Racism in School and High Schoolers' Mental Health, Suicide Risk and Substance Use, 2023

Racism — which CDC describes as a system of structures, policies, practices and norms that assigns value and opportunity by how people look or the color of their skin — is a fundamental driver of health inequities, and experiences of it in childhood and adolescence can be especially harmful. Students spend up to 6 hours a day, 180 days a year in school, so school is a major setting for such experiences. In 2021, the Adolescent Behaviors and Experiences Survey (ABES) found that up to a third of high school students — and more than half of Asian, Black and multiracial students — had experienced racism in school.

In 2023, the national Youth Risk Behavior Survey (YRBS) asked about it for the first time.

The survey

• 20,103 students in grades 9–12, in public and private schools across the 50 states and D.C. — a nationally representative sample.
• The question: "During your life, how often have you felt that you were treated badly or unfairly in school because of your race or ethnicity?" Any answer but "never" counted as ever experiencing racism. No definition of racism was given.
• It was compared with poor mental health (past 30 days), persistent sadness or hopelessness (past 12 months), seriously considering and attempting suicide (past 12 months), and current use of tobacco, alcohol, marijuana and misused prescription opioids.

Who experienced racism in school

Overall, 31.5% — about one in three students.

Students of every other group were two to three times as likely as White students to report it. Among Asian, Black, Hispanic and multiracial students, girls reported it about 1.2 times as often as boys; among Black, Hispanic and multiracial students, LGBQ+ students about 1.2–1.5 times as often as heterosexual students.

Links with mental health, suicide risk and substance use

Across all students, those who had experienced racism in school reported more of every problem measured:

Within each group:

• AI/AN, Asian, Black, Hispanic and multiracial students who had experienced racism had more poor mental health and sadness or hopelessness; White students had more sadness or hopelessness but not significantly more poor mental health.
• In every group of students of color, seriously considering and attempting suicide were more than twice as common among those who had experienced racism — for Black students, attempts were 15.2% against 4.7%; for Asian students, serious consideration was 19.7% against 6.4%.
• Black, Hispanic and White students who had experienced racism used tobacco, alcohol, marijuana and misused opioids more; multiracial students, all but alcohol.
• Associations could not be assessed for Native Hawaiian or other Pacific Islander students, because the numbers were too small.

What schools can do

Racism in school can come from policies and practices — discipline, for example — or from students, teachers and staff. The authors suggest schools:

• train staff to recognize racism and their own biases, to intervene when they see it, and to connect students with support, with teaching and discipline that reflect cultural competency and humility — as San Diego Unified School District's Equity Collective does;
• review discipline for bias, using the 2023 Department of Justice and Department of Education resource on racial discrimination in student discipline, and use culturally responsive positive behavior supports that involve families and communities;
• support student-led affinity groups, and approaches like Seattle Public Schools' Office of African American Male Achievement (2019), which builds on Black students' strengths;
• ensure access to school counselors and social workers;
• use CDC resources such as Promoting Mental Health and Well-Being in Schools, the Suicide Prevention Resource for Action and the Drug-Free Communities Support Program.

The high figures for Asian students match the 2021 ABES and a 2023 U.S. Commission on Civil Rights report documenting rising anti-Asian discrimination since the COVID-19 pandemic; federal responses include a 2021 Department of Justice initiative against youth hate crimes and identity-based bullying aimed at Asian American and Pacific Islander students.

Limits

• The survey is cross-sectional: racism was measured over a lifetime, the outcomes over the past 30 days or 12 months, so cause and timing can't be determined.
• A single question can't capture the full complexity of experiences of racism.
• Grouping all students of more than one race as multiracial, and all Hispanic students together, may hide differences.
• The 2023 YRBS and 2021 ABES figures can't be directly compared, because their methods differ.

If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.

Sources

Based on McKinnon II, Krause KH, Suarez NA, et al., "Experiences of Racism in School and Associations with Mental Health, Suicide Risk, and Substance Use Among High School Students — Youth Risk Behavior Survey, United States, 2023," MMWR Supplements, volume 73, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The report's summary graphic gives the Black and multiracial percentages the other way round from its text and table, so it is not shown; the figures here follow the table.