Risk and Promotive Factors Related to Cannabis Use Among American Indian Adolescents.

Reservation-dwelling American Indian adolescents are at exceedingly high risk for cannabis use. Prevention initiatives to delay the onset and escalation of use are needed. The risk and promotive factors approach to substance use prevention is a well-established framework for identifying the timing and targets for prevention initiatives. This study aimed to develop predictive models for the usage of cannabis using 22 salient risk and promotive factors. Models were developed using data from a cross-sectional study and further validated using data from a separate longitudinal study with three measurement occasions (baseline, 6-month follow-up, 1-year follow-up). Application of the model to longitudinal data showed an acceptable performance contemporaneously but waning prospective predictive utility over time. Despite the model's high specificity, the sensitivity was low, indicating an effective prediction of non-users but poor performance in correctly identifying users, particularly at the 1-year follow-up. This divergence can have significant implications. For example, a model that misclassifies future adolescent cannabis use could fail to provide necessary intervention for those at risk, leading to negative health and social consequences. Moreover, supplementary analysis points to the importance of considering change in risk and promotive factors over time.

School-related Promotive Factors Related to Cannabis Use Among American Indian Adolescents.

Reservation-dwelling American Indian adolescents are at exceedingly high risk for cannabis use. Prevention initiatives to delay onset and escalation of use are needed. School engagement and student's positive experiences at school have been identified as key promotive factors against cannabis use in the general population of adolescents, but little work has examined these factors among American Indian youth. Seven school-related promotive factors were examined as predictors of past 30-day cannabis use (measured 6 months later), controlling for previous onset of cannabis use as well as a set of relevant potential confounders. Models were tested using 280 adolescents in 6th or 7th grade at the start of the study from two reservation-based schools in the US. Students were surveyed three times, with 6 months in between each survey. The average age at the start of the study was 11.99 years (SD = 0.87) and 54% of participants were female. Using a cumulative logit model to predict past 30-day use, American Indian youth who reported greater school bonding, academic aspirations, proclivity to endeavor in their studies, and interest in school at Wave 2 reported less 30-day cannabis use at Wave 3 (controlling for onset of cannabis at Wave 1 and several other control variables). No evidence of an effect of self-reported grades, perceived safety, or participation in school-related extracurricular activities was found. Given substantial deterioration of these school-related promotive factors over time, and the effect of the school-related promotive factors on subsequent cannabis use, efforts to design and test interventions to promote school engagement as a protective measure against cannabis use is warranted.

Opioid Misuse Among American Indian Adolescents.

Objectives. To present data for opioid misuse among US reservation-based American Indian (AI) adolescents and to compare these data with national rates from Monitoring the Future (MTF).Methods. Data were from a national sample of 33 schools participating in a substance use epidemiological survey of reservation-based AI adolescents during 2018 and 2019. Participants were 8th-, 10th-, and 12th-grade AI students (n = 1592). Measures included 12-month and 30-day use of OxyContin, Vicodin, heroin, and narcotics. We computed prevalence and compared it with MTF national prevalence.Results. Across grades, AI youths demonstrated significantly greater past 12-month and 30-day opioid use relative to a national sample. Significant absolute differences in 12-month and 30-day prevalence levels ranged from 1.6% (8th-grade heroin) to 4.7% (12th-grade narcotics) and from 1.6% (12th-grade narcotics) to 1.8% (12th-grade heroin), respectively.Conclusions. Opioid misuse prevalence levels were significantly greater for reservation-based AI adolescents relative to national prevalence levels.Public Health Implications. Findings suggest that implementation of evidence-based efforts, adapted or developed to be culturally appropriate, should be significantly increased in tribal communities, along with policies to address the unique social, economic, and health issues they face.

Be under your own influence: Effectiveness of a Culturally-Adapted drug prevention campaign targeting Reservation-Dwelling American Indian youth.

