Rates of substance use of American Indian students in 8th, 10th, and 12th grades living on or near reservations: update, 2009-2012.

OBJECTIVES: Understanding the similarities and differences between substance use rates for American Indian (AI) young people and young people nationally can better inform prevention and treatment efforts. We compared substance use rates for a large sample of AI students living on or near reservations for the years 2009-2012 with national prevalence rates from Monitoring the Future (MTF). METHODS: We identified and sampled schools on or near AI reservations by region; 1,399 students in sampled schools were administered the American Drug and Alcohol Survey. We computed lifetime, annual, and last-month prevalence measures by grade and compared them with MTF results for the same time period. RESULTS: Prevalence rates for AI students were significantly higher than national rates for nearly all substances, especially for 8th graders. Rates of marijuana use were very high, with lifetime use higher than 50% for all grade groups. Other findings of interest included higher binge drinking rates and OxyContin(®) use for AI students. CONCLUSIONS: The results from this study demonstrate that adolescent substance use is still a major problem among reservation-based AI adolescent students, especially 8th graders, where prevalence rates were sometimes dramatically higher than MTF rates. Given the high rates of substance use-related problems on reservations, such as academic failure, delinquency, violent criminal behavior, suicidality, and alcohol-related mortality, the costs to members of this population and to society will continue to be much too high until a comprehensive understanding of the root causes of substance use are established.

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.

The normative environment for substance use among American Indian students and white students attending schools on or near reservations.

American Indian and White students who attended the same schools located on or near reservations were surveyed to determine the comparative normative environment for substance use. Descriptive norms increased and student injunctive norms decreased across grade in school. Female students reported higher levels of descriptive norms compared to male students. For marijuana use, a substantial decrease in student injunctive norms occurred between grades 8 and 10. Adult injunctive norms were perceived by female students to be higher than those perceived by male students, particularly among American Indian females. Somewhat surprisingly, 8th grade White female students reported high descriptive norms for inhalant use compared to 8th grade American Indian students. Overall, however, higher descriptive norms and lower injunctive norms among American Indian youth suggested that their risk for substance use is higher compared to White students because of the normative environment created by peers, family, and other adults.

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.

The normative environment for drug use: comparisons among American Indian and white adolescents.

The current study examined the influence of descriptive norms, injunctive norms, perceived outcome expectancies, and ethnicity on marijuana and inhalant use among 2334 American Indian (AI) and White high school students who lived on or near reservations in the United States. Hierarchical multiple regression analyses were conducted with survey data collected during the 2009-2010 and 2010-2011 school years. Results suggest differences between ethnicities in the influence of the normative environment and outcome expectancies on both marijuana and inhalant use. Study limitations are noted, and future research is suggested.

School bonding as a moderator of the effect of peer influences on alcohol use among American Indian adolescents.

OBJECTIVE: Previous research suggests that substance use among American Indian youth is associated with disproportionate rates of morbidity and substance misuse. Additional work to understand risk and protective factors for alcohol use is needed. The current study examined the role of school bonding in buffering the effect of peer alcohol use on a student's own alcohol use among American Indian adolescents. METHOD: The present study is part of a larger examination of alcohol use among American Indian youth. Survey data were collected from middle and high school students during the 2009-2010 and 2010-2011 school years from 37 school districts in the United States. The sample consisted of 2,582 students ages 11-19 years: 1,606 were younger than 16, and 976 were age 16 or older. All students self-identified as American Indian or Alaskan Native. The sample was approximately equally divided by gender (49% male). RESULTS: For all students, peer alcohol use was a risk factor for (a) lifetime alcohol use and (b) level of alcohol use among users. School bonding was associated with a lower likelihood of lifetime alcohol use for adolescents younger than age 16 and a lower level of use among users for all adolescents. School bonding emerged as a protective factor that buffers against peer alcohol use among adolescent alcohol users younger than 16. CONCLUSIONS: Results of the study demonstrate the influence of exposure to alcohol-using peers and the protective role of school bonding on alcohol use among American Indian adolescents. Implications for prevention are discussed.

Regional differences in drug use rates among American Indian youth.

