As a child growing up in a small North Carolina town, Trenette Clark watched as substance use wreaked havoc on the lives of those she cared deeply about.
“I saw people who were very close to me living a lifestyle that was severe as it relates to the social and health consequences of substance use,” said Clark, an assistant professor at UNC’s School of Social Work. “I saw people lose their children to the child welfare system and never get them back. I saw 16- and 17-year-old teenagers convicted of felonies for drug possession. I saw people die—that was probably the most profound. Seeing people die young, in their 20s and 30s, had a real impact on me, and I started wondering, ‘Why do people use drugs?’ ”
Clark’s interest in solving that question led her to earn a master’s and Ph.D. degree in social work and continues to guide her current research, which largely focuses on substance use among adolescents of color. Her persistence for answers paid off this year when the National Institutes of Health selected her to receive a nearly $829,000 grant for her work. The five-year federal grant is among those designated for leading research scholars across the country.
Clark will use the funding to support research that few scholars have explored, specifically: Why black adolescents, who have been shown to use alcohol and drugs at substantially lower rates than their white peers, often catch up to and increasingly surpass the substance use rates of whites during young adulthood.
“What’s interesting about this phenomenon is that it’s paradoxical,” Clark said. “During young adulthood, we expect a plateau or decline in substance use. But instead what we find among blacks is a larger number of new users during young adulthood combined with a smaller number of blacks who are quitting relative to other racial/ethnic groups.”
Clark thinks that part of the answer to that puzzle may be found by looking at racial groups in other ways. Historically, blacks have been treated as one homogenous population in scholarly research. However, this practice ignores the diversity within the black race, including experiences of people who identify with multiple races, she explained. And nationally, more and more individuals are identifying with more than one race. In fact, according to the U.S. Census, an estimated 5.2 million people in the country identify as biracial, a population that is projected to triple by 2050.
“I think about my friends who identify as African American, and those who identify as African, Afro Caribbean, or biracial,” the assistant professor said. “Their stories are similar to mine in many ways but also different in some ways.”
Learning more about the “uniqueness” of these different groups is vital, Clark said, especially when trying to understand why some people of color begin to use alcohol or smoke cigarettes or marijuana, while others avoid the gateway drugs altogether.
“What we do know is that for blacks, young adulthood introduces reduced protective factors such as limited, if any, parental monitoring but increased risk factors such as unemployment and the cumulative effect of racism and discrimination.” Clark explained. “So, could the substance use be a bit of self-medicating? I think it could be. It could be a way of coping with depressive symptoms and a sense of hopelessness.”
Once more is known about why young people of color use substances, researchers can then focus on strengthening prevention efforts. Clark said such efforts could ultimately help to reduce disparities in substance-use and help to diminish health-related problems that impact people of color at higher rates than other populations, including hypertension, diabetes, and cancer.
“If I can use findings from this (NIH) study to develop or modify a prevention program that we can evaluate and implement nationwide, hopefully, that will help us chip away at these health disparities,” Clark added.
Clark’s latest project will build on her previous research, which has focused on the experiences of substance use among biracial youth compared to the experiences of single-race youth, including use of cigarettes, marijuana, and alcohol over several years. Overall, researchers have found that adolescents who use substances are at greater risk for addiction, risky sexual behavior, and death.
For Clark, the answer to why some youth of color start smoking or drinking may lie deep within patterns of data from a national longitudinal study on adolescent health. The study followed youth and young adults from about age 11 to 35. Clark began digging into the data a couple of years ago and found some interesting substance-use trends, especially among single-race and biracial groups, including individuals who identified as black white; black American Indian; black Asian and black Hispanic.
Among her findings: In some cases, individuals who identify as biracial use substances at earlier ages than people who identify with just one race, such as black.
However, Clark said the most intriguing finding from her research suggests that biracial youth are influenced by both cultures of the single-race groups that make up their racial identity. This blend of cultures affects biracial youth in such a way that their rates of substance use tend to be on a middle ground between the rates of the two racial groups that make up the youths’ identity. For example, the prevalence rates of substance use among youth who identify as biracial black/white tend to fall between the prevalence rates of youth who identify as either only-white or youth who identify as only-black.
“Again, what that tells me is that when we have been looking at these racial groups altogether, we’ve been blurring the picture,” Clark said. “In my studies, we found that biracial youth have distinct substance use rates and patterns. These findings have important implications for prevention efforts because they may help us identify groups or subgroups that may be at higher risk of engaging in substance use and help us to target these groups in prevention programs.”
Clark’s research findings also support a growing need for parents to have multiple serious conversations with their children about drugs. That realization became even clearer, she said, during a recent visit at an elementary school. While talking to a 10-year-old girl, Clark said she was surprised to learn that the student knew a lot more about drugs than she expected. For example, the girl described drug buys that she had witnessed in her own neighborhood and even demonstrated to Clark how a buyer and a purchaser carefully cup their hands to help conceal the exchange of money for drugs.
“The comments made during these conversations were shocking but also reminded me why I do what I do,” she said.
In the short-term, Clark hopes to raise drug prevention awareness among parents over the next few years, including through the use of social media. Her project team has already created Facebook and Twitter pages where announcements, resources and helpful information can be shared.
“Ultimately, I know that parents work hard and want to do everything they can to keep their children away from drugs,” Clark said. “But studies show that adolescents continue to use substances. So the point is, it’s not enough to have a single conversation with your children about drugs. You need to clearly convey expectations and monitor your kids. You need to know where they are, what they’re doing and who their friends are. It really requires active parenting.”