Be Under Your Own Influence (BUYOI) is a previously validated school-based intervention designed to delay adolescent substance use (SU) initiation. This study examined the effectiveness of a culturally-adapted version of BUYOI in delaying SU initiation among reservation-dwelling American Indian (AI) youth. Five reservation-based middle schools participated. Three schools were randomly assigned to receive BUYOI-AI (N = 321), and two schools served as controls (N = 176). Beginning in 7th grade, all participating students completed four assessments over the study period. Discrete time hazard models estimated the effects of BUYOI on students' risk of initiating alcohol, alcohol intoxication and marijuana before the end of 8th grade. AI students exposed to BUYOI had a lower risk of initiating alcohol use or intoxication, though sex moderated the effect on intoxication. These findings provide preliminary support for the effectiveness of a culturally-adapted version of BUYOI in delaying AI youth's first-time alcohol use and intoxication.

Predictors of Substance Use Latent Classes Among American Indian Youth Attending Schools On or Near Reservations.

BACKGROUND AND OBJECTIVES: Identical latent classes of substance use for 7 to 8 grade and 9 to 12 grade American Indian (AI) youth living on or near reservations suggest that patterns of substance use are established early among these youth. This study examines relationships of substance-related factors to latent class membership and whether these relationships differ by grade group. METHODS: In-school surveys were administered to 1503 7 to 8 grade and 1995 9 to 12 grade students from 46 schools on or near reservations during the 2009/2010 to 2012/2013 school years. Four-class latent class models of substance use were specified and five classes of substance-related factors (peers, substance availability, perceived harm, family, early initiation), plus grade level and gender, were evaluated as predictors. RESULTS: For 7 to 8 grade students, substance-related factors differentiated nonusers from users, while for 9 to 12 graders, these factors also differentiated types of users. Early initiation and peer factors were strongly related to class membership, while other factors were less strongly related. DISCUSSION AND CONCLUSIONS: Early initiation of alcohol or marijuana is strongly related to being in a substance-using class for AI youth. Because these youth tend to initiate use earlier that other US youth, prevention resources should be targeted to reaching them and their families before age 12. SCIENTIFIC SIGNIFICANCE: Predictors of latent classes of substance use were identified for reservation-based AI youth. While the classes were identical for 7 to 8 grade and 9 to 12 grade youth, predictors varied across grade group, which may inform how best to develop prevention efforts unique to middle and high school AI youth.

The Role of Future Orientation and Self-determination on American Indian Adolescents' Intentions to Use Alcohol and Marijuana.

Substance use (SU) rates among American Indian (AI) adolescents have been greater than national rates for decades, with little progress made on reducing them. Reasons for this may include lack of evidence on which to base effective interventions, the uniqueness of this population, and the overall lack of attention that this population has received in reducing socioeconomic and health disparities. Moreover, there has been limited focus on understanding how positive individual characteristics may serve as protective factors for AI adolescents. Using data from 379 AI youth living on or near four northern plains reservations, the current study examines the relationship between future orientation (FO) and self-determination (SD) and intentions to use alcohol and marijuana, with negative consequences of SU for future goals and autonomy evaluated as potential mediators. SEM models were estimated for alcohol use and marijuana use intentions, with two separate models for each dependent variable-one assessing the direct and indirect effects of FO via perceived consequences for future goals and the other assessing the effects of SD via perceived consequences for autonomy. All models displayed good fit, but the pattern of significant effects varied by substance, by construct (FO vs. SD), and by gender. Findings suggested that SD, and more proximally, perceived consequences of use for autonomy, may be particularly useful promotive factors to target SU prevention in AI adolescents. Culturally congruent interventions designed to promote SD and autonomous motivations to abstain may be particularly impactful within a young AI adolescent population, as early adolescence represents a critical period of development for personal autonomy and identity.

The Imperative for Research to Promote Health Equity in Indigenous Communities.

