. Efforts to sustain human capital development among black adolescents may contribute to reducing TCU disparities.

Implications

This is one of few studies to examine human capital development factors and their associations with TCU among black youth. Efforts to eliminate tobacco/cannabis-related disparities among black youth should also invest in social, emotional, cognitive, and physical health development opportunities.

Introduction

Tobacco and cannabis use (TCU) are closely related behaviors, and their concurrent use is associated with well-documented adverse outcomes that surpass the risk of either substance alone.^1–4 Although the percentage of black middle and high school students in the United States who reported past 30-day tobacco use in 2019 (13.2%) is lower than their white (17.8%) and Hispanic (17.2%) counterparts,⁵ this lower prevalence does not persist into adulthood.^6–8 Previous studies found that lower rates of tobacco use among black adolescents, compared to white adolescents, largely disappear or are reversed in adulthood.^6–8 Later age of tobacco use initiation and lower rates of cessation in adulthood are viewed as responsible for the loss of this advantage among black adults.^6,9,10 Additionally, compared to their white counterparts, black adults are less likely to quit and more likely to be burdened with tobacco-related diseases even though they initiate tobacco use later in life.¹¹ Similarly, despite lower prevalence of cannabis use in black adolescents compared to whites, increased cannabis use has been documented in black adolescents in the past decade,⁸ and black adults are more likely to report cannabis use disorder compared to white adults.¹² This underscores the significance of elucidating pathways and correlates of risk for TCU among black adolescents.

Evidence suggests protective factors such as educational attainment,¹³ school connectedness,¹⁴ satisfaction with maternal-child relationship,¹⁵ and religiosity^16–18 contribute to cognitive, social, and emotional development (foundational aspects of human capital development),^19,20 future productivity, and prevent tobacco use among youth.²¹ In contrast, peer drug use and truancy,¹³ marijuana use,¹³ and experience of discrimination^22,23 can increase risk of tobacco use and adverse health and economic outcomes. Identifying these individual risk and protective factors have been instrumental for designing tobacco use prevention programs. However, there is a dearth of evidence regarding the collective impact of black youths’ ability to build human capital and the association with TCU risk.¹⁹ To better understand factors that could contribute to current and later TCU among black youth which leads to tobacco/cannabis-related health disparities during adulthood, more studies that examine the collective impact of human capital development factors and the role they play in TCU risk are needed.¹⁹

Human capital, a store of values such as knowledge, skills, and abilities acquired by individuals to increase personal productivity over time,²⁴ is closely associated with educational attainment.²⁵ There is overwhelming evidence of an education and health gradient (ie, greater educational attainment strongly correlated with better health),²⁶ as such, educational attainment is often used as the proxy for human capital development. However, the concept of human capital is multifaceted, including dimensions such as cognition (eg, intelligence), social and emotional development (eg, capacity to socialize), and physical and mental health that affect health behaviors such as TCU.²⁷ These varied dimensions of human capital cannot be adequately represented or explained by educational attainment alone.^26,28,29

Human capital is accrued through intergenerational factors and interactive biological-environmental-behavioral processes.^19,20 Studies have called for a broad conceptualization of human capital to include key domains such as health (physical and mental) and well-being, cognitive (knowledge and skill acquisition), and social and emotional (interpersonal and socioemotional skills) development.^19,20 The development of these domains is particularly crucial during adolescence as this is a period of high susceptibility to risky behaviors such as TCU which could interrupt an individual’s mental and normative development needed to fulfill individual and societal potential.^19,20 Human capital development provides the skills needed to handle life’s challenges, which is a key factor identified as a reason for TCU initiation among black youth.¹¹ For example, Zullig et. al found that black youth with lower emotional self-efficacy were at increased odds of tobacco use compared to white adolescents.²¹ Another study reported that good overall physical health has also been found to be protective against substance use among black youth.³⁰

Adolescence is also a particularly challenging life stage for assessing the influence of human capital on TCU behaviors because human capital stores of knowledge, skills, and dispositions are still being shaped and acquired, the full stock of which, and its impact on TCU, cannot be known until later in life. Particularly among many black people, tobacco use initiation coincides with a time period (young/early adulthood)¹¹ when lack of adequate prior investments in human capital development becomes apparent and could pose additional significant health (eg, susceptibility to substance initiation and escalation)¹⁰ and economic risk,³¹ exacerbating tobacco-related health disparities. Historically, black adolescents have been and continue to be disadvantaged across factors associated with human capital development such as educational attainment,^32,33 neighborhood poverty,³⁴ and health as a result of structural racism.³⁵ There is, therefore, an urgent need to better understand the contributions of human capital development factors to TCU among black youth. The purpose of this study was to examine the association between four human capital domains (cognitive development, social and emotional development, physical health, and mental health) and exclusive and concurrent TCU among black adolescents in the United States.

