Race by age crossover effect: Substance use among mid life and older African americans

Drug use remains a critical national problem that adversely impacts the healthcare, mental health, and criminal justice systems. As substance users move into middle age, age-related health concerns and psychosocial factors can complicate substance use. While African Americans (AA) have a lower rate of substance use in adolescence compared to whites, their rates of use increase with age and surpass those of whites who experience a substantial decline. In addition, we know that life course consequences of substance use differ for AA compared to whites and these differences are related to substantial social and health inequities. The present study sought to examine differences in recent drug use patterns including (1) drugs of choice and (2) frequency of use for 21 different substances by various routes of transmission (nasal, injection, inhaled and swallowed) between younger and older cohorts of AA's. As expected we found a high prevalence of 27% or greater for marijuana, crack, and nasal heroin in both age cohorts. However, those in the older cohort were 2 times (OR=2.07, 95% CI 1.25-3.43, p<.01) more likely to have smoked crack in the last 6 months and half as likely (OR=.48, 95% CI .28-.80, p<.01) to have smoked marijuana. These findings support the race by age crossover theory whereby AA's use less risky drugs at younger ages but use escalates to higher risk drugs by mid and later life. Research is needed to map common and distinctive courses and consequences of long term drug use in this population.