Health disparities exact a devastating toll upon Indigenous people in the USA. However, there has been scant research investment to develop strategies to address these inequities in Indigenous health. We present a case for increased health promotion, prevention, and treatment research with Indigenous populations, providing context to the recent NIH investment in the Intervention Research to Improve Native American Health (IRINAH) network. We discuss the disproportionate costs and consequences of disparities borne by Indigenous groups, the limited evidence base on effective intervention for this population, how population uniqueness often makes transfer of existing intervention models difficult, and additional challenges in creating interventions for Indigenous settings. Given the history of colonial disruption that has included genocide, forced removal from lands, damaging federal, state and local policies and practices, environmental contamination, and most recently, climate change, we conclude research that moves beyond minor transformations of existing majority population focused interventions, but instead truly respects Indigenous wisdom, knowledge, traditions, and aspirations is needed, and that investment in intervention science to address Indigenous health disparities represent a moral imperative.

Early onset of cannabis use and alcohol intoxication predicts prescription drug misuse in American Indian and non-American Indian adolescents living on or near reservations.

BACKGROUND: Prescription drug misuse (PDM) is a growing issue within the American Indian (AI) population, especially in younger populations. OBJECTIVES: This study estimates relationships between PDM and early initiation (prior to 14 yrs) of cannabis use and alcohol intoxication for a national sample of AI and non-AI adolescents attending schools on or near reservations. METHOD: Participants were 2580 students (50.2% female; 58.1% AI), ages 15-18, attending schools located on or near an AI reservation. Four models of PDM were estimated: 1) demographic variables; 2) demographics plus cannabis use initiation status; 3) demographics plus alcohol intoxication initiation status; and 4) all variables. All analyses were conducted using multilevel modeling. RESULTS: Results indicated that early onset of cannabis use and alcohol intoxication were individually significant predictors of PDM for AI and non-AI adolescents, with odds ratios (OR) of 47.00 for cannabis (p <.01) and 35.73 (p <.01) for intoxication and with no significant differences by race (AI vs. non-AI). Results also indicated a greater likelihood of PDM when a student was an early initiator of both cannabis use and intoxication than when they were one or the other. Finally, there was a significantly greater association between cannabis use and PDM (ORearlycannabis = 24.95, p <.01) than between intoxication and PDM (ORearlyintoxication = 3.98, p <.01) when both predictors were in the model. CONCLUSIONS: These findings suggest that for AI and non-AI youth who have some shared living experience, early initiation of cannabis use and alcohol intoxication are risk factors that are similarly related to PDM and that targeting early initiation for both groups of adolescents is critical in prevention of PDM.

Self-esteem, cultural identification, and substance use among American Indian youth.

OBJECTIVES: Determine potential mediating and moderating effects of self-esteem on the relationship between cultural identification and substance use among American Indian (AI) youth. METHODS: Anonymous surveys were administered to middle and high school AI students assessing levels of last month alcohol and marijuana use, cultural identification, and self-esteem. Structural equation modeling assessed potential mediating and moderating effects of self-esteem on the relationship between AI and white identification on alcohol and marijuana use. RESULTS: No mediating effects were found for middle school students. Among high school students, no mediating effects were found for alcohol. Among female high school students, a small mediating effect was found between AI identification and marijuana use, with AI identification protecting against use. Across all students, no moderating effects of self-esteem were found. CONCLUSIONS: The literature on cultural identification and substance use among minority youth is unclear. It was anticipated that consideration of self-esteem as a potential mediator or moderator might help clarify some of the confusion. However, no moderating effects were found and mediating effects were limited to female high school students for marijuana. Consideration should be given to assessing other measures of cultural identification and subscales of self-esteem to confirm that these findings are robust.

Cultural Adaptation of the Be under Your Own Influence Media Campaign for Middle-School American Indian Youth.