Materials and Methods

Data Source

Study data were obtained from the 2015–2019 public-use data files of the National Survey on Drug Use and Health (NSDUH), a nationally representative annual cross-sectional survey of non-institutionalized individuals aged 12 years and older in the U.S. NSDUH provides ongoing national prevalence estimates of drug use and disorders. Additional description of NSDUH is available online.³⁶ The data used in this analysis were limited to the 2015–2019 period, as the 2020 survey was disrupted because of COVID. Because of the study’s purpose and focus, the data were also limited to youth (12–17 years) who identified as being black. The institutional review board at RTI International approved the NSDUH data collection protocol, and verbal informed consent was obtained from each participant.

Human Capital Measures

The NSDUH questionnaire was not intentionally designed to measure human capital development; however, guided by previous studies (eg,^{16,20,21,37,38}) highlighting contributors to adolescents’ cognitive, social and emotional and development, relevant questions in the survey were used to obtain data for foundational evidence to assess human capital development among black youth. The different stand-alone questions were grouped into four human capital domains.

Social and Emotional Development

Six questions assessed youth exposure to social and emotional development opportunities and activities. One question asked, “During the past 12 months, have you participated in a problem-solving, communication skills, or self-esteem group?” Response options included no (coded as 0) or yes (coded as 1). Another question asked, “During the past 12 months, have you participated in a violence prevention program, where you learn ways to avoid fights and control anger?” Response options were no (coded as 0) or yes (coded as 1). Participants also indicated how many times, during the past 12 months, they participated in community-based, church or faith-based, or other social activities. Response options ranged from none = 0 to 3 or more = 3, and were dichotomized as no (coded as 0) or yes (coded as 1) to indicate whether they had attended any of the four activities or not. Youth were further asked three questions about their religious beliefs during the 12 months preceding the survey, including their feelings that religious beliefs influenced how they made decisions in their life, their religious beliefs were a very important part of their life, and it was important for friends to share religious beliefs. The original response options were on a scale of 1 = strongly disagree to 4 = strongly agree, which were dichotomized as no (coded as 0) or yes (coded as 1) indicating whether they had each of these beliefs or not. After recoding, a composite score for social and emotional development was calculated by adding up youth’s responses to each of the six questions, with total scores ranging from 0 to 6, with a higher total score indicating higher social and emotional development. We chose to consistently dichotomize responses to all items to avoid overweighting on items with more score options. The social and emotional development scale in the black youth sample showed good internal consistency, with Cronbach’s α values ranging from 0.66 to 0.71 for annual data across the survey years.

Cognitive Development

Four questions were used to measure cognitive development: 1) How do you feel overall about going to school in the past 12 months (1 = You liked going to school a lot, 2 = You kind of liked going to school, 3 = You didn’t like going to school very much, 4 = You hated going to school); 2) How important things learned in the past 12 months are going to be (1 = very important, 2 = Somewhat important, 3 = Somewhat unimportant, 4 = Very unimportant); 3) How often they feel school work is meaningful in the past 12 months (1 = Always, 2 = Sometimes, 3 = Seldom, 4 = Never); and 4) Grades for last semester/grading period completed (1 = An “A+,” “A” or “A-minus” average, 2 = A “B+,” “B” or “B-minus” average, 3 = A “C+,” “C” or “C-minus” average, 4 = A “D” or less than a “D” average). After reverse coding, youth’s total scores on the four questions were dichotomized by the median split into high and low cognitive development. The cognitive development scale in the black youth sample showed excellent internal consistency, with Cronbach’s α values ranging from 0.98 to 0.99 for annual data across the survey years.

Physical Health

One question assessed the perceived physical health of respondents. Participants rated their overall health on a scale from 1 = excellent to 5 = poor. For analytic prudency given response distribution, participants who indicated a rating of 1–3 were coded as having “good” overall physical health while participants who indicated a rating of 4–5 were coded as “poor” overall physical health.

Mental Health

Based on DSM-IV, adolescents in the NSDUH were classified as having a 12-month major depressive episode (0 = No, 1 = Yes) if they had either depressed mood or loss of interest or pleasure in daily activities for 2 weeks or longer in the past year, while also experiencing four or more other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-worth.

