Patterns of substance use initiation among young adolescents in a Northern Plains American Indian tribe

Investigating Cannabis-Use Among Students Attending High Schools Within the Cherokee Nation Reservation 2017 and 2019

Oklahoma's medical cannabis is some of the least restrictive in the US. Previous research suggests that American Indian/Alaska Native (AIAN) have higher rates of cannabis use than other racial or ethnic groups. The goals of this paper are, first, to look at cannabis use among high school students living on the Cherokee Nation Reservation before (2017) and after (2019) medical cannabis because legal in Oklahoma (2018) utilizing the Cherokee Nation Youth Risk Behavior Survey (CNYRBS). Second, to describe the socio-demographic characteristics of youth using cannabis in the Cherokee Nation Reservation. Data were retrieved from the 2017 and 2019 CNYRBS. The data for this study included 1,216 high school students who completed the 2017 and 1,476 who completed the 2019 CNYRBS. After removal of incomplete records, there were 2,602 students whose data was analyzed in this study. Data were weighted to be representative of public-school students attending grades 9-12 within Cherokee Nation Reservation. Despite the legalization of medical cannabis in Oklahoma in 2018, there was no change in cannabis use among youth between 2017 and 2019. There were variations in cannabis use based on demographic factors and other substance uses. AIAN individuals had higher odds of current cannabis use compared to non-Hispanic White students, but there were no differences based on ethnicity. Additionally, the use of cigarettes, e-cigarettes, alcohol, and illegal drugs were associated with increased odds of cannabis use among both current and former users compared to those who had never used it. There was no spike in use among youth at least immediately after the legalization of cannabis in the Cherokee Nation Reservation. There were socio-demographic as well as substance use disparities in the use of cannabis.

Understanding Resilience and Mental Well-Being in Southwest Indigenous Nations and the Impact of COVID-19: Protocol for a Multimethods Study

BACKGROUND

Despite experiencing many adversities, American Indian and Alaska Native populations have demonstrated tremendous resilience during the COVID-19 pandemic, drawing upon Indigenous determinants of health (IDOH) and Indigenous Nation Building.

OBJECTIVE

Our multidisciplinary team undertook this study to achieve two aims: (1) to determine the role of IDOH in tribal government policy and action that supports Indigenous mental health and well-being and, in turn, resilience during the COVID-19 crisis and (2) to document the impact of IDOH on Indigenous mental health, well-being, and resilience of 4 community groups, specifically first responders, educators, traditional knowledge holders and practitioners, and members of the substance use recovery community, working in or near 3 Native nations in Arizona.

METHODS

To guide this study, we developed a conceptual framework based on IDOH, Indigenous Nation Building, and concepts of Indigenous mental well-being and resilience. The research process was guided by the Collective benefit, Authority to control, Responsibility, Ethics (CARE) principles for Indigenous Data Governance to honor tribal and data sovereignty. Data were collected through a multimethods research design, including interviews, talking circles, asset mapping, and coding of executive orders. Special attention was placed on the assets and culturally, socially, and geographically distinct features of each Native nation and the communities within them. Our study was unique in that our research team consisted predominantly of Indigenous scholars and community researchers representing at least 8 tribal communities and nations in the United States. The members of the team, regardless of whether they identified themselves as Indigenous or non-Indigenous, have many collective years of experience working with Indigenous Peoples, which ensures that the approach is culturally respectful and appropriate.

RESULTS

The number of participants enrolled in this study was 105 adults, with 92 individuals interviewed and 13 individuals engaged in 4 talking circles. Because of time constraints, the team elected to host talking circles with only 1 nation, with participants ranging from 2 to 6 in each group. Currently, we are in the process of conducting a qualitative analysis of the transcribed narratives from interviews, talking circles, and executive orders. These processes and outcomes will be described in future studies.

CONCLUSIONS

This community-engaged study lays the groundwork for future studies addressing Indigenous mental health, well-being, and resilience. Findings from this study will be shared through presentations and publications with larger Indigenous and non-Indigenous audiences, including local recovery groups, treatment centers, and individuals in recovery; K-12 and higher education educators and administrators; directors of first responder agencies; traditional medicine practitioners; and elected community leaders. The findings will also be used to produce well-being and resilience education materials, in-service training sessions, and future recommendations for stakeholder organizations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/44727.

Measurement Invariance and Application of an Alcohol-Related Consequence Scale for American Indian Adolescents

American Indian (AI) adolescents experience disproportionate alcohol-related consequences. The present study evaluated the psychometric properties and application of the American Drug and Alcohol Survey (ADAS™) alcohol-related consequence scale for AI adolescents through a secondary analysis of a large population-based sample of adolescents living on or near AI reservations. We found support for the ADAS alcohol-related consequence scale as a one-factor model, invariant discretely across race, sex assigned at birth, and age, and with good internal consistency. Evidence for construct validity was found through significant positive correlations between frequency of past 12 months of drinking, frequency of past 12 months of intoxication, and lifetime alcohol-related consequences. AI adolescents were significantly more likely to report more alcohol-related consequences than their non-Hispanic White peers. Race significantly interacted with frequency of drinking in predicting alcohol-related consequences such that these associations were stronger for AI adolescents. However, race did not significantly interact with frequency of intoxication in predicting alcohol-related consequences. Results from this study demonstrate the utility of the ADAS alcohol-related consequence scale for use across demographic groups with little risk of measurement bias.

Grounding evidence-based prevention within cultural context: promising effects of substance use prevention adapted for American Indian families

Background: Effective substance use prevention strategies are needed for American Indian (AI) youth, who face disproportionate risk for early substance use and consequently bear a disproportionate burden of health and developmental disparities related to early use. With few exceptions, significant advances in prevention science have largely excluded this population, leaving gaps in the evidence of effective practice. This paper builds on emerging efforts to address this gap, reporting first outcome findings from an evidence-based early substance use prevention program culturally adapted for young adolescents on a Northern Plains reservation. Methods: Using a community-based participatory approach, the Thiwáhe Gluwáš'akapi Program (TG, sacred home in which family is made strong) was developed by embedding cultural kinship teachings within the Strengthening Families Program for Parents and Youth 10-14 and aligning other elements of program content with local culture and context. Results: Results of pre and post comparisons of proximal program outcomes showed that youth reported significant improvements in parental communication about substance use, substance use resistance skills, stress management, family cohesion, and overall well-being. Adults reported improvements in a wide array of parenting behaviors and indicators of family dynamics. Conclusions: These findings provide an initial glimpse into the potential effects of the TG program and suggest that it holds promise for helping AI families address risks for youth substance use through positive impacts on modifiable risk and protective factors documented to influence early substance use.