American Indian (AI) adolescents living on reservations report much higher substance use rates compared to other youth yet there are few effective prevention interventions developed for them. This paper presents findings from formative research undertaken to guide adaptation for AI youth of a prevention intervention, Be Under Your Own Influence (BUYOI), previously found to be effective in reducing substance use among middle-school youth. We conducted focus groups with 7th graders, the primary target audience, and photovoice with 11th graders, the role models who would help deliver the campaign, to inform surface and deep structure adaptation. Both age groups noted the pervasiveness of substance use on the reservation and indicated that this posed a major challenge to being drug and alcohol free. Students also described aspects of their community that tied to signs of social disorganization. However, these youth have much in common with other youth, including high future aspirations, involvement in activities and hobbies, and influence from family and friends. At the same time, there were important differences in the experiences, environment, and values of these AI youth, including emphasis on different types of activities, a more collectivist cultural orientation, tribal identity and pride, and the importance of extended families.

Alcohol consumption among rural African American and White adolescents: The role of religion, parents, and peers.

Although studies have examined ethnic differences in psychosocial factors and adolescent alcohol use, most have not examined these relationships for rural adolescents. The Community Drug and Alcohol Survey (CDAS) was completed by 23,163 rural adolescents attending African American secondary schools. Multilevel analysis tested the hypothesis of stronger relationships of peer use and religiosity with alcohol use and a weaker relationship for parental permissiveness and alcohol use for White compared to African American adolescents. Results suggested that peer use, religiosity, and parental permissiveness were more strongly associated with changes in alcohol use for White adolescents. Findings provide insight for alcohol prevention among rural adolescents.

The Role of Norms in Marijuana Use Among American Indian Adolescents.

American Indian adolescents residing on reservations report high levels of marijuana use. Understanding the relationships between normative mechanisms and marijuana use in this group can be especially important in designing effective strategies to prevent use. Participants were 3446 students identifying as American Indian in grades 7-12 across four academic years (2009-2012) from 45 schools. Multilevel logistic analysis was used to examine the relationships between lifetime, last month, and frequent marijuana use and measures of the normative environment. Descriptive and injunctive norms were distinctly and directly associated with all measures of marijuana use, with family injunctive norms showing a strong relationship to use (0.49 < OR < 0.58 for a 9th grade student). Family injunctive norms moderated the relationship between descriptive norms and lifetime and last month use (OR = 0.79 and 0.82, respectively), with higher family disapproval associated with a weaker relationship between descriptive norms and use. Anticipatory socialization was positively related to all measures of marijuana use, with the relationship stronger for lifetime and last month use than for frequent use (OR = 1.88, 1.74, and 1.30, respectively). A contextual variable of descriptive norms was related to lifetime and last month use (OR = 1.66 and 1.51, respectively) but not frequent use. These findings reinforce the importance of parental norms in reducing the likelihood of using marijuana. In addition, prevention strategies that increase the perception that healthy behaviors not involving marijuana use are an enjoyable way to socialize may be more effective in preventing occasional marijuana use.

Predicting an Alcohol Use Disorder in Urban American Indian Youth.

This study examines predictors of alcohol use disorders (AUDs) among an urban American Indian cohort who were followed from approximately age 11 to age 20. Approximately 27% of the sample had a lifetime diagnosis of alcohol abuse or dependence. The results indicated that externalizing, but not internalizing, behaviors, family conflict, and school liking served as significant predictors of an AUD. Neither having an alcoholic mother nor an alcoholic father was found to be significantly predictive of an alcohol use disorder at ages 19-20. Finally, early alcohol initiation is a substantial predictor of an AUD and acts as a partial mediator.

Can High and Consistent School-Related Protective Factors Prevent Cannabis Use Among American Indian Middle School Students?

