Background: Racial identity and perceived treatment based on race may influence health behaviors, but limited research has examined these associations across racial and ethnic groups. This study evaluated whether frequency of thinking about race and perceived treatment compared to other races were associated with binge drinking, heavy drinking, cannabis use, tobacco smoking, and poor mental health.

Methods: Analyses were based on cross-sectional data from the 2022 and 2023 Behavioral Risk Factor Surveillance System (BRFSS), including over 300,000 adults from U.S. states and the District of Columbia. Logistic regression models were employed, which adjusted for age, sex, marital status, race/ethnicity, annual household income, education, and health insurance status.

Results: Individuals who thought about their race more frequently or felt they were treated worse than people of other races had significantly higher odds of binge drinking, heavy drinking, cannabis use, and poor mental health. Those who reported being treated better than people of other races also had significantly higher odds of binge drinking, heavy drinking, cannabis use, and poor mental health.

Conclusions: These findings suggest that not only is racism related to substance use and poor mental health, but racial superiority may also increase the risk of these outcomes. Race-related perceptions are linked to substance use and mental health and should be considered in efforts to reduce health disparities.