Low English Proficiency and Socioeconomic Inequality as Risk Pathways for Alcohol and Marijuana Use Among Adolescents

Abstract

Substance use among adolescents continues to be a significant public health concern in the United States and has been linked to a variety of social, cultural, and environmental factors. Existing research has identified trauma, discrimination, family dynamics, acculturation stress, and socioeconomic disadvantage as important influences on adolescent substance use behaviors. However, relatively little research has examined whether English proficiency is associated with alcohol and marijuana use among adolescents. Given the role of language in shaping communication, access to resources, and experiences within educational and healthcare settings, understanding the relationship between English proficiency and substance use may provide additional insight into factors influencing adolescent behavioral health.This study examined the association between English proficiency and substance use among adolescents aged 12 to 17 years using data from the 2023 National Survey on Drug Use and Health (NSDUH). Four substance use outcomes were assessed: past-30-day marijuana use, past-30-day alcohol use, lifetime marijuana use, and lifetime alcohol use. English proficiency was categorized as “Very Well,” “Well,” “Not Well,” and “Not at All.” Descriptive statistics, bi-variate chi-square analyses, and multivariable logistic regression models were used to evaluate associations between English proficiency and substance use outcomes while controlling for race and ethnicity, household income, and government assistance status. The findings did not support the hypothesis that lower English proficiency would be associated with increased substance use risk; in fact, the observed pattern was in the opposite direction. Relative to adolescents reporting English proficiency as “Very Well” (the reference category), adolescents reporting proficiency as “Well” demonstrated significantly lower odds of past-30-day marijuana use, lifetime marijuana use, and lifetime alcohol use, and adolescents reporting “Not Well” demonstrated significantly lower odds of lifetime marijuana use. Estimates for adolescents reporting “Not at All” could not be reliably estimated for most outcomes because of zero events. Race and ethnicity, household income, and government assistance status were each associated with multiple substance use outcomes. Overall, the findings suggest that English proficiency alone does not function as a direct risk factor for adolescent substance use and that, consistent with the acculturation literature, greater English proficiency may track with higher use. Substance use behaviors appear to be shaped by a broader combination of social, cultural, and structural influences. These results contribute to a limited body of literature examining English proficiency and adolescent substance use and highlight the importance of considering social determinants of health when addressing behavioral health outcomes among diverse adolescent populations.