TCU Measures

TCU (including any tobacco use, any cannabis use, and concurrent TCU) in the 12 months preceding the survey were the main outcomes in this study. To assess any tobacco use, youths were asked whether they had used any tobacco products in the past 12 months (yes or no), including cigarettes, smokeless tobacco (chewing tobacco or snuff), cigars, or pipe tobacco. To assess cannabis use, youths were asked whether they used marijuana or hashish in the past 12 months (yes or no). Participants reporting use of both tobacco and cannabis products during the past 12 months were considered concurrent users (yes or no). Participants who reported using no tobacco or cannabis during the past 12 months preceding the survey were considered as non-users. Detailed description of the variables under consideration and the exact question wordings can be found on the Inter-university Consortium for Political and Social Research website.³⁹

Demographic Measures

The NSDUH collects information on respondents’ age, sex, family income, and geographical setting (large metropolitan, small metropolitan, or rural). Race/ethnicity was based on the respondent’s self-classification of racial and ethnic and identification and origin based on the classifications developed by the U.S. Census Bureau. Only data from respondents who identified themselves as non-Hispanic black were included in this analysis.

Statistical Analysis

First, we estimated time changes in the prevalence of past 12 months (1) tobacco use, (2) cannabis use, and (3) concurrent TCU among black youth using bivariate logistic regression. Survey year was used as the continuous independent variable, and unadjusted odds ratios (OR) with 95% confidence intervals (CI) were reported. For each bivariate regression model, the trend was considered statistically significant if the coefficient (ie, slope) of the year was statistically significant. Next, a multivariable logistic regression model was fit to assess the relationship between past-year TCU/concurrent use and human capital development factors among black youth, controlling for demographic characteristics and use of alcohol (past 12-month use: Yes/ no) and other drugs (past 12-month use: Yes/no). To adjust for potential time influence, the survey year variable was further included in all multiple regression models as a continuous control variable, and adjusted odds ratios (aOR) were reported. All analyses were performed using R, version 4.2.2, accounting for the complex survey design of the NSDUH.⁴⁰ In the NSDUH surveys from 2015 to 2019, the weighted response rates for adolescents ranged from 70.1% to 77.7.0%. Missing data ranged from 0% to 5.5% for the variables included in this study.³⁶ Given that missing data were minimal,⁴¹ we excluded participants with missing values, as recommended by the NSDUH.

Results

Between 2015 to 2019, a total of 26 526 adolescents aged 12 to 17 participated in the NSDUH, among whom 9017 were blacks. Table 1 displays the sociodemographic characteristics of black adolescents included in the study. Based on bivariate analysis, the prevalence of 12-month tobacco use among black adolescents fluctuated insignificantly between 5.6% and 7.6%. Similarly, the prevalence of 12-month cannabis use remained relatively stable at below 13% from 2015 to 2019, with no significant linear change. The prevalence of concurrent TCU further fluctuated insignificantly between 3.5% and 5.3% across the survey years (Figure 1).

Table 1.

Sociodemographic Characteristics of U.S. Black Adolescents in the NSDUH, 2015–2019 (N = 9017)

Characteristics	n (%)
Gender
Male	4534 (50.4)
Female	4483 (49.6)
Age
12–13	2793 (31.4)
14–15	3039 (34.2)
16–17	3185 (34.4)
Household income, $
<20 000	3017 (32.0)
20 000–49 999	3342 (37.2)
50 000–74 999	1095 (12.2)
≥75 000	1563 (18.6)
Setting
Large metropolitan	5426 (65.2)
Small metropolitan	2499 (24.3)
Rural	1092 (10.5)
Overall health
Good	8579 (94.9)
Poor	435 (5.1)
12-month major depressive episode
No	7824 (90.0)
Yes	871 (10.0)
12-month alcohol use
No	7641 (85.4)
Yes	1376 (14.6)
12-month other drug use
No	8367 (92.9)
Yes	650 (7.1)

Unweighted number of participants and weighted percentages are reported. NSDUH = National Survey on Drug Use and Health.

Figure 1.

