Traditional Ceremonial Practices as a Strategy to Reduce Problem Substance Use in American Indian Communities: A Systematic Review

Drug overdose mortality rates among non-Hispanic American Indian/Alaska Native individuals, 1999-2022

PURPOSE

To examine epidemiological trends in drug overdose deaths for non-Hispanic American Indian/Alaska Native (AIAN) individuals compared to White individuals.

METHODS

We obtained data from the CDC WONDER database to examine crude drug overdose death rates per 100,000 among AIAN and White individuals from 1999-2022. Rates were further stratified by manner of death, sex, age, urbanization, Census region, state, and specific drug types.

RESULTS

From 1999-2022, drug overdose death rates for AIAN individuals increased from 3.17 (95 % CI, 2.48-4.00) to 40.73 (95 % CI, 38.19-43.27), representing a 12-fold increase; in contrast, rates rose by five-fold for White individuals. In 2022, methamphetamine was the leading driver of overdose death rates for AIAN individuals, at 31.39 (95 % CI, 29.16-33.62) per 100,000, followed by fentanyl, at 22.35 (95 % CI, 20.46-24.23) per 100,000. Geographical variations were notable, with the highest rates for AIAN individuals in large central metropolitan regions (53.54 per 100,000) and the Midwest (50.31 per 100,000). Rates were higher for AIAN than White individuals in 20 of the 21 states (95.2 %) included in our analysis.

CONCLUSIONS

AIAN individuals are disproportionately impacted by the overdose crisis. Further efforts are needed to expand access to harm reduction-informed, culturally-competent health education, addiction treatment, and social services in the AIAN population.

Change in Health Status Among American Indian/Alaska Native Adolescents Living Outside of Tribal Land in California Before and During the COVID-19 Pandemic

PURPOSE

This article describes change in health status by analyzing key health domains at two time points before and during the COVID-19 pandemic among a sample of American Indian/Alaska Native (AI/AN) adolescents living outside of tribal land (n = 114) throughout California.

METHODS

Data were analyzed from a longitudinal study, Native American Youth Sleep Health and Wellness (NAYSHAW). To test changes in health from baseline (March 2018-March 2020) to follow-up (December 2020-June 2022), we ran a series of linear regression models for continuous measures and repeated measures logistic regression models for dichotomous measures for physical health, behavioral health, and cultural contexts of health and well-being.

RESULTS

For physical health, body mass index percentile significantly decreased (p = 0.02), and both systolic and diastolic blood pressure significantly increased (p < 0.001 for both), although both measures remained within the normal range for adolescents. For behavioral health, depression and anxiety significantly increased (p = 0.005 and 0.008, respectively), although they remained within subclinical levels, and no significant changes were observed with alcohol and cannabis use. For cultural contexts of health and well-being, both cultural identity and sense of historical loss significantly increased (p < 0.001 and p = 0.03, respectively).

DISCUSSION

We observed a mix of positive and negative health changes among AI/AN adolescents living outside of tribal land before and during COVID-19. Findings highlight that enhanced cultural identity during adolescence may have helped foster resilience during this difficult period.

The protective role of valuing cultural activities on cannabis use in reserve-Dwelling First Nation youth

Cannabis legalization and use across North America disproportionately negatively affects North American Indigenous (NAI) youth. Cultural activities may function as an alternative reinforcer to protect against substance use and promote engagement in substance-free activities. The present study explored the role of valuing cultural activities on positive cannabis expectancies and past-month cannabis use. This was a secondary data analysis of data from one NAI adolescent population reporting any past-month cannabis use. 106 NAI adolescents (50% female) from a Canadian reserve community completed surveys in spring 2017. The Institutional Review Board, tribal chief, and council approved this study and informed consent, assent, and parental permission were obtained from participants. Linear regression results revealed significant main effects of positive cannabis expectancies (b = 2.926, SE = 1.198, p = .017, 95%CI[0.542, 5.309]) and valuing cultural activities (b= -0.471,SE = 0.234, p=.048, 95%CI[-0.937, -0.005]) on cannabis use, but no significant interaction between cannabis expectancies and valuing cultural activities. Previous research found valuing cultural activities significantly moderates the relationship between positive alcohol expectancies and alcohol use. Divergent findings may relate to the different historical significance of alcohol versus cannabis. Alcohol was used as a method to colonize NAIs. Thus, our non-significant interaction may result from cannabis not holding the same historical significance in comparison to alcohol for First Nation people, although this is only a hypothesis and should be confirmed with a follow up study. Despite this, calls from Indigenous communities emphasize the need for strength-based approaches and our results indicate that valuing culture is still significantly related to reduced cannabis use, independent of cannabis expectancies.