BACKGROUND: Research over the past several decades has shown that, compared to other American ethnic and racial groups, American Indian (AI) youth use alcohol and other drugs at significantly higher rates than their non-AI peers. However, to date, much of the research on AI adolescent substance use has been limited in the types of data used. METHODS: We used a national sample of AI youth living on or near reservations to estimate how lifetime and 30-day use of four substances (alcohol, marijuana, inhalants, and methamphetamine) differ by gender, grade in school, and region of the country. RESULTS: Female use was equal to or greater than use by otherwise similar males for all substances assessed. Substance use also increased as grade increased except in the case of inhalants, where use peaked in the 8th grade and then decreased. Regional differences proved to be one of the most salient findings in that individuals in the Northern Plains and Upper Great Lakes were more likely to have used substances at much higher rates than those living in the Southwest and Oklahoma, except in the case of methamphetamine, where individuals in the Southwest were most likely to have used. CONCLUSIONS: It is clear that substance use continues to be a problem for AI youth although the severity of use differs by region of the country, grade, and gender. Future research is needed to better understand the reasons behind these differences. Such research will aid in the development of targeted, regionally tailored prevention.

The effects of parental diagnosis and changing family norms on alcohol use and related problems among urban American Indian adolescents.

This study investigated the role of parental diagnosis of alcohol abuse/dependence and perceived family norms for adolescent drinking on alcohol use and alcohol-related problems among urban American Indian youth. A total of 251 urban, American Indian youth and their parents/caregivers were followed from ages 13 to 18. Perceived family norms against alcohol decreased and alcohol use increased from ages 13 to 18. Relative to no parental diagnosis, youth with one or two parents diagnosed with alcohol abuse/dependence were less likely to perceive family norms against alcohol use. Youth with two parents diagnosed were more likely to report alcohol-related problems at age 18 compared to no parental diagnosis. Faster rates of decrease in perceived family norms against alcohol use were associated with faster increases in alcohol use over time. Higher rates of perceived family norms against alcohol use protected youth from high rates of use at age 13, but higher rates of alcohol use at age 13 predicted more alcohol-related problems at age 18. These results suggest that both family history and family behaviors in the form of communication of norms for adolescent alcohol use are likely to impact both rates of use and eventual alcohol-related problems.

Age of onset of first alcohol intoxication and subsequent alcohol use among urban American Indian adolescents.

The objective was to assess the effect of early onset intoxication on subsequent alcohol involvement among urban American Indian youth. The data come from the American Indian Research (AIR) project, a panel study of urban Indian youth residing in King County, Washington. Data were collected annually from the adolescent and his/her primary caregiver from the 1988-89 school year to the 1996-97 school year, providing a total of nine waves of data. Early intoxication (by age 14) was related to delinquency, family history of alcohol abuse or dependence, poverty, broken family structure, less family cohesiveness, and more family conflict. The effects of these characteristics were, therefore, partialed out in testing effects of early intoxication on later alcohol involvement. Two-part latent growth models of alcohol use and alcohol problems were specified. Effects of early onset intoxication on these trajectories, as well as lifetime alcohol abuse or dependence by the transition to young adulthood, were examined. Findings indicate that adolescents who experienced their first intoxication early (by age 14), used alcohol more heavily from the ages of 16 to 18, experienced more problems related to the alcohol's use from the ages of 16 to 18, and were more likely to have a diagnosed alcohol disorder by the final wave of data collection. Congruent with similar studies in the general population, early intoxication appears to be associated with a deleterious course of alcohol involvement during adolescence and into the transition to young adulthood among urban American Indian youth. Implications for prevention are discussed.

Reflections on a proposed theory of reservation-dwelling American Indian alcohol use: comment on Spillane and Smith (2007).

In their recent article, N. Spillane and G. Smith suggested that reservation-dwelling American Indians have higher rates of problem drinking than do either non-American Indians or those American Indians living in nonreservation settings. These authors further argued that problematic alcohol use patterns in reservation communities are due to the lack of contingencies between drinking and "standard life reinforcers" (SLRs), such as employment, housing, education, and health care. This comment presents evidence that these arguments were based on a partial review of the literature. Weaknesses in the application of SLR constructs to American Indian reservation communities are identified as is the need for culturally contextualized empirical evidence supporting this theory and its application. Cautionary notes are offered about the development of literature reviews, theoretical frameworks, and policy recommendations for American Indian communities.

Initiation of alcohol use among urban American Indian youth: a discrete time hazards model.

This study uses data collected over 8 time periods to examine time-varying and time-invariant predictors of alcohol initiation among urban American Indian youth, an understudied population. Similar socialization risk and protective factors were found to be related to initiation as other American youth. However, a nuclear family was not found to be protective against initiating alcohol use and living with a father only and having an alcoholic father significantly increased initiation odds. In general, these urban Indian youth are much like other American youth in their initiation of alcohol use, although they may initiate alcohol use at slightly lower rates.