Annual prevalence and time trends of 12-month tobacco, cannabis, and cooccurring tobacco and cannabis use among black adolescents, 2015–2019

Table 2 lists sociodemographic differences in black adolescents’ tobacco, cannabis, and concurrent TCU identified in multivariable regression analyses. Compared to males, female black youth were less likely to report tobacco (adjusted odds ratio [aOR] = 0.71, 95% Confidence Interval [CI] = 0.55, 0.92), cannabis (aOR = 0.74, 95% CI = 0.60 to 0.90, and concurrent TCU (aOR = 0.59, 95% CI = 0.44 to 0.81). With increasing age, odds of reporting tobacco, cannabis, and concurrent TCU increased approximately 2- to 3-fold (Table 2). Specifically, compared to adolescents aged 12–13 years, those in the14–15-year-old age group (aOR = 1.70, 95% CI = 1.12, 2.59) and the 16–17-year-old age group (aOR = 3.47, 95% CI = 2.31, 5.20) were more likely to report tobacco use. Similar patterns in age-related odds were observed for cannabis and concurrent TCU (see Table 2). Black youth with family income ≥$75 000 were less likely to report tobacco (aOR = 0.46, 95% CI = 0.31, 0.69) and concurrent TCU (aOR = 0.56, 95% CI = 0.35, 0.89) compared to those from families with annual household income <$20 000. No other association was found between income levels and tobacco and/or cannabis use. Black youth who live in rural areas were more likely to report tobacco use than those living in large metropolitan areas (aOR = 1.71, 95% CI = 1.22, 2.39), while those living in small metropolitan areas had lower prevalence of cannabis use (aOR = 0.74, 95% CI = 0.59, 0.93).

Table 2.

Multivariable Correlates of 12-Month Tobacco, Cannabis, and Concurrent Tobacco and Cannabis Use Among Black Adolescents in the United States, 2015–2019

	No. of adolescents	Tobacco use		Cannabis use		Concurrent tobacco and cannabis use
		%	AOR (95% CI)	%	AOR (95% CI)	%	AOR (95% CI)
Survey year	—	—	0.95 (0.87, 1.04)	—	1.10 (1.03, 1.18) **	—	0.95 (0.86, 1.05)
Demographic predictors
Gender
Male	4534	7.1	(ref.)	13.0	(ref.)	8.6	(ref.)
Female	4483	5.2	0.71 (0.55, 0.92) **	11.8	0.74 (0.60, 0.90) **	5.6	0.59 (0.44, 0.81) **
Age
12–13		2.0	(ref.)	2.2	(ref.)	1.5	(ref.)
14–15	2793	4.8	1.70 (1.12, 2.59) *	10.9	3.80 (2.58, 5.61) ***	5.9	2.42 (1.31, 4.45) **
16–17	3039	11.3	3.47 (2.31, 5.20) ***	23.1	7.55 (5.17, 11.01) ***	13.3	5.60 (3.12, 10.07) ***
Family income, $
<20 000	3017	6.8	(ref.)	11.3	(ref.)	7.3	(ref.)
20 000–49 999	3342	6.4	0.89 (0.67, 1.19)	13.2	1.06 (0.83, 1.34)	7.7	0.93 (0.66, 1.31)
50 000–74 999	1095	6.8	0.99 (0.67, 1.48)	12.3	0.84 (0.61, 1.17)	8.0	1.25 (0.78, 2.01)
≥75 000	1563	4.0	0.46 (0.31, 0.69) ***	12.7	0.82 (0.62, 1.08)	5.0	0.56 (0.35, 0.89) *
Setting
Large metropolitan	5426	5.8	(ref.)	13.1	(ref.)	6.7	(ref.)
Small metropolitan	2499	6.3	1.08 (0.82, 1.42)	11.0	0.74 (0.59, 0.93) **	7.5	1.01 (0.73, 1.39)
Nonmetropolitan (rural)	1092	8.3	1.71 (1.22, 2.39) **	11.5	0.92 (0.68, 1.23)	8.8	1.51 (0.98, 2.35)
Covariates
Alcohol use (past 12 months)
No	7641	3.5	(ref.)	6.58	(ref.)	1.9	(ref.)
Yes	1376	21.9	5.30 (4.05, 6.92) ***	46.4	8.74 (7.15, 10.68) ***	17.2	7.07 (5.16, 9.69) ***
Other drug use (Past 12 months)
No	8367	4.9	(ref.)	10.6	(ref.)	3.2	(ref.)
Yes	650	22.0	3.32 (2.42, 4.54) ***	36.3	3.23 (2.43, 4.28) ***	15.9	3.29 (2.29, 4.73) ***
Human capital development factors
Social and emotional ­development	—	—	0.90 (0.82, 0.98) *	—	0.84 (0.78, 0.91) ***	—	0.85 (0.76, 0.95) ***
Cognitive development
Low	1529	10.2	(ref.)	21.4	(ref.)	12.8	(ref.)
High	6738	4.9	0.67 (0.51, 0.89) **	10.7	0.73 (0.59, 0.91) ***	5.7	0.68 (0.49, 0.95) *
Overall physical health
Poor	435	11.0	(ref.)	18.6	(ref.)	12.7	(ref.)
Good	8579	5.9	0.55 (0.34, 0.89) *	12.1	0.67 (0.45, 0.99) *	6.8	0.59 (0.33, 1.05)
Mental health: 12-month MDE
No	7824	5.9	(ref.)	11.5	(ref.)	6	(ref.)
Yes	871	7.7	0.81 (0.56, 1.18)	20.6	1.17 (0.88, 1.55)	10.7	0.84 (0.55, 1.27)