BACKGROUND: High cannabis use rates among American Indian (AI) adolescents necessitate the identification of factors that protect against early cannabis initiation. METHODS: Data collected from 279 AI middle school students attending reservation-based schools in 2018 and 2019 were analyzed. Three waves of data, with approximately 6 months between each, were used. A repeated measures latent class analysis examined a school-related protective factor index over three waves. The predictive power of lifetime cannabis use on school protection class membership was estimated, along with differences in past month cannabis use at follow-up 2 across school protection classes while holding baseline use constant. RESULTS: Four school protection classes were identified: high, moderate, low, and declining protection. Abstinence at baseline was associated with an increased odds of membership in the high protection class compared to the moderate and low protection classes. Students with consistent and high school protection throughout middle school were significantly less likely to report past month cannabis use at follow-up 2 compared to other classes. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Maintaining a high level of school protection throughout middle school substantially lowers the odds of cannabis use among AI adolescents. CONCLUSIONS: Interventions to promote school-related protective factors in this population are essential and should be designed and tested.

Nicotine use among reservation-area American Indian adolescents compared with a national sample.

BACKGROUND: Past research has found significant nicotine use disparities for reservation-area American Indian adolescents when compared to national levels. However, adolescent nicotine use has changed markedly, with reduced smoking and rapid increases in nicotine vaping. This study presents 2021-2022 prevalence estimates of tobacco product use, perceived harm and availability for reservation-area American Indian youth, with comparisons to the Monitoring the Future (MTF) national study. METHODS: Participants were 8th, 10th and 12th grade students. American Indian data were 33 reservation-area schools in 2021-2022 (n=2420); MTF data were 308 schools in Spring 2022 (n=31,438). Measures were lifetime, 30-day cigarette smoking, smokeless tobacco use, and nicotine vaping; past-year nicotine vaping; daily smoking; perceived harmfulness and availability of these tobacco products. Prevalence and 95% confidence intervals were computed by grade. RESULTS: Estimated prevalence of lifetime, monthly and daily cigarette smoking among American Indian 8th and 10th graders was higher than national levels. Nicotine vaping prevalence was similar between samples. American Indian students were less likely to report tobacco product use poses great risk, but also less likely to report tobacco products are easily available. CONCLUSIONS: Although estimated smoking prevalence among American Indian 8th and 10th graders was higher than national levels, prevalence appears lower than reported in earlier studies, suggesting declining disparities. Prevalence of nicotine vaping among reservation-area American Indian adolescents generally mirrors the national population; however, a lower percentage reported regular nicotine vaping poses a serious risk. This discrepancy suggests a need for prevention and intervention efforts culturally tailored for this population.

Outcome expectancies, descriptive norms, and alcohol use: American Indian and white adolescents.

This study examined the relationships between adolescent alcohol use and outcome expectancies and descriptive norms for a sample of American Indian and white youth living on or near reservations. Three outcome expectancies proposed by the theory of normative social behavior (perceived benefits to self, perceived benefits to others, and anticipatory socialization) were examined. Survey data were collected from high school students in the 2009-2010, 2010-2011, and 2011-2012 school years. Stronger descriptive norms for use and higher perceived benefits to self from use were associated with alcohol use in the last month, drunkenness in the last month, and binge drinking. Perceived benefits to self also moderated the relationship between descriptive norms and both alcohol use in the last month and binge drinking, and the effect of descriptive norms on use became more robust as perceived benefits to self increased. Outcome expectancies of perceived benefits to others and anticipatory socialization did not moderate the relationship between norms and alcohol use. Implications for prevention are discussed.

Intersecting sex and American Indian identity moderates school and individual correlates of binge drinking among reservation-area adolescents.

Reservation-area American Indian (AI) youth demonstrate higher rates of binge drinking (BD) than their non-AI peers. However, individual and school-level differences in BD disparities between reservation-area AI/non-AI female and male adolescents remain unexamined. This study applies an Intersectional framework to examine risk and protective factors of BD among reservation-area youth at the intersection of their sex and AI identities. A nationally representative sample of adolescents (N = 14,769; Mage = 14.6, 49% female; 61% AI) attending 103 reservation-serving schools completed a survey between 2015 and 2019. Multilevel modeling was used to examine differences in risk and protective factors of BD between AI and non-AI male and female adolescents. Our findings indicate that the effects of student and school-level risk and protective factors on adolescents' BD are driven primarily by sex within AI and non-AI groups. Implications for future confirmatory research and tailoring school-based prevention programs are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Family ties: examining family functioning and alcohol use among American Indian youth.