The changing patterns of drug use among American Indian students over the past 30 years.

Drug use among American Indian (AI) youth continues at higher levels than those found among other youth. While the rates are higher, the patterns of increases and decreases over the past 30-year period have been similar, indicating that AI youth are part of the larger adolescent culture. There is a set of secular influences that affect the rates of drug use in both groups in the same manner. The major implication of these findings is that effective interventions in non-AI groups may also be effective among AI adolescents. Intervention activities, however, must be adapted to be culturally congruent. Despite rising concern over methamphetamine use on reservations, the data presented here indicate that, with the exception of two points in time, the rates have not increased substantially for AI youth who remain in school. School dropouts and young adults/adults may be more vulnerable to the abuse of methamphetamines and the rates of use may be higher in these groups.

A comparison of American Indian and non-Indian fourth to sixth graders' rates of drug use.

Although there is a large body of literature examining adolescent drug use, little is known about drug use rates among younger children. This paper presents such information for both American Indian and non-Indian fourth to sixth grade students for "having gotten drunk," the "use of marijuana," the "use of inhalants," and the use of "other" drugs over a 10-year period. Generally, the rates of use for Indian youth are higher, with a particularly high rate of marijuana use. Despite historically high rates of inhalant use among Indian youth, their rates are now similar to their non-Indian counterparts. Indian fourth to sixth grade students are displaying patterns of use that parallel those of older students with the possible implication that they are subjected earlier to societal attitudes that encourage drug use.

Prevalence of American Indian adolescent tobacco use: 1993-2004.

Tobacco use rates for American Indian adolescents are examined and compared to rates for non-Indian youth. The data are taken from an ongoing surveillance project of substance use among Indian youth and the Monitoring the Future Project for the years 1993 to 2004. Sample sizes are in the range of 14,000 to 17,000 for non-Indian youth and 600 to 2400 for Indian youth. Tobacco use is considerably higher for Indian youth; however, these rates are following the national trends of significant reductions over the past three years. Indian youth manifested a lower perception of harm from regular tobacco use, which may, in part, account for their higher levels of use. Indian females have had slightly higher rates of lifetime and daily smoking rates than males in the past but recent trends indicate a narrowing of this gap.

Surveillance of drug use among American Indian adolescents: patterns over 25 years.

PURPOSE: To examine the trends in drug use among American Indian adolescents attending schools on, or near, Indian reservations in the United States, to provide comparisons with non-Indian youth, and to discuss implications for prevention. METHODS: Reliable and valid school administered drug use surveys have been given every year for 25 years (1975-2000) to representative samples of Indian youth living on reservations, yielding a continuous record of trends in drug use. Comparisons are made with non-Indian youth with data from the Monitoring the Future project. Data were analyzed to obtain measures of lifetime prevalence ("ever tried a drug"), use in the last 30 days, and proportions at high risk and at moderate risk from their drug use. Comparisons utilized difference in proportion tests. RESULTS: From 1975 to 2000, reservation Indian youth show elevated levels of drug use for most illicit drugs compared with non-Indian youth. Despite higher levels of use, the trends showing increases and decreases in use over time mirror those shown by non-Indian youth. Indian youth who use drugs can be divided into moderate and high levels of use. The number of youth in the moderate category varies over time whereas the number in the high category remains relatively constant. CONCLUSIONS: There is a clear need for intensive efforts to reduce the levels of drug use among Indian youth. Although interventions must be tailored to the social and cultural milieu of Indian reservations, the rates of use vary over time in the same pattern as seen for non-Indian youth. Further, interventions must address the differing characteristics of high and moderate risk users of drugs.

Inhalant abuse among American Indian, Mexican American, and non-Latino white adolescents.

The abuse of volatile solvents, or inhalants, is an enduring problem among adolescents although a number of factors obscure the nature and extent of this drug using behavior. The data presented here indicate that a number of social and perceptual correlates of inhalant use operate similarly across Mexican American, American Indian and non-Latino white adolescents. Peer factors appear to dominate, although they are somewhat less important for Mexican American and Indian youth. Increased perception of harm reduces inhalant use for all groups. Of particular significance in the findings here are the continued increase of inhalant use among females compared to males and the strong pattern of decreases in inhalant use among American Indian adolescents over the last decade. A number of implications for increased effectiveness of prevention are discussed.