Baseline results from NenŨnkUmbi/EdaHiYedo: A randomized clinical trial to improve sexual and reproductive health among American Indian adolescents

We report on baseline findings from NenUnkUmbi/EdaHiYedo, a community based participatory research randomized controlled trial with American Indian adolescents to reduce sexual and reproductive health disparities. American Indian adolescents aged 13-19 years participated in a baseline survey that was administered in five schools. We used zero-inflated negative binomial regression to evaluate how the count of protected sexual acts was associated with independent variables of interest. We stratified models by self-reported gender of adolescents and tested for a two-way interaction effect between gender and the independent variable of interest. Two hundred twenty-three girls and 222 boys (n = 445) were sampled. The average number of lifetime partners was 1.0 (standard deviation = 1.7). Each additional lifetime partner was associated with a 50% increase in the number of protected sexual acts incident rate ratio (IRR = 1.5, 95% confidence interval [CI] 1.1-1.9) and more than a twofold increase in the likelihood of not having protected sexual acts (adjusted odd ratio [aOR] = 2.6, 95% CI 1.3-5.1). Each additional number of substances used in adolescentss' lifetime was associated with an increased likelihood of not having protected sexual acts (aOR = 1.2, 95% CI 1.0-1.5). In boys, each one standard deviation increase in depression severity was associated with a 50% reduction in the number of times a condom was used adjusted IRR (aIRR = 0.5, 95% CI 0.4-0.6, p < .001). Each 1-unit increase in positive prospections of pregnancy was associated with a pronounced decrease likelihood of not having protected sexual acts (aOR = 0.01, 95% CI 0.0-0.1). Findings support the importance of tribally driven tailoring of sexual and reproducive health interventions and services for American Indian adolescents.

Cultural identity affiliation and alcohol use and related consequences among American Indian and White adolescents: A latent profile analysis

BACKGROUND

Adolescent alcohol use is a significant public health concern and rates of alcohol use are higher among American Indian (AI) adolescents than national samples of non-AI youth. A potential factor in understanding AI alcohol use is cultural identity, which can vary widely based on experiences of historical trauma. We used latent class analysis to examine cultural identity in AI and White adolescents and their alcohol use outcomes in relation to the latent class solutions.

METHODS

The samples included 3189 AI adolescents (M_age  = 14.76, 48.9% female) and 1579 White adolescents (M_age  = 15.56, 48.7% female) living on or near a reservation. Participants completed self-report measures of AI and White cultural identity affiliation, alcohol use, and alcohol-related problems. We examined (1) the best-fitting latent class solution with respect to American Indian (AI) and White cultural identity; (2) equivalence of the latent class solution; and (3) alcohol use outcomes across the optimal latent class solution.

RESULTS

Latent profile analyses indicated an optimal 3-class solution in both the AI and White samples, which differed by level of affiliation with AI and White cultural identity. While the optimal number of classes were similar across racial groups (configural profile similarity), the nature of the classes differed (structural profile dissimilarity). The three classes represented low overall scores on AI and White cultural identity (Marginalized), a mixture of high and low scores on AI and White cultural identity (Third Culture), and overall high scores on AI and White cultural identity (Bicultural). Alcohol-related problems predicted membership in the Third Culture class compared with the Marginalized class and the Bicultural class. Specifically, youth in the Third Culture class reported significantly fewer alcohol-related problems than youth in the Marginalized and Bicultural classes. Alcohol use did not predict latent class membership.

CONCLUSIONS

The future-oriented nature of the Third Culture class may provide protection against adverse alcohol-related outcomes. Research is needed to test interventions that target greater future orientation and future plans to integrate culture into adolescents' lives.

Harm reduction acceptability and feasibility in a North American indigenous reserve community

AIMS

The present study assessed community and culturally specific alcohol-related harm among North American Indigenous (NAI) individuals, as well as the acceptability and feasibility of harm reduction approaches in one reserve-based NAI community.

METHODS

Participants lived on or near a NAI reserve in Canada. Semi-structured focus groups were conducted with health care workers (N = 8, 75% NAI) and community members (N = 9, 100% NAI). Self-report questionnaires were administered that measured acceptability and feasibility of harm reduction strategies.

RESULTS

Conventional content analysis revealed loss of culture as culturally specific alcohol-related harm. Health care workers rated harm reduction approaches to be acceptable and feasible, while community participants were more mixed. Majority of participants felt that some harm reduction strategies could provide opportunities for individuals who use alcohol to connect to Indigenous culture and traditions. However, there were mixed findings on whether harm reduction strategies are consistent with Indigenous cultural traditions and values.

CONCLUSION

Future research is needed to evaluate potential utility of harm-reduction approaches for NAI communities.

Rationale, Design, and Methods for Nen Unkumbi/Edahiyedo ("We Are Here Now"): A Multi-Level Randomized Controlled Trial to Improve Sexual and Reproductive Health Outcomes in a Northern Plains American Indian Reservation Community

American Indian (AI) youth in the United States experience disproportionate sexual and reproductive health (SRH) disparities relative to their non-Indigenous, white counterparts, including increased rates of sexually transmitted infections (STIs), earlier sexual debut, increased rates of teen birth, and reduced access to SRH services. Past research shows that to improve SRH outcomes for AI youth in reservation communities, interventions must address complex factors and multiple levels of community that influence sexual risk behaviors. Here, we describe development of a multi-level, multi-component randomized controlled trial (RCT) to intervene upon SRH outcomes in a Northern Plains American Indian reservation community. Our intervention is rooted in a community based participatory research framework and is evaluated with a stepped wedge design that integrates 5 reservation high schools into a 5-year, cluster-randomized RCT. Ecological Systems Theory was used to design the intervention that includes (1) an individual level component of culturally specific SRH curriculum in school, (2) a parental component of education to improve parent-child communication about SRH and healthy relationships, (3) a community component of cultural mentorship, and (4) a systems-level component to improve delivery of SRH services from reservation healthcare agencies. In this article we present the rationale and details of our research design, instrumentation, data collection protocol, analytical methods, and community participation in the intervention. Our intervention builds upon existing community strengths and integrates traditional Indigenous knowledge and values with current public health knowledge to reduce SRH disparities.

