Why Context Matters: Rethinking Minoritized Youth Substance Use Care and Outcomes.

Substance use disorders (SUDs) among adolescents remain a major public health concern, with racially and ethnically minoritized, and sexual minority youth disproportionately affected by structural inequities, trauma exposure, and barriers to care. Despite equal or lower prevalence of most SUDs compared with White peers, minoritized adolescents often experience disproportionate involvement in the legal system, lower access to treatment, and lower rates of engagement with evidence-based services. This narrative review synthesizes current knowledge on determinants of SUD among minority youth, emphasizing structural racism, trauma, measurement and identification challenges, and cultural protective factors.