Introduction

Racism, defined as “a system of structuring opportunity and assigning value based on the social interpretation of how one looks (i.e., race) that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources,” (1) is a critical social determinant of health and a key driver of systemic inequities in health outcomes (1,2). Racism influences the health and well-being of racial and ethnic minority persons and families throughout the lifespan and contributes to racial and ethnic disparities in health outcomes (2,3). Self-reported or perceived racial discrimination among adults is associated with poor mental health, high-risk behaviors (e.g., substance use and misuse), physical health conditions (e.g., hypertension and cardiovascular disorders), and other adverse health outcomes (3). Although less is known about perceptions of racial discrimination among children and adolescents (4,5), a growing body of research describes associations between racial discrimination and health outcomes for youths. Experiences of racial discrimination are associated with poor mental health (e.g., anxiety, depression, and low self-esteem), health risk behaviors, reduced social and adaptive functioning, and delinquent behaviors among youths (6,7). Racial discrimination in educational settings contributes to racial disparities in academic achievement and educational attainment, which are important markers for long-term health outcomes (7).

Understanding experiences of racism and racial discrimination among adolescents and how those experiences influence health is important to promote equitable health outcomes for racial and ethnic minority youths. To understand the effects of racism on health, well-defined, consistent definitions and reliable measures of racial discrimination are critical (6). To date, few measures have been designed to assess perceived racial discrimination among child and adolescent populations (5).

Throughout the COVID-19 pandemic, communities of color have been disproportionately affected by severe outcomes of COVID-19 (e.g., hospitalizations, intensive-care admissions, or in-hospital deaths) and limited access to quality health care (8). Structural racism, a central pathway through which racism influences health (3), is associated with inequities in COVID-19 morbidity, hospitalization, and mortality (8). Less is understood about adolescent perceptions of racism and its consequences during the COVID-19 pandemic. Perceived racism in school is an important yet understudied determinant of adolescent health and well-being, and knowing how perceived racism influences adolescent health can help reduce health inequities. In spring 2021, CDC implemented the Adolescent Behaviors and Experiences Survey (ABES) to assess student behaviors during the pandemic. ABES, a nationally representative sample of high school students, included a single-item measure of perceived racism. Using ABES data, this report examines perceived racism and the extent to which perceptions of racism are associated with behavioral health outcomes among adolescents. The findings in this report can help inform the development of school staff trainings and interventions to support the health and well-being of all students.