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.

Impacts of the respecting the circle of life teen pregnancy prevention program on risk and protective factors for early substance use among native American youth

BACKGROUND

Early substance use disproportionately impacts Native American (Native) youth and increases their risk for future abuse and dependence. The literature urges for interventions to move beyond focusing on single risk behaviors (e.g. substance use) and instead have capacity to improve health risk behaviors co-occuring during adolescence, particularly among Native populations for whom few evidence-based interventions (EBI) exist. We evaluated the effectiveness of the Respecting the Circle of Life program (RCL) on risk and protective factors for early substance use. RCL is a culturally tailored EBI shown to improve sexual health outcomes among Native youth.

METHODS

We conducted secondary analyses of data collected through a community-based randomized controlled trial of RCL evaluated among Native youth (ages 11-19) residing on a rural reservation between 2015-2020 (N = 534, 47.4 % male). We used linear regression, controlling for baseline age and sex, to test between study group differences in outcomes at 3-, 9-, and 12-month post-intervention. Models were stratified by sex and age (11-12, 13-14, and 15+ years of age) to examine differences within these subgroups.

RESULTS

Youth receiving RCL reported lower intention to use substances through 12-months follow-up (p = 0.006). Statistically significant improvements were also observed across peer, parent, and sexual partner risk and protective factors to delay substance use initiation, with notable differences among boys and participants ages 13-14.

CONCLUSIONS

RCL is a primary prevention, skills-based program effective in preventing risks for substance use. This evaluation underscores the value in developing programs that influence concurrent adolescent risk behaviors, especially for Native communities who endure multiple health disparities.

Diné (Navajo) female perspectives on mother-daughter communication and cultural assets around the transition to womanhood: a cross-sectional survey

Background

The inclusion of protective factors (“assets”) are increasingly supported in developing culturally grounded interventions for American Indian (AI) populations. This study sought to explore AI women’s cultural assets, perspectives, and teachings to inform the development of a culturally grounded, intergenerational intervention to prevent substance abuse and teenage pregnancy among AI females.

Methods

Adult self-identified AI women (N = 201) who reside on the Navajo Nation completed a cross-sectional survey between May and October 2018. The 21-question survey explored health communication around the transition to womanhood, cultural assets, perceptions of mother–daughter reproductive health communication, and intervention health topics. Univariate descriptive analyses, chi squared, and fisher’s exact tests were conducted.

Results

Respondents ranged in age from 18 to 82 years, with a mean age of 44 ± 15.5 years. Women self-identified as mothers (95; 48%), aunts (59; 30%), older sisters (55; 28%), grandmothers (37; 19%), and/or all of the aforementioned (50; 25%). 66% (N = 95) of women admired their mother/grandmother most during puberty; 29% (N = 58) of women were 10–11 years old when someone first spoke to them about menarche; and 86% (N=172) felt their culture was a source of strength. 70% (N = 139) would have liked to learn more about reproductive health when they were a teenager; 67% (N = 134) felt Diné mothers are able to provide reproductive health education; 51% (N = 101) reported having a rite of passage event, with younger women desiring an event significantly more than older women. Responses also indicate a disruption of cultural practices due to government assimilation policies, as well as the support of male relatives during puberty.

Conclusions

Results informed intervention content and delivery, including target age group, expanded caregiver eligibility criteria, lesson delivery structure and format, and protective cultural teachings. Other implications include the development of a complementary fatherhood and/or family-based intervention to prevent Native girls’ substance use and teen pregnancy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01473-4.

Assessment of the Reach, Usability, and Perceived Impact of "Talking Is Power": A Parental Sexual Health Text-Messaging Service and Web-Based Resource to Empower Sensitive Conversations with American Indian and Alaska Native Teens

BACKGROUND

Early sexual debut among American Indian and Alaska Native (AI/AN) adolescents has been associated with an increased risk of teenage pregnancies and sexually transmitted infections, along with an increased risk of having multiple lifetime sexual partners, and engaging in greater frequency of sex, substance abuse, and lack of condom use. A major protective factor against early sexual debut among AI/AN youth is the familial system. Interventions aiming to improve parent-child communication and parental warmth toward adolescent sexual health topics were reported to contribute to positive youth sexual health outcomes, specifically among minority youth. Healthy Native Youth thus developed the Talking is Power text-messaging service to guide parents and caring adults on how to initiate sensitive topics with youth and how to support them in making informed decisions regarding sex and healthy relationships.

METHODS

Descriptive statistics were used to demonstrate website analytics and reach per views and time spent on each page, and for displaying participants' responses to the questions on the usability of the Talking is Power text-messaging series. To assess the perceived impact of the series, the differences in mean percentage scores of the question assessing parental comfort in engaging in sexual health topics with youth between pre- and post-intervention were calculated using two-sample t-tests of equal variances. Descriptive content analysis was adopted to highlight emerging themes from open-ended items.

RESULTS

When looking at reach, 862 entrances were recorded during the specified time period (5.8% of total entrances to HNY website), while the bounce rate was set at 73.1% (22.6% greater than the industry average), and the exit rate was 54.3% (15.2% greater than the industry average). Series usability was highly ranked on the 5-Likert scale in terms of signing up for a similar series on a different topic, quality of images, texts, and links, relating to prompts, and change in sparking sensitive conversations with youth. High likelihood of recommending the series to a friend or colleague was also reported by participants (0-10). No significant difference in parental comfort levels was reported (p = 0.78 > 0.05). Main themes provided suggestions for improving the series mode of delivery, while others included positive feedback about the material, with the possibility of expanding the series to other adolescent health topics.

CONCLUSION

Lessons learned during the design, dissemination, and evaluation of the resource's usability, reach, and perceived impact may be of interest to other Indigenous communities who are in the process of adapting and/or implementing similar approaches.

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.

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.

