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Mental Telehealth Utilization Patterns Among High School Students from Racial and Ethnic Minority Backgrounds Affected by Violence and Substance Use

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Abstract

Background

Recent data show high school students from racial and ethnic minority (REM) backgrounds in the United States confront a twofold challenge, marked by the highest rates of firearm-related homicides since 1994 and increased youth substance use. The pandemic increased online and telehealth usage opportunities for at-risk REM youth. Therefore, this study investigated (1) the frequency and prevalence of co-occurring youth violence and substance use among REM adolescents, (2) racial/ethnic, age, and natal sex (as gender data was not collected) differences in patterns and trends in co-occurring youth violence and substance use among REM adolescents, and (3) the relationship between these syndemic issues and REM adolescent mental telehealth use during the pandemic.

Methods

Data was sourced from a nationally representative sample of U.S. 9th–12th students (n = 3241) who completed the CDC’s 2021 Adolescent and Behavioral Experiences Survey (ABES). Using univariate (frequency distribution), bivariate (Pearson’s chi-squared test), and multivariate logistic regression models, we examined seven violence victimization outcomes, four violence perpetration outcomes, two family violence outcomes, and six substance use outcomes and their associations with telehealth use for mental health (dependent variable) among REM adolescents.

Results

This sample was primarily female (50.7%), Black or African American (48.3%), Hispanic or Latinx (20.6%), and identified as straight or heterosexual (69.5%). The study found significant sex-based differences in violence perpetration/victimization, substance use, and telehealth use for mental health. In general, mental telehealth use was significantly associated with substance use among REM adolescents (cigarette smoking, vaping, alcohol, marijuana, prescription meds, and illicit drug use) (p-value = .001). Mental telehealth use was also significantly associated with all peer and family violence outcomes (p < 0.001). Controlling for covariates, gun carrying was associated with 4.8 times higher odds of using mental telehealth. Students in a physical fight or carrying a weapon (gun, knife, or club) on school property had 2.45 times and 8.09 times the odds of utilizing mental telehealth. Bullied students were 2.5 times more likely to use mental telehealth (p-value < 0.05). Illicit drug use (cocaine, heroin, methamphetamines, and ecstasy) was associated with a higher likelihood of mental telehealth use (AOR = 1.3, p-value = .05).

Conclusion

Our results suggest crucial insights for shaping violence and substance use prevention strategies, with implications for the future of online and telehealth behavioral services. Mental telehealth help-seeking emerges as a crucial avenue for supporting adolescents affected by violence and substance use, especially when they face obstacles to accessing traditional services. It can work in tandem with in-person services to address these challenges.

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Data Availability

Adolescent Behaviors and Experiences Survey (ABES) data are available to the public (https://www.cdc.gov/healthyyouth/data/abes.htm).

Code Availability

Code executed within SPSS is currently available upon request, with plans to deposit the code on GitHub in the near future.

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Authors and Affiliations

  1. Department of Women, Children, and Family Nursing, College of Nursing, Rush University Medical Center, Chicago, USA

    Chuka N. Emezue, Aaron Dunlap & Wrenetha Julion

  2. Department of Psychiatry, Institute for Juvenile Research (IJR), University of Illinois Chicago, Chicago, USA

    Niranjan S. Karnik

  3. Johns Hopkins University, School of Nursing, Baltimore, USA

    Bushra Sabri

  4. Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA

    Adaobi Anakwe

  5. College of Nursing, Rush University Medical Center, Chicago, USA

    Jessica C. Bishop-Royse

  6. School of Humanities and Social Sciences, University of Missouri Kansas City - Volker Campus, Kansas City, USA

    Dale Dan-Irabor

  7. Faculty Practice and Department of Women, Children, and Family Nursing, Rush University Medical Center, Chicago, USA

    Andrew Paul Froilan

  8. University of Mississippi Medical Center, School of Nursing, Jackson, USA

    Qing Li

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  1. Chuka N. Emezue
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Contributions

All authors (CE, NK, BS, AA, JRB, DDI, APF, AD, QL, WJ) contributed to the study conception, design, supervision, writing—review and editing. Material preparation, data collection, validation, and analysis were performed by CE and JBR. The first draft of the manuscript was written by CE, and all other authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Chuka N. Emezue.

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Emezue, C.N., Karnik, N.S., Sabri, B. et al. Mental Telehealth Utilization Patterns Among High School Students from Racial and Ethnic Minority Backgrounds Affected by Violence and Substance Use. J. Racial and Ethnic Health Disparities (2024). https://doi.org/10.1007/s40615-024-01936-y

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