Even worse for Black girls: the longitudinal association of racial bullying with the initiation of alcohol and tobacco use.

We used Poisson's linear regression to examine the association between racial bullying (RB) and the initiation of alcohol and tobacco uses after nine months. Two cluster randomized controlled trials were conducted in 2019 with fifth (girls: 50.0%; 10 years old: 82.0%; White: 36.8%; Black: 58.7%; Others: 4.5%) and seventh graders (girls: 49.5%; 12 years old: 78.1%; White: 33.2%; Black: 60.4%; Others: 6.4%) from 30 public schools in the municipality of São Paulo, Brazil. We restricted our analyzes on two subsets of students in each grade: those who reported no lifetime alcohol use at baseline and those who reported no lifetime baseline tobacco use. At baseline, 16.2% of fifth and 10.7% of seventh graders reported suffering from RB in the 30 days before data collection. After nine months, 14.9% of fifth graders started using alcohol and 2.5%, tobacco. Among seventh graders, the figures were 31.2% and 7.7%, respectively. RB predicted the initiation of use of alcohol (risk ratio - RR=1.36, 95%CI=1.07-1.70) and tobacco (RR=1.81, 95%CI=1.14-2.76) among seventh graders, with race-gender differences, particularly in Black girls (alcohol: RR=1.45, 95%CI=1.07-1.93; tobacco: RR=2.34, 95%CI=1.31-3.99). School-based programs and policies must explicitly address issues related to racism and gender in alcohol and tobacco prevention strategies.