The protective effects of self-compassion on alcohol-related problems among First Nation adolescents

Given the disproportionate alcohol-related consequences experienced by North American Indigenous youth, there is a critical need to identify related risk and protective factors. Self-compassion, which has been found to mitigate the effects of trauma exposure, may serve as one such protective factor given the high-degree of historical trauma and contemporary discrimination identified as contributing to the alcohol-related disparities experienced by Indigenous communities. However, no research has examined how self-compassion (i.e., the ability to be kind and accepting and to extend compassion towards oneself) plays a unique role in Indigenous peoples' experiences with alcohol. First Nation adolescents between the ages of 11 and 18 living on a reserve in Eastern Canada (N=106, M _age =14.6, 50.0% female) completed a pencil-and-paper survey regarding their alcohol use, alcohol-related problems, and self-compassion. Self-compassion was significantly inversely associated with alcohol-related problems (b=-.51, p=.01, 95%CI [-.90, -.12], and significantly interacted with frequency of alcohol use in predicting alcohol-related problems (b=-.42, p=.04, 95%CI [-.82, -.03]). Simple slopes analyses revealed that the association between frequency of alcohol use and frequency of experiencing alcohol-related problems was significant and positive at low (b=4.68, p<.001, 95%CI [2.62, 6.73]), but was not significant at high (b=-.29, p=.89, 95%CI [-4.35, 3.77]) levels of self-compassion. Binary logistic regression revealed that higher scores of self-compassion were associated with a lower odds of being in the high-risk group for AUD (OR=0.90, 95%CI [0.83, 0.98], p=.02). Our results suggest self-compassion may be protective against experiencing alcohol problems in Indigenous youth and thus may be a target for behavioral interventions.

Alcohol- and drug-related consequences across latent classes of substance use among American Indian adolescents

INTRODUCTION

Substance use among American Indian (AI) adolescents is a significant public health concern, as they report greater health disparities related to substance use compared to other racial/ethnic groups. The present study examines differences across classes of substance use behaviors regarding alcohol- and drug-related consequences.

METHODS

The current study was a secondary analysis of the dataset used by Stanley and Swaim (2018). AI adolescents (n = 3498, 47.8% female, M_age = 14.8) completed a survey including substance use and related consequences. Protocols were approved by institutional IRB, tribal authority, school boards, and parental consent/child assent were obtained.

RESULTS

In line with Stanley and Swaim (2018), we identified four classes of substance use: no past month substance use; marijuana and cigarette use only; alcohol, marijuana, and cigarette use only; and polysubstance use. Cross-class comparisons revealed that adolescents in classes characterized by the use of a greater number of substances also reported experiencing greater alcohol- and drug-related consequences with one exception: the class characterized by marijuana and cigarette use reported greater drug-related consequences compared to the class characterized by alcohol, marijuana, and cigarette use.

CONCLUSIONS

AI adolescents who engage in the use of multiple substances should be provided with psychoeducation around the increased risk of associated negative consequences. Given the health disparity experienced by AI adolescents, interventions to alleviate the burden of negative consequences are necessary.

Valuing Cultural Activities Moderating the Association Between Alcohol Expectancies and Alcohol Use Among First Nation Adolescents

OBJECTIVE

Indigenous youth often exhibit high rates of alcohol use and experience disproportionate alcohol-related harm. We examined the moderating role that valuing cultural activities has on the relationship between positive alcohol expectancies and alcohol use and heavy drinking in a sample of Indigenous youth.

METHOD

First Nation adolescents between ages 11 and 18 living on a reserve in eastern Canada (N = 106; mean age = 14.6; 50.0% female) completed a pencil-and-paper survey regarding their positive alcohol expectancies, alcohol use, and beliefs about the importance of cultural activities.

RESULTS

A significant interaction was identified between positive alcohol expectancies and valuing cultural activities on past-3-month alcohol use (b = -0.01, SE = 0.001, p < .001) and past-3-month heavy drinking (b = -0.01, SE = 0.001, p < .001). Simple slopes analysis revealed that the association between positive alcohol expectancies and past-3-month alcohol use and heavy drinking was significant for those with low (b = 0.06, SE = 0.007, p < .001; b = 0.07, SE = 0.008, p < .001; respectively) but not high levels of valuing cultural activities (b = 0.01, SE = 0.008, p = .12; b = 0.01, SE = 0.009, p = .08; respectively).

CONCLUSIONS

Highly valuing cultural activities may interrupt the relationship between positive alcohol expectancies and alcohol use. This suggests that community interventions and treatment programs targeting alcohol use among Indigenous adolescents should prioritize increasing the value of cultural activities by perhaps making them more available.

History of sexual assault, past-year alcohol use, and alcohol-related problems in American Indian adolescents

American Indian (AI) adolescents have been found to experience higher rates of sexual violence, alcohol misuse, and alcohol-related consequences compared to other racial and ethnic groups. Adolescent alcohol use and sexual assault experiences have been linked to increased negative consequences across physical and mental health, school, work, and legal domains. The purpose of the present study was to examine the associations among endorsing a history of experiencing sexual assault, past-year alcohol use, and experiences of alcohol-related problems, and to examine how these associations differed across sex, using a large, nationally-representative sample of reservation-dwelling AI adolescents. The present study utilized secondary data analysis of a sample of 3498 AI 7th to 12th grade students from a larger national epidemiological study. Participants completed The American Drug and Alcohol Survey™ to assess their alcohol use, sexual assault history, and alcohol-related consequences. Multilevel regression analyses revealed a significant effect of an alcohol use by sex by sexual assault history interaction on experiencing alcohol-related problems (b = -0.88, 95%CI [-1.55, -0.22], p = .009). Furthermore, results revealed that males who endorsed a history of experiencing sexual assault demonstrated the strongest relationship between past-year alcohol use and alcohol-related consequences (b = 2.60, p < .001). Results indicate the importance of early intervention for alcohol use, alcohol-related problems, and sexual assault, perhaps particularly among adolescent males. Future research should examine the directionality between alcohol-use and sexual assault among AI adolescents.

Sexual risk behaviors and the legacy of colonial violence among Northern plains American Indian youth: A mixed methods exploratory study

INTRODUCTION

In this article, we honor the tribal remembering of two Northern Plains tribes to illustrate how the legacy of colonial violence frames the way in which substance use and mental health affect sexual risk behaviors among American Indian youth on the reservation today.