*p ≤.05; **p ≤.01; ***p ≤.001. Unweighted sample sizes and weighted percentages are presented. All variables listed were included in the multivariable model to predict tobacco, cannabis, and concurrent tobacco and cannabis use. AOR = multivariable adjusted odds ratio, Ref. = reference category, MDE = Major depressive episode, CI = confidence intervals.

Human Capital Factors and TCU

Black youth with higher cognitive development scores were at reduced odds of using tobacco (aOR = 0.67, 95% CI = 0.51, 0.89), cannabis (aOR = 0.73, 95% CI = 0.59, 0.91), and both substances concurrently (aOR = 0.68, 95% CI = 0.49, 0.95). Similarly, a higher social and emotional development score was associated with reduced odds of tobacco use (aOR = 0.90, 95% CI = 0.82 to 0.98), cannabis use (aOR = 0.84, 95% CI = 0.78, 0.91), and concurrent TCU (aOR = 0.85, 95% CI = 0.76, 0.95). Having good physical health was associated with reduced odds of tobacco (aOR = 0.55, 95% CI = 0.34, 0.89), and cannabis (aOR = 0.67, 95% CI = 0.45, 0.99). We found no association between major depressive episodes and tobacco, cannabis, or concurrent TCU.

Covariates

The regression models adjusted for alcohol and other drug use. Past 12-month alcohol use significantly increased the odds of tobacco (aOR = 5.30, 95% CI = 4.05, 6.92), cannabis (aOR = 8.74, 95% CI = 7.15, 10.68), and concurrent TCU (aOR = 7.07, 95% CI = 5.16, 9.69). Similarly, past 12-month drug use other than cannabis significantly increased the odds of tobacco (aOR = 3.32, 95% CI = 2.42, 4.54), cannabis (aOR = 3.23, 95% CI = 2.43, 4.28), and concurrent TCU (aOR = 3.29, 95% CI = 2.29, 4.73).

Discussion

This study of the association of human capital development factors with single and concurrent TCU risk among black youth, using nationally representative data from 2015 to 2019 NSDUH, found that higher social/emotional and cognitive development reduced the odds of single or concurrent TCU. Good overall physical health was also protective against TCU. Black youth in the oldest age category (16–17 years) were at highest risk for all forms of TCU examined and those living in rural areas were at increased odds of tobacco use. However, being from a higher-income family was protective against tobacco use.

Previous examinations of correlates of TCU among black youth have focused on identifying behavioral determinants and have demonstrated that educational attainment/grades,¹³ school connectedness,¹⁴ and religiosity^16–18 influence substance use risk. Our study expands on previous work by conducting a race-specific examination of engaging in human capital development activities—operationalized from a broader multifaceted perspective—and its association with TCU. Our findings demonstrate that higher engagement with human capital development opportunities significantly reduced the odds of single and concurrent TCU among black youth. There are several implications for the significant role social and emotional development, cognitive development, physical health, and mental health play in reducing TCU risk among black youth.

Social and emotional development, as operationalized in this study, includes participation in activities to develop problem-solving skills, communication skills for self-esteem, anger management skills, and community and social activities. These activities are often available through schools, parental engagement, and community organizations. However, black youth are more likely to attend resource-poor or high-poverty schools,³³ live in impoverished neighborhoods,³⁴ and have lower parental educational attainment which influences parental engagement and their ability to access economic resources needed for extracurricular developmental activities.⁴² Thus, the finding that greater engagement with opportunities for social and emotional development significantly reduced TCU among black youth supports urgent calls to address structural racism given its far-reaching impact on black youth and their families.⁴³ There is a need for more robust interventions and programs that are not focused solely on providing awareness and knowledge of TCU risks but on broader structural changes to equitable distribution of resources for social and emotional development opportunities, especially in schools and communities with limited resources or that have a large black youth population.⁴³ Increased school/district-level funding and capacity to provide opportunities for social and emotional development among black youth could not only reduce the risk of current use but also protect against the late onset use common among black youth.

