[Skip to Content]
[Skip to Content Landing]

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

Educational Objective To review how substance use rates among American Indian youths compare with rates among national US adolescents.
1 Credit CME
Key Points

Question  How do substance use rates among American Indian youths compare with rates among national US adolescents?

Findings  Lifetime and last-30-day substance use rates and relative risk were significantly higher for nearly all substances among American Indian youths.

Meaning  Early prevention and culturally sensitive interventions are needed for this population in addition to careful screening by medical staff for signs of early initiation and substance abuse and dependence.


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.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: March 23, 2018.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2018 Swaim RC et al. JAMA Network Open.

Corresponding Author: Randall C. Swaim, PhD, Colorado State University, 106 Sage Hall, Fort Collins, CO 80523-1979 (randall.swaim@colostate.edu).

Author Contributions: Drs Swaim and Stanley had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: All authors.

Obtained funding: All authors.

Administrative, technical, or material support: All authors.

Supervision: All authors.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by grant R01 DA003371-27A1 from the National Institute on Drug Abuse, National Institutes of Health.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Meeting Presentation: This article was presented at the 26th Annual Meeting of the Society for Prevention Research; May 31, 2018; Washington, DC.

Additional Contributions: We thank the tribal groups, school boards, school staff, and students for their participation in this study. Stacy Biggerstaff, MS, managed all of the data for this study. Allison Burford, MA, coordinated all relationships and procedures with all participating schools. Erin Whipple, BA, provided grant management. Pat Blakey, BA, recruited schools for participation. These 4 staff members from the Tri-Ethnic Center for Prevention Research at the Colorado State University reported receiving support from grant R01DA003371 from the National Institute on Drug Abuse.