METHODS

We used a multi-phase, mixed quantitative and qualitative methods design within a community based participatory research framework to illustrate how the legacy of colonial violence frames epidemiological links between substance use, mental health, and sexual risk behavior among American Indian youth. We conducted semistructured interviews with 29 individuals and administered questionnaires to 298 American Indian youth living in a reservation environment.

RESULTS

Our findings explicate how a legacy of colonial violence underlies epidemiological links between mental health and substance use with sexual risk behavior among youth. Salient facets of colonial violence included systematically altered living arrangements, the boarding school era, eroded traditional practices, and the entry of extractive industries onto native lands.

DISCUSSION

The colonial violence enacted against the ancestors of Northern Plains tribal peoples materializes in the health of those living on the reservation today. Community interventions, which seek to address the role of substance use and mental health in sexual risk behavior, could benefit from delineating tribal perceptions regarding the legacy of colonial violence on public health outcomes through the use of a CBPR framework.

The factor structure of self-esteem and its association with alcohol use in American Indian (AI) adolescents

American Indian (AI) adolescents experience disproportionately higher rates of alcohol use and related consequences. While self-esteem has been found to be associated with alcohol use in non-AI samples, little is known about this relationship in AI adolescents. Further, there is a dearth of literature examining the psychometric properties of self-esteem measures for AI adolescents. The current study aims to examine the factor structure of the self-esteem items of the American Drug and Alcohol Survey (ADAS) and to better understand the relationships among self-esteem, alcohol use, and alcohol-related problems in AI adolescents. The present study represents secondary analyses of cross-sectional data collected between 2009 and 2013. Participants (n = 3,498) were AI adolescents (Mage = 14.8, 47.7% female) attending schools on or near reservations across 11 states. Participants completed the American Drug and Alcohol Survey. Factor analytic results suggested 2 factors, representing intrapersonal (from intrinsic sources) and interpersonal self-esteem (from extrinsic sources). Multilevel regression analyses revealed that, with both factors entered into the model, intrapersonal self-esteem was negatively associated with alcohol consumption and alcohol-related problems, while interpersonal self-esteem was positively associated with alcohol consumption and alcohol-related problems. Results suggest the importance of examining the properties of assessment tools before they are used with a community for whom they were not developed. Further, self-esteem does not appear to be universally protective. Rather, interventions should aim to consider sources from which AI adolescents are drawing self-esteem and focus on promoting more intrinsic sources rather than aiming to increase self-esteem in general. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Self-reported Exposure to Sexual and Reproductive Health Information among American Indian Youth: Implications for Technology Based Intervention

While technology-based interventions show promise in certain populations of American youth, the technology may intrinsically widen intergenerational communication chasms associated with youth's increased access to Smartphone technologies. The authors examined self-reported exposure to sexual and reproductive health information and evaluated its relationship with sexual risk behaviors with American Indian youth. Approximately 296 students, ages of 15-18 years old, were surveyed to examine self-reported exposure and attitudes to information received about sexual intercourse, reproduction, and social media use in relation to sexual risk behaviors. Results indicate that information received regarding sexual intercourse and birth control from intra-familial network members was associated with more engagement in sex, and that increased social media use to talk or learn about sex was associated with not using a condom at the last sexual encounter. We advise that researchers and programmers considering technology-based interventions with AI communities carefully consider the gravity of investing preventive resources into technology-based interventions that may further deepen communication gaps that youth experience within their community networks.

Identifying Competing Life Reinforcers for Substance Use in First Nation Adolescents

Background: Indigenous youth are at increased risk of initiating substance use at early ages and suffer greater negative consequences related to substance use as compared to non-Indigenous youth. Behavioral Theories of Choice suggests that substance use is contingent on the availability of substances and the availability of alternatives to substance use. Objectives: The present study aimed to investigate risk and protective factors associated with substance use in one group of First Nation adolescents. Methods: Using a modified grounded theory approach, the present study conducted qualitative focus groups and individual interviews with fifteen reserve-dwelling (75% female, M age = 15.2 years) First Nation adolescents to assess categories of risk and protective factors based upon Behavioral Theories of Choice. Results: Adolescents identified peer influences, parental/family influences, and community influences and issues as risk and protective factors associated with substance use. Conclusions: Results highlight possible targets of culturally appropriate prevention strategies for Indigenous populations.

Factors Influencing Smoking Among Indigenous Adolescents Aged 10–24 Years Living in Australia, New Zealand, Canada, and the United States: A Systematic Review

Introduction

Smoking rates are higher among Indigenous populations in most high-income countries with initiation primarily occurring in adolescence for all population groups. This review aims to identify protective and risk factors for smoking behavior among Indigenous adolescents and young adults.

Aims and Methods

We searched Medline, Embase, and Psychinfo for all original research published between January 2006 and December 2016 that reported influences on smoking for Indigenous adolescents or young adults aged 10–24 living in Australia, New Zealand, Canada, and the United States (US). Extracted data were coded to individual, social, and environmental level categories using a modified Theory of Triadic Influence framework.

Results

A total of 55 studies were included, 41 were descriptive quantitative and 14 qualitative, and 26 included Indigenous participants only. The majority were from the US (32). Frequently reported influences were at the individual and social levels such as increasing age; attitudes and knowledge; substance use; peer and family relationships; smoking norms; mental health; physical activity. At the environmental level, smoke-free spaces; second-hand smoke exposure; high community level prevalence; and social marketing campaigns were also frequently reported. Some studies referenced price, access, and traditional tobacco use. Few reported historical and cultural factors.

Conclusions

Young Indigenous people experience similar influences to other populations such as smoking among family and friends. Greater youth smoking is related to broader community level prevalence, but few studies explore the distal or historical contributing factors such as traditional tobacco use, colonization, experiences of intergenerational trauma and discrimination, or the role of cultural connection.

Implications

This review identified a range of factors that influence Indigenous youth smoking and contributes to an understanding of what prevention measures may be effective. Youth tobacco use occurs alongside other substance use and may also serve as an indicator of mental health. Comprehensive community-based programs that work more broadly to address the risk factors related to tobacco, including improving youth mental health, will be important for other behaviors as well. This research highlights the importance of social influence and need for ongoing denormalization of smoking. Future Indigenous led and community owned research is needed to identify likely protective cultural factors.