Previous research has demonstrated good academic grades to be protective against TCU;⁴⁴ however, this study employed a more robust assessment of cognitive development which included attitudes toward schooling and schoolwork. Our finding that perceptions about school and importance and meaningfulness of schoolwork in combination with academic grades are important protective factors against current TCU underscores that the benefits of schooling lie not in strict measures of achievement such as grades alone but in attitudinal qualities that mature as part of cognitive development. School environments are complex, and the factors that contribute to an environment that encourages cognitive and personal development—broadly construed—are multifaceted. A comparative study on the dynamics and educational opportunities of high school students of color in Los Angeles³⁷ found, for example, that a broad range of factors such as school personnel (eg, teachers and administrators), resource levels and allocation, school culture and climate, social networks and capital, intergroup dynamics, and educational policy can all affect student engagement with schooling and learning. Though shaping school environments is typically out of the purview and influence of tobacco control and public health professionals, study results reinforce the importance of multisectoral collaboration between health and educational systems and greater interprofessional education to enact systemic changes to make schooling more relevant and meaningful for black adolescents.

Owing to the legacy of years of racial and social injustice, black people remain the least healthy ethnic group in the United States.^45,46 According to the Social Genome Model—a tool that identifies developmental and social mobility patterns from birth through adulthood, black youth are less likely to be on track for healthy development compared to white youth.⁴⁷ In addition to the many systemic and structural factors influencing the poor health and development of black youth, stressors beyond those normally experienced by adolescents (eg, racial discrimination,⁴⁸ racial harassment⁴⁹), have been linked to increased risk for unhealthy behaviors such as TCU.^46,50 Given that individuals who live in stressful environments engage in unhealthy behaviors to cope with stressors and generally report poor overall health, it is not surprising our findings showed having good overall physical health was associated with reduced likelihood to engage in TCU. One may speculate that youth who perceive themselves to have good overall physical health engage in physical activity and value their health. Hence, it is not surprising that good overall physical health was protective against TCU. This finding corroborates available evidence which demonstrates opportunities for physical activity engagement are protective against TCU.³⁰ Similar to other findings in this study, this work demonstrates the need for robust programs and policies targeting the social and structural factors that shape overall physical health including ensuring access to physical education during school time, and investment in safe parks, green spaces, and gyms within black communities.

This study examined a crucial aspect of TCU determinants among a vulnerable population; however, it is not without a few limitations. First, this is an analysis of pooled, cross-sectional, nationally representative data; therefore, we are unable to establish causality or the direction of some of the associations we found. Also, given that the NSDUH was not specifically designed to examine human capital development, it is plausible that our selected variables did not examine all the pertinent aspects of human capital development among black youth. Another limitation of the study is the use of self-reported data for all the factors and behaviors examined which could bias the findings.

Despite this study’s limitations, several important conclusions can be drawn from this study. First, overall prevalence in TCU among black youth has remained stable, with cannabis being the more prevalent product used (in the previous 12 months) in 2019. Human capital development factors—social and emotional development, cognitive development, and overall physical health—are important distal determinants that shape behaviors and should be focused on when developing TCU prevention interventions among black youth. Similar to previous work,⁴² poor mental health is a significant player in cannabis use among black youth. Black youth would benefit from comprehensive TCU prevention programs that simultaneously address mental health symptoms, especially depression. State and local educational policies should incentivize, and programs modified to address substance use and mental health comorbidities to more effectively address these growing concerns.

Funding

National Cancer Institute (NCI) Grant number 3R01CA229617-03S1 supported WJ’s time working on this study.

Authors’ Contribution

Wura Jacobs: Conceptualization, Methodology, Writing—original draft, Writing—review and editing. Wenhua Lu: Validation, Formal analysis, Writing—original draft. Andrea McDonald: Validation, Writing—original draft. Joshua Yang: Conceptualization, Validation, Writing—original draft, Writing—review and editing. All authors have given feedback on the final manuscript and approved its submission.

Declaration of Interests

The authors declare no conflict of interest.

Data Availability

The National Survey on Drug Use data are publicly available at the following website: https://www.datafiles.samhsa.gov/dataset/national-survey-drug-use-and-health-2020-nsduh-2020-ds0001