Social exclusion and substance use among African immigrants: The role of discrimination

Due to their racialized identity and immigrant status, African immigrants face increased risk for social exclusion and other negative outcomes. Research indicates that discrimination, social and economic disadvantage increase risk for substance use among Black populations in the United States. While emerging studies on African immigrants have explored consequences of social exclusion on psychological health, little is known about how these conditions impact substance use patterns. This study examined the effects of social exclusion on alcohol and/or other drug use, and non-medical use of prescription drugs among African immigrants, and explored whether perceived discrimination mediated this relationship. Data were collected between 2019 and 2020 from a cross-sectional survey examining experiences of first and second-generation African immigrants across the United States (N = 597). The majority of the sample identified as female (71%) and Black (82%). Structural equation modeling was conducted with probit regression paths to examine the direct and indirect effects of three dimensions of social exclusion (sociocultural, economic, and structural) on alcohol and/or other drug use and non-medical use of prescription drugs, with perceived discrimination as the mediator. Increased sociocultural and structural exclusion significantly increased the likelihood of alcohol and/or other drug use and non-medical use of prescription drugs through the perceived discrimination pathway. Structural exclusion also had direct effects on substance use. Findings highlight the importance of examining social stressors when exploring risk for substance use, and point to the need for prevention efforts that reduce negative attitudes and promote inclusivity of this marginalized population.