Integrating Community-Engagement and a Multiphase Optimization Strategy Framework: Adapting Substance Use Prevention for American Indian Families

Initiation of substance use often occurs earlier among American Indian (AI) youth than among other youth in the USA, bringing increased risk for a variety of poor health and developmental outcomes. Effective prevention strategies are needed, but the evidence base remains thin for this population. Research makes clear that prevention strategies need to be culturally coherent; programs with an evidence base in one population cannot be assumed to be effective in another. However, guidance on effective adaptation is lacking. This paper reports on cultural adaptation of an evidence-based program utilizing the multiphase optimization strategy (MOST) framework embedded within a community-engaged process to evaluate intervention components. The Strengthening Families Program for Parents and Youth 10-14 was adapted to become the Thiwáhe Gluwáš'akapi Program for American Indian youth and families. Three program components were evaluated for their effectiveness with regard to outcomes (youth substance use, theoretical mediators of program effects on substance use, and program attendance) in a sample of 98 families (122 youth and 137 adults). Consistent with the MOST framework, the value of components was also evaluated with regard to efficiency, economy, and scalability. Expanding on the MOST framework for cultural adaptation, we also considered the results of the MOST findings regarding the acceptability of each component from the perspectives of community members and participants. The promise of a strategic component-based approach to adapting evidence-based interventions is discussed, including the benefits of engaging community to ensure relevance and considering both cultural and scientific rationale for each component to enhance impact.

Substance Use Among American Indian Youths on Reservations Compared With a National Sample of US Adolescents

IMPORTANCE

American Indian adolescents attending schools on or near reservations are historically at high risk for substance use.

OBJECTIVE

To compare rates of substance use among reservation-based American Indian adolescents vs rates among national US youths.

DESIGN, SETTING, AND PARTICIPANTS

Population-based survey study of 8th-, 10th-, and 12th-grade students attending participating schools on or near reservations, stratified by region, during the 2016-2017 school year. Substance use rates were compared with those of a national sample of comparably aged students from the Monitoring the Future study.

MAIN OUTCOMES AND MEASURES

Lifetime and last-30-day self-reported use of alcohol, marijuana, and other drugs, using relative risk (RR) ratios with 95% confidence intervals to compare American Indian student rates with Monitoring the Future student rates.

RESULTS

Participants included 570 students in eighth grade (49.6% girls; mean age, 13.5 years), 582 in 10th grade (50.0% girls; mean age, 15.4 years), and 508 in 12th grade (53.5% girls; mean age, 17.4 years). American Indian students reported substantially higher lifetime and last-30-day substance use rates compared with the Monitoring the Future students, with greatest disparity at eighth grade: last-30-day substance use RRs for grade 8 were 2.1 (95% CI, 1.4-3.0) for alcohol, 4.2 (95% CI, 3.1-5.8) for marijuana, and 2.4 (95% CI, 1.7-3.3) for other illicit drugs. Compared with 2009 to 2012 data, the RRs between American Indian and Monitoring the Future students for lifetime alcohol and marijuana use did not change substantially from the 2016-2017 school year (alcohol: RR, 1.5 [95% CI, 1.4-1.6] vs RR, 1.3 [95% CI, 1.2-1.4], respectively; marijuana: RR, 2.0 [95% CI, 1.8-2.1] vs RR, 2.1 [95% CI, 1.9-2.3], respectively), but increased substantially for other drugs (RR, 1.8 [95% CI, 1.7-1.9] vs RR, 3.0 [95% CI, 2.9-3.2], respectively).

CONCLUSIONS AND RELEVANCE

Reservation-based American Indian students are at high risk for substance use compared with US youths in general, making prevention efforts critical. Cultural and value-based characteristics unique to American Indian populations may provide beneficial targets for prevention, but there is limited evidence on how cultural factors work to prevent risky behaviors. Without increased attention to these disparities, the costs to American Indian youths and their communities will remain high.

Advancing Scientific Methods in Community and Cultural Context to Promote Health Equity: Lessons From Intervention Outcomes Research With American Indian and Alaska Native Communities

Evidence-based interventions hold promise for reducing gaps in health equity across diverse populations, but evidence about effectiveness within these populations lags behind the mainstream, often leaving opportunities to fulfill this promise unrealized. Mismatch between standard intervention outcomes research methods and the cultural and community contexts of populations at greatest risk presents additional challenges in designing and implementing rigorous studies; these challenges too often impede efforts to generate needed evidence. We draw on experiences with American Indian and Alaska Native (AIAN) communities to illustrate how consideration of culture and context can constructively shape intervention research and improve the quality of evidence produced. Case examples from a partnership with one AI community highlight opportunities for increasing alignment in intervention development, research design, and study implementation to maximize both validity and feasibility. We suggest that responsively tailoring intervention outcome research to cultural and community contexts is fundamental to supporting health equity.

Cannabis Use and Disorder From Childhood to Adulthood in a Longitudinal Community Sample With American Indians

OBJECTIVE

Recent changes in DSM criteria require new documentation of the prevalence and developmental sequences of cannabis use disorder (CUD). The goal of this study was to investigate the early course of DSM-5 CUD and its overlap with DSM-IV and consumption constructs in a community-representative sample of American Indians.

METHOD

Data came from the prospective, longitudinal, population-based Great Smoky Mountains Study in North Carolina (N = 1,420, including 349 American Indians). Cannabis use and disorder were assessed during yearly interviews from 9 to 16 years of age and at 19, 21, 26, and 30 years of age (up to 11 assessments per participant from 1993 through 2015).

RESULTS

By 30 years of age, approximately 70% of participants had used cannabis, 34% had used cannabis daily, and 18% had met criteria for DSM-5 CUD. Approximately 1 in 4 cannabis users met criteria for CUD at some point. Those who met criteria initiated use more than 2 years previously (at 13.3 years old) compared with other users. Despite higher risks from increased poverty, American Indians' patterns of use were similar to those of the rest of the sample. Concordance between DSM-5 CUD and DSM-IV abuse or dependence was substantial but was even higher between DSM-5 CUD and daily use.

CONCLUSION

It was common to have used cannabis daily or to have met criteria for DSM-5 CUD by adulthood. DSM-5 CUD was an improvement over DSM-IV diagnostic constructs by raising the threshold for diagnosis.

