Adolescent perceptions of alcohol risk: variation by sex, race, student activity levels and parental communication

Drawing on data gathered from adolescents (N = 18,991) in the 2011 National Survey on Drug Use and Health (NSDUH), this study examined the effects of sex and race, as well as measures of student activity levels and frequency of recognition from parents, on perceptions of the risks associated with binge drinking. Overall, female, Black, Asian, and Hispanic adolescents, as well as individuals who indicated belonging to more than one race, perceived higher levels of risk. Male, White, and Native American/Alaskan/Pacific Islander respondents perceived lower risk levels. In addition, those who participated the most in school and community activities, as well as those who received more frequent recognition from parents, estimated higher levels of risk associated with binge drinking.

Adaptation and implementation of cognitive behavioral intervention for trauma in schools with American Indian youth

American Indian adolescents experience higher rates of suicide and psychological distress than the overall U.S. adolescent population, and research suggests that these disparities are related to higher rates of violence and trauma exposure. Despite elevated risk, there is limited empirical information to guide culturally appropriate treatment of trauma and related symptoms. We report a pilot study of an adaptation to the Cognitive Behavioral Intervention for Trauma in Schools in a sample of 24 American Indian adolescents. Participants experienced significant decreases in anxiety and posttraumatic stress disorder symptoms, and avoidant coping strategies, as well as a marginally significant decrease in depression symptoms. Improvements in anxiety and depression were maintained 6 months postintervention; improvements in posttraumatic stress disorder and avoidant coping strategies were not.

Preventing Substance Abuse in American Indian and Alaska Native Youth: Promising Strategies for Healthier Communities

Substance abuse has had profoundly devastating effects on the health and well-being of American Indians and Alaska Natives. A wide variety of intervention methods has been used to prevent or stem the development of alcohol and drug problems in Indian youth, but there is little empirical research evaluating these efforts. This article is an overview of the published literature on substance use prevention among Indian adolescents, providing background epidemiological information, a review of programs developed specifically for Indian adolescents, and recommendations for the most promising prevention strategies currently in practice.

Prevention of alcohol misuse: a review of health promotion efforts among American Indians

PURPOSE

The purpose of this review is to provide an overview of a wide range of potentially useful strategies to address the prevention of alcohol misuse among American Indians. This broad approach to the review is useful because the extreme heterogeneity of the American Indian population requires that health promotion professionals explore many options and tailor their activities to specific communities.

SEARCH METHOD

A literature search was initiated through MEDLINE using the following key words: prevention, alcohol, substance abuse, American Indian, and Native American. The search yielded 29 articles from the years 1982 through 1994. These articles, along with 45 previously identified in three overview articles, form the basis of the review and discussion in this paper.

SUMMARY OF FINDINGS

As a group, American Indians experience many health problems that are related to alcohol misuse. Comparison of Indians to non-Indians shows that the age of first involvement with alcohol is younger, the frequency and amount of drinking is greater, and negative consequences are more common. Health promotion programs that address these issues must take into account American Indian heterogeneity and should use a comprehensive approach that addresses both heavy drinking and the sequelae of problems related to alcohol misuse.

MAJOR CONCLUSIONS

Important concepts for providing health promotion services to this population are: cultural relevance must be carefully planned and monitored; individuals in the local community must be involved; the drunken Indian stereotype must be addressed; and community empowerment should be an important goal.

Psychosocial factors in the use of smokeless tobacco and their implications for P.L. 99-252

This article briefly reviews the prevalence of smokeless tobacco use by males in the United States, the relationship of smokeless tobacco use to cigarette use, and patterns of use that include dosage, topography, products, and function of use. The primary focus of the article is to describe the concurrent and predictive factors associated with onset, use, and cessation of smokeless tobacco. The implications of P.L. 99-252, the Comprehensive Smokeless Tobacco Act of 1986, are discussed in the context of what is known about the psychosocial variables associated with the use of smokeless tobacco.

Indian and Anglo adolescent alcohol use and emotional distress: path models

Anonymous surveys of alcohol use and emotional distress of 11th and 12th grade students were administered to 327 reservation Indian adolescents and 524 Anglo adolescents. Path models based on peer cluster theory were developed and tested. Results argue against a self-medication theory of adolescent alcohol use. Emotional distress variables had little effect on alcohol involvement, with the exception of anger which operated in opposite directions for the two groups. The highest relationship with alcohol involvement in both groups was with peer alcohol associations, confirming the a priori hypothesis that much of adolescent alcohol use is linked to peer associations. Those relationships, however, were much stronger in Anglo youth, suggesting that alcohol may be used more frequently in nonpeer situations by Indian youth, or at least in situations where the peers are not those close friends who have very similar patterns of alcohol use. The most important difference between Indian and Anglo youth, however, may be the role that anger plays in alcohol involvement. In Anglo youth, anger may be associated with problem behaviors including alcohol use. In Indian youth, higher anger is linked to higher self-esteem, and tends to reduce alcohol use.

Hispanic youth, substance abuse, and stress: implications for prevention research

Hispanic adolescents are the fastest growing ethnic-minority age group in America. They are also at high risk for drug, alcohol, and tobacco use. In this paper, the authors discuss the etiology of Hispanic adolescents' substance abuse, as explained in part by psychological stress. Based on the authors' research and on other data, a model for preventing substance abuse among Hispanic youths is presented. The model draws from coping, acculturation, social learning, and informal network theories. Concluding with a research agenda, the paper calls for descriptive, correlative, and intervention outcome studies to scientifically understand and prevent substance use among Hispanic adolescents.

Alcohol Education Programs and Minority Youth

Research relative to the drinking behavior of minority youth, as well as alcohol-abuse prevention programs for these youth, have been largely neglected. Moreover, the existing data on both of these subjects are limited in that they either treat minority youth as a homogeneous entity or apply a white middle-class curriculum to prevention activity. This paper examines several alcohol-education protocols within schools and how these strategies present unique problems to prevention programs for minority youth. Curricula derived from the developmental and the socio-cultural models appear most applicable to minorities.

Skills enhancement to prevent substance abuse among American Indian adolescents

Skills enhancement programs to prevent drug abuse have shown promise in tests with majority-culture adolescents. To date few applications of this preventive strategy have been evaluated with American Indian youth. A culturally tailored 10-session skills enhancement program was delivered in reservation and nonreservation settings in the Pacific North west. At 6-month follow-up, compared with test-only control condition subjects, intervention condition subjects had better knowledge of drug effects, better interpersonal skills for managing pressures to use drugs, and lower rates of alcohol, marijuana, and inhalant use. Intervention condition subjects were also less likely to label or consider themselves users of these substances. The findings suggest that behavioral skills training approaches hold promise for reducing substance use and abuse among American Indians.

Assessment of refusal skill in minority youth

The Assertive Friend Cartoon Test was developed and evaluated for Native American youth. Preliminary findings on this refusal skill assessment approach are reported. Psychometric data and feedback from adolescent ethnic group spokespersons support using cartoons to augment paper-pencil measurement.