Racism, intersectionality and health: examining experiences of racism at school with school connectedness and persistent feelings of sadness or hopelessness among us high school students

Racism experienced by adolescents negatively impacts developmental trajectories for long-term health and well-being. Experiencing racism at school robs students of a safe and supportive school environment, which is essential to facilitate healthy development. There is a dearth of nationally representative data on the health outcomes associated with experiencing racism among high school students. A recent study found that more than half of Asian, Black, and Multiracial high school students have experienced racism at school. Intersectionality theorizes that students will have unique experiences of racism based on their social position at the nexus of racial/ethnic, sex, and sexual identities. These experiences and their associated social and behavioral outcomes need to be understood to dismantle racism in schools. In this study, school connectedness and persistent feelings of sadness and hopelessness are indicators of a safe and supportive school environment. We used intersectionality as a framework to investigate the associations between experiencing racism at school with school connectedness and persistent feelings of sadness and hopelessness. Data from the 2021 Adolescent Behavior and Experiences Survey, a nationally representative sample of U.S. high school students, were used to create 20 student groups to reflect combinations of race/ethnicity, sex, and sexual identity. We calculated weighted prevalence estimates for school connectedness and persistent feelings of sadness or hopelessness. We conducted population average and stratified logistic regression models to estimate the prevalence difference (PD) and prevalence ratio (PR) of each outcome to compare students who ever experienced racism versus those who never experienced racism at school. Among students who experienced racism, 39.1% felt connected compared to 51.1% of students who never experienced racism (PD=12%, p<0.001; PR=0.77, 95% CI 0.69-0.85). Experiencing racism did not decrease school connectedness among Black students, students identifying as lesbian, gay, bisexual, questioning, or other (LGBQ+), and Black LGBQ+ students. Among students who experienced racism, 57.8% had persistent feelings of sadness or hopelessness compared with 37.8% of students who never experienced racism (PD=20%, p<0.001; PR=1.53, 95% CI 1.39-1.69). In aggregate and among almost every group, experiencing racism exacerbated persistent feelings of sadness or hopelessness. Among all students, experiencing racism at school decreased school connectedness and increased persistent feelings of sadness or hopelessness. However, experiencing racism did not affect school connectedness among Black and/or LGBQ+ students, possibly because experiencing racism and discrimination cannot be separated from the experience of attending school. Dismantling racism in educational systems will require commitment and reimagination. Schools can act immediately to implement alternatives to policies that are known drivers of racial disparities, such as suspension and expulsion, which disproportionately impact Black students. Engaging youth can illuminate unique student experiences that inform the development of new or revised school policies and practices. For example, supporting culturally affirming groups, such as gay/straight alliances, has shown potential for improving school connectedness and other health outcomes among all students, but especially Black and/or LGBQ+ students. Centering programs on youth with identities that have been marginalized is essential to create equitable, safe and supportive school environments for all students.