AMERICAN INDIAN AND ALASKA NATIVE BOYS: EARLY CHILDHOOD RISK AND RESILIENCE AMIDST CONTEXT AND CULTURE

American Indian and Alaska Native (AIAN) adolescent and adult men experience a range of health disparities relative to their non-AIAN counterparts and AIAN women. Given the relatively limited literature on early development in tribal contexts, however, indicators of risk during early childhood specific to AIAN boys are not well-known. The current article reviews sources of strength and challenge within AIAN communities for AIAN children in general, including cultural beliefs and practices that support development, and contextual challenges related to socioeconomic and health disparities and historical trauma affecting the AIAN population as a whole. The research literature on early development is reviewed, highlighting what this literature reveals about early gender differences. The article concludes with calls to action on behalf of AIAN boys that align with each of the five tiers of R. Frieden's (2010) Public Health Pyramid.

Effects of the "Circle of Life" HIV-prevention program on marijuana use among American Indian middle school youths: a group randomized trial in a Northern Plains tribe

BACKGROUND

Early substance use threatens many American Indian/Alaska Native (AI/AN) communities, as it is a risk factor for maladaptive use and adverse health outcomes. Marijuana is among the first substances used by AI/AN youth, and its use becomes widespread during adolescence. Interventions that delay or reduce marijuana use hold the promise of curbing substance disorders and other health risk disparities in AI/AN populations.

OBJECTIVES

We evaluated the effectiveness of the Circle of Life (COL) program in reducing marijuana use among young AI adolescents. COL is a culturally tailored, theory-based human immunodeficiency virus (HIV) and sexually transmitted disease (STD) intervention shown to delay sexual initiation among AI youths.

METHODS

We conducted secondary analyses of data from a school-based group randomized trial conducted between 2006 and 2007 in all 13 middle schools on a rural, Northern Plains reservation (N = 635, 47% female). We used discrete-time survival analysis (DTSA) to assess COL effectiveness on risk of marijuana initiation among AI youths and latent growth curve modeling (LGCM) to evaluate effects on frequency of marijuana use over time.

RESULTS

DTSA models showed that the overall risk of marijuana initiation was 17.3% lower in the COL group compared to the control group. No intervention effect on frequency of marijuana use emerged in LGCM analyses.

CONCLUSION

COL is a multifaceted, culturally tailored, skills-based program effective in preventing marijuana uptake among AI youth.

Trajectories of Substance Use: Onset and Adverse Outcomes Among North American Indigenous Adolescents

North American Indigenous communities experience disproportionately high rates of substance use, abuse, and dependence and their accompanying consequences. This study uses group-based trajectory modeling of past-year substance use (alcohol, marijuana, and cigarettes) with a longitudinal sample of Indigenous adolescents from the northern Midwest and Canada (spanning ages 10-18 years). The early-onset trajectory (36.3%) had more adverse psychosocial difficulties at baseline than the mid-onset group (38.3%); both trajectories were associated with several negative outcomes at the end of the study. The late-onset trajectory (25.3%) did not initiate substance use until later adolescence and had far better outcomes at the last wave of the study. Timing of onset matters. Prevention efforts should begin in late childhood and continue through mid-adolescence.

Multivariate family factors in lifetime and current marijuana use among American Indian and white adolescents residing on or near reservations

BACKGROUND

Rates of marijuana use are consistently high among reservation-based American Indian adolescents. The roles of family are unique in this ethnic group and can serve as sources of both risk and protection for substance use.

PURPOSE

To assess the relationships between distal and proximal family factors and lifetime and current marijuana use among American Indian and white middle and high school students who attend the same schools on or near reservations.

METHODS

In-school surveys were administered to 3380 American Indian and 1562 white students from 35 middle schools and 17 high schools regarding levels of marijuana use and family characteristics. Three logistic regression models (Control, Control+Distal; Control+Distral+Proximal) estimated effects of multiple family variables on lifetime and current marijuana use.

RESULTS

Strong effects were found for family structure, parental monitoring, family conflict, and family sanctions against marijuana use. Weaker effects were found for family participation in school events, and no relationship was found for family communication about marijuana. Anumber of similar results were found across ethnicity and middle and high school students.

CONCLUSIONS

Family variables exert strong and largely consistent effects across reservation-based American Indian and white youth on lifetime and current marijuana use. Interventions that include a broad range of targeted family components may serve to both limit uptake and forestall increases in adolescent marijuana use in these two groups.

Healing of the canoe: preliminary results of a culturally tailored intervention to prevent substance abuse and promote tribal identity for Native youth in two Pacific Northwest tribes

Using Community-based and Tribal Participatory Research (CBPR/TPR) approaches, an academic-tribal partnership between the University of Washington Alcohol and Drug Abuse Institute and the Suquamish and Port Gamble S'Klallam Tribes developed a culturally grounded social skills intervention to promote increased cultural belonging and prevent substance abuse among tribal youth. Participation in the intervention, which used the Canoe Journey as a metaphor for life, was associated with increased hope, optimism, and self-efficacy and with reduced substance use, as well as with higher levels of cultural identity and knowledge about alcohol and drugs among high school-age tribal youth. These results provide preliminary support for the intervention curricula in promoting positive youth development, an optimistic future orientation, and the reduction of substance use among Native youth.

Predicting the Onset of Alcohol Use and the Development of Alcohol Use Disorder Among Indigenous Adolescents

Empirical efforts to identify the predictors of drinking behavior among North American Indigenous adolescents are relatively limited. Using longitudinal data, this study considers perceived discrimination, positive drinker prototypes, and peer drinking behavior as risk factors for the onset of alcohol use and development of an alcohol use disorder among 674 Indigenous adolescents as they progressed from early to late adolescence (M age at baseline = 11.11, SD = 0.83). Results showed that positive drinker prototypes and associations with peers who drink increased the risk for the onset of drinking, while perceived discrimination and associations with peers who drink increased the risk for the development of an alcohol use disorder. The theoretical and practical implications of our results are discussed.

Initiation of alcohol, marijuana, and inhalant use by American-Indian and white youth living on or near reservations

BACKGROUND

Early initiation of drinking, intoxication, marijuana, and inhalant use is associated with negative outcomes and substance use trajectories. Using national datasets, American Indian (AI) youth have been found to initiate substance use earlier than other youth. This study uses a population-based sample of youth living on or near reservations to compare substance use onset for AI and white youth where socioeconomic conditions may be similar for these youth.