Purpose: This study aims to examine a second-order latent variable of family functioning built from two established protective factors for American Indian (AI) youth, i.e. family cohesion and parental monitoring. This study then examines if family functioning is related to alcohol use frequency or age of initiation for AI youth. Additionally, this study examines if family functioning served as a moderator for the risk factor of peer alcohol use. Design/methodology/approach: Data came from the 2021 Our Youth, Our Future survey. Participants were 4,373 AI adolescents from Grades 6-12 across the contiguous USA. Structural equation modeling (SEM) was used to test the latent variable of family functioning. Structural paths and interaction terms between peer use and family functioning were added to the SEM to explore direct and moderating effects. Findings: Family cohesion and parental monitoring were best represented by a second-order latent variable of family functioning, which was related to later initiation and lower alcohol use frequency. Practical implications: The findings regarding the initiation of alcohol use may be applicable to prevention programs, with family functioning serving as a protective factor for the initiation of alcohol use. Programs working toward alcohol prevention may be best served by focusing on family-based programs. Originality/value: The latent variable of family functioning is appropriate for use in AI samples. Family functioning, which is an inherent resilience factor in AI communities, was shown to be protective against harmful alcohol use behaviors.

A Comparison of COVID-19 Outcomes Between Reservation-Area American Indian and U.S. National Students.

Introduction: This study presents data from 2 population-based surveys of youth (reservation-area American Indian adolescents and U.S. adolescents) on self, family, and friend morbidity and changes in substance use and negative impacts during COVID-19. Methods: Data were obtained in spring 2021 from surveys of American Indian students living on or near reservations (8th grade, n=398; 10th grade, n=367; 12th grade, n=290) and national students from Monitoring the Future (8th grade, n=11,446; 10th grade, n=11,792; 12th grade, n=9,022). The main outcomes were COVID-19 testing, perceived morbidity/mortality, substance-use changes, and emotional changes during COVID-19. Results: The American Indian sample had a greater proportion of testing (e.g., American Indian 8th grade: 58.1% [95% CI=48.6, 68.8]; Monitoring the Future 8th grade: 43.6% [95% CI=39.8, 47.5]) and friend/family hospitalization (e.g., American Indian 8th grade: 36.2% [95% CI=26.2, 47.5]; Monitoring the Future 8th grade: 11.9% [95% CI=10.6, 13.3]). Across grades, greater proportions of the national sample reported increased anxiety, anger, boredom, loneliness, depression, worry, and trouble concentrating, whereas greater proportions of reservation-area American Indians reported decreased anxiety, loneliness, and depression. Conclusions: Findings indicate that reservation-area American Indian youth experienced unique health consequences 1 year into the COVID-19 pandemic compared with national students, illustrating the need for American Indian-specific COVID-19 public health monitoring and response.

Latent Class Analysis and Predictors of Marijuana Use among Reservation-based American Indian High School Students.

American Indian (AI) youth residing on reservations report higher rates of marijuana use compared to national youth. Latent class analysis (LCA) was used to identify unique types of marijuana use among 2,884 AI high school students surveyed from 26 schools across six indigenous geographic regions. Predictors of class membership were then assessed using social, cultural, and individual measures relevant to adolescent substance use. Classes and predictors were examined separately for males and females. Four-class models fit the data best for both male and female AI students. Classes differed by sex, as did predictors. Overall, social predictors related to family and peers and the individual predictor, using marijuana to cope, were the best predictors of class membership. Based on these results, prevention and intervention efforts should provide alternative coping methods for these adolescents who often live in difficult situations, and should focus on encouraging parents to effectively monitor their adolescent children and communicate clear sanctions against marijuana use.