Beauvais  F, Oetting  ER, Wolf  W, Edwards  RW.  American Indian youth and drugs, 1976-87: a continuing problem.  Am J Public Health. 1989;79(5):634-636.PubMedGoogle ScholarCrossref
Beauvais  F, Jumper-Thurman  P, Burnside  M.  The changing patterns of drug use among American Indian students over the past 30 years.  Am Indian Alsk Native Ment Health Res. 2008;15(2):15-24.PubMedGoogle ScholarCrossref
Beauvais  F.  Comparison of drug use rates for reservation Indian, non-reservation Indian and Anglo youth.  Am Indian Alsk Native Ment Health Res. 1992;5(1):13-31.PubMedGoogle ScholarCrossref
Oetting  ER, Beauvais  F, Edwards  RW, Waters  M, Velarde  J.  Drug Use Among Native American Youth: Summary of Findings (1975-1981). Fort Collins, CO: Western Behavioral Studies; 1982.
Bachman  JG, Wallace  JM  Jr, O’Malley  PM, Johnston  LD, Kurth  CL, Neighbors  HW.  Racial/ethnic differences in smoking, drinking, and illicit drug use among American high school seniors, 1976-89.  Am J Public Health. 1991;81(3):372-377.PubMedGoogle ScholarCrossref
Henry  KL, McDonald  JN, Oetting  ER, Walker  PS, Walker  RD, Beauvais  F.  Age of onset of first alcohol intoxication and subsequent alcohol use among urban American Indian adolescents.  Psychol Addict Behav. 2011;25(1):48-56.PubMedGoogle ScholarCrossref
Dickerson  DL, Fisher  DG, Reynolds  GL, Baig  S, Napper  LE, Anglin  MD.  Substance use patterns among high-risk American Indians/Alaska Natives in Los Angeles County.  Am J Addict. 2012;21(5):445-452.PubMedGoogle ScholarCrossref
Stanley  LR, Harness  SD, Swaim  RC, Beauvais  F.  Rates of substance use of American Indian students in 8th, 10th, and 12th grades living on or near reservations: update, 2009-2012.  Public Health Rep. 2014;129(2):156-163.PubMedGoogle ScholarCrossref
O’Connell  JM, Novins  DK, Beals  J, Whitesell  NR, Spicer  P; AI-SUPERPFP TEAM.  The association between substance use disorders and early and combined use of alcohol and marijuana in two American Indian populations.  J Subst Use. 2011;16(3):213-229.PubMedGoogle ScholarCrossref
Whitesell  NR, Beals  J, Mitchell  CM,  et al.  Marijuana initiation in 2 American Indian reservation communities: comparison with a national sample.  Am J Public Health. 2007;97(7):1311-1318.PubMedGoogle ScholarCrossref
Whitesell  NR, Kaufman  CE, Keane  EM, Crow  CB, Shangreau  C, Mitchell  CM.  Patterns of substance use initiation among young adolescents in a Northern Plains American Indian tribe.  Am J Drug Alcohol Abuse. 2012;38(5):383-388.PubMedGoogle ScholarCrossref
Stanley  LR, Swaim  RC.  Initiation of alcohol, marijuana, and inhalant use by American-Indian and white youth living on or near reservations.  Drug Alcohol Depend. 2015;155:90-96.PubMedGoogle ScholarCrossref
Novins  DK, Barón  AE.  American Indian substance use: the hazards for substance use initiation and progression for adolescents aged 14 to 20 years.  J Am Acad Child Adolesc Psychiatry. 2004;43(3):316-324.PubMedGoogle Scholar
Landen  M, Roeber  J, Naimi  T, Nielsen  L, Sewell  M.  Alcohol-attributable mortality among American Indians and Alaska Natives in the United States, 1999-2009.  Am J Public Health. 2014;104(suppl 3):S343-S349.PubMedGoogle ScholarCrossref
Substance Abuse and Mental Health Services Administration.  The NSDUH Report: Need for and Receipt of Substance Use Treatment Among American Indians or Alaska Natives. Rockville, MD: Center for Behavioral Health Statistics and Quality; 2012.
Compton  WM, Han  B, Jones  CM, Blanco  C, Hughes  A.  Marijuana use and use disorders in adults in the USA, 2002-14: analysis of annual cross-sectional surveys.  Lancet Psychiatry. 2016;3(10):954-964.PubMedGoogle ScholarCrossref
Azofeifa  A, Mattson  ME, Schauer  G, McAfee  T, Grant  A, Lyerla  R.  National estimates of marijuana use and related indicators—national survey on drug use and health, United States, 2002-2014.  MMWR Surveill Summ. 2016;65(11):1-28.PubMedGoogle ScholarCrossref
Snipp  CM.  American Indian and Alaska Native Children: Results From the 2000 Census Population Reference Bureau. Washington, DC: Population Reference Bureau; 2005.
Miech  RA, Johnston  LD, O’Malley  PM, Bachman  JG, Schulenberg  JE, Patrick  ME.  Monitoring the Future National Survey Results on Drug Use, 1975–2016, Volume I: Secondary School Students. Ann Arbor: Institute for Social Research, University of Michigan; 2017.
Kish  L.  Survey Sampling. New York, NY: Wiley; 1965.
Jumper-Reeves  L, Dustman  PA, Harthun  ML, Kulis  S, Brown  EF.  American Indian cultures: how CBPR illuminated intertribal cultural elements fundamental to an adaptation effort.  Prev Sci. 2014;15(4):547-556.PubMedGoogle ScholarCrossref
Stanley  LR, Swaim  RC, Dieterich  SE.  The role of norms in marijuana use among American Indian adolescents.  Prev Sci. 2017;18(4):406-415.PubMedGoogle ScholarCrossref
Swaim  RC, Stanley  LR.  Multivariate family factors in lifetime and current marijuana use among American Indian and white adolescents residing on or near reservations.  Drug Alcohol Depend. 2016;169:92-100.PubMedGoogle ScholarCrossref
Center for the Application of Prevention Technologies, Substance Abuse and Mental Health Services Administration. Risk and protective factors for substance abuse and/or mental health problems among Alaska Native and Native American populations. https://www.samhsa.gov/capt/sites/default/files/resources/factors-substance-abuse-mental-health.pdf. Accessed February 3, 2018.
Braveheart  MY, Chase  JA.  Historical trauma informed clinical intervention research and practice.  Paper presented at: 2014 AIHEC Behavioral Health Institute; June 16-20, 2014; Bellingham, WA.
Brockie  TN, Heinzelmann  M, Gill  J.  A framework to examine the role of epigenetics in health disparities among Native Americans.  Nurs Res Pract. 2013;2013:410395.PubMedGoogle Scholar
Sarche  M, Spicer  P.  Poverty and health disparities for American Indian and Alaska Native children: current knowledge and future prospects.  Ann N Y Acad Sci. 2008;1136:126-136.PubMedGoogle ScholarCrossref
Anda  RF, Felitti  VJ, Bremner  JD,  et al.  The enduring effects of abuse and related adverse experiences in childhood: a convergence of evidence from neurobiology and epidemiology.  Eur Arch Psychiatry Clin Neurosci. 2006;256(3):174-186.PubMedGoogle ScholarCrossref
Dube  SR, Anda  RF, Felitti  VJ, Edwards  VJ, Croft  JB.  Adverse childhood experiences and personal alcohol abuse as an adult.  Addict Behav. 2002;27(5):713-725.PubMedGoogle ScholarCrossref
Koss  MP, Yuan  NP, Dightman  D,  et al.  Adverse childhood exposures and alcohol dependence among seven Native American tribes.  Am J Prev Med. 2003;25(3):238-244.PubMedGoogle ScholarCrossref
Libby  AM, Orton  HD, Novins  DK, Beals  J, Manson  SM, Team  AS; AI-SUPERPFP Team.  Childhood physical and sexual abuse and subsequent depressive and anxiety disorders for two American Indian tribes.  Psychol Med. 2005;35(3):329-340.PubMedGoogle ScholarCrossref
Stanley  LR, Swaim  RC, Kaholokula  JK, Kelly  KJ, Belcourt  A, Allen  J.  The imperative for research to promote health equity in indigenous communities.  Prev Sci. 2017.PubMedGoogle Scholar
Crump  AD, Etz  K, Arroyo  JA, Hemberger  N, Srinivasan  S.  Accelerating and strengthening Native American health research through a collaborative NIH initiative.  Prev Sci. 2017.PubMedGoogle Scholar
Rusby  JC, Westling  E, Crowley  R, Light  JM.  Legalization of recreational marijuana and community sales policy in Oregon: impact on adolescent willingness and intent to use, parent use, and adolescent use.  Psychol Addict Behav. 2018;32(1):84-92.PubMedGoogle ScholarCrossref
Kerr  DCR, Bae  H, Phibbs  S, Kern  AC.  Changes in undergraduates’ marijuana, heavy alcohol and cigarette use following legalization of recreational marijuana use in Oregon.  Addiction. 2017;112(11):1992-2001.PubMedGoogle ScholarCrossref
Gregg  A.  Native American reservations now free to legalize marijuana. https://www.