METHODS

Student survey data were gathered from 32 schools in 3 regions from 2009 to 2012. A retrospective person-period data set was constructed using reported age of initiation of intoxication and marijuana and inhalant use. Multi-level modeling and event history analysis were used to estimate initiation as a function of age, gender, ethnicity, and region.

RESULTS

The results provide further evidence that AI youth living on or near reservations initiate substance use significantly earlier than white youth who attend the same schools and live in the same communities. Differences between the two cultural groups were most evident for marijuana initiation where the odds of initiating marijuana use ranged from seven to 10 times greater for nine vs. eight-year-old AI compared to white youth.

CONCLUSIONS

Prevention efforts targeted to AI youth must begin earlier than for non-AI youth in order to delay or prevent initiation. In addition, better understanding about the differences in the psychosocial environments of AI and white youth living in these communities is of paramount importance in designing prevention efforts.

Patterns of substance use initiation among Indigenous adolescents

BACKGROUND

The data for this study come from an eight-wave panel study of Indigenous (Canadian First Nations and American Indian) adolescents from three U.S. reservations and four Canadian reserves.

OBJECTIVES

Our objective was to investigate variations in patterns of substance use initiation from early adolescence through early adulthood using data collected annually for 8 years.

METHOD

At baseline the sample included 675 Indigenous adolescents (M age=11.10, SD=.83; 50.3% girls). First, we calculated cumulative rates of substance use initiation by age. We then examined whether the cumulative initiation rates were moderated by gender using logistic regression analyses. Second, we calculated hazard rates for substance use initiation by age. Third, we focused on the ordering of two substances, paired two substances, and three substance initiation sequences.

RESULTS

If one looks only at the cumulative rates of substance use initiation there appears to be support for a sequential progression of substance use during early adolescence. In contrast to the cumulative rates of substance use initiation, the hazard analyses showed a much more mixed, less progressive sequence. Among two substance pairings a nicotine to marijuana initiation sequence was most likely, followed by a nicotine to alcohol sequence. An alcohol to marijuana sequence was nearly twice as likely as a marijuana to alcohol sequence. Refined analyses to conform to those of many of the traditional gateway studies by introducing paired two substance orderings indicated that nicotine and/or alcohol prior to marijuana use was by far the most likely sequence. In two of the three most likely three substance sequences (nicotine to alcohol to marijuana and nicotine to marijuana to alcohol) nicotine was the first substance initiated.

CONCLUSION

This study refines the gateway hypothesis for Indigenous adolescents by providing an in-depth analysis of substance use initiation. The only evidence for a "gateway" substance that emerged in our analyses was for nicotine use which was likely to precede alcohol and marijuana use in both two-substance pairings and to a lesser extent in three-substance initiation sequences.

Vulnerabilities faced by the children of sex workers in two Mexico-US border cities: a retrospective study on sexual violence, substance use and HIV risk

Most studies of female sex workers (FSWs) conducted in the Mexico-US border region have focused on individual HIV risk, centered on sexual behaviors and substance abuse patterns. Little attention has been drawn to the reality that sex workers are often parents whose children potentially face vulnerabilities unique to their family situation. The objective of the present study was to identify the vulnerabilities faced by the children of FSWs in two Mexican-US border cities. From 2008 to 2010, 628 FSW-injection drug users underwent interviewer-administered surveys and HIV/STI testing. Approximately one in five participants (20%) reported having a parent involved in sex work and majority referred it was their mother (88%). Close to one-third of participants (31%) reported first injecting drugs <18 years of age, and 33% reported they began working regularly as a prostitute <18 years of age. First drinking alcohol <18 years old (AOR = 1.87, 95%CI: 1.13-3.08), lifetime cocaine use (AOR = 1.76, 95%CI: 1.09-2.84), ever being forced or coerced into non-consensual sex as a minor (<18 years of age; AOR = 1.54, 95%CI: 1.01-2.35), and injecting drugs with used syringes in the prior month (AOR = 1.63, 95%CI: 1.07-2.49) were the factors associated with having had a parent involved in sex work. These findings begin to lay the groundwork for understanding the potential vulnerabilities faced by the children of sex workers. Understanding these potential needs is necessary for creating relevant, evidence-based interventions focused on supporting these women.

Trajectories of substance use among young American Indian adolescents: patterns and predictors

Substance use often begins earlier among American Indians compared to the rest of the United States, a troubling reality that puts Native youth at risk for escalating and problematic use. We need to understand more fully patterns of emergent substance use among young American Indian adolescents, risk factors associated with escalating use trajectories, and protective factors that can be parlayed into robust prevention strategies. We used growth mixture modeling with longitudinal data from middle-school students on a Northern Plains reservation (Wave 1 N = 381, M age at baseline = 12.77, 45.6% female) to identify subgroups exhibiting different trajectories of cigarette, alcohol, and marijuana use. We explored how both risk (e.g., exposure to stressful events, deviant peers) and protective (e.g., positive parent-child relationships, cultural identity) factors were related to these trajectories. For all substances, most youth showed trajectories characterized by low rates of substance use (nonuser classes), but many also showed patterns characterized by high and/or escalating use. Across substances, exposure to stress, early puberty, and deviant peer relationships were associated with the more problematic patterns, while strong relationships with parents and prosocial peers were associated with nonuser classes. Our measures of emergent cultural identity were generally unrelated to substance use trajectory classes among these young adolescents. The findings point to the importance of early substance use prevention programs for American Indian youth that attenuate the impact of exposure to stressful events, redirect peer relationships, and foster positive parent influences. They also point to the need to explore more fully how cultural influences can be captured.

Advancing American Indian and Alaska Native substance abuse research: current science and future directions

American Indians and Alaska Natives (AI/AN) have disproportionately high rates of substance abuse yet there is little empirical research addressing this significant public health problem. This paper is an introduction to a special issue that includes cutting edge science in this research area. We identify several areas that require consideration in this field and indicate how the papers in the special issue address these gaps. These overarching areas of need, which should be considered in any substantive research, include attention to heterogeneity within the population, research that has tangible health benefits, continued work on research methods and strategies, increased focus on strength based and community oriented approaches, and the need for strong research partnerships. The special issue marks a major step forward for AI/AN substance abuse research. However, articles also highlight where more work is need to improve public health in AI/AN communities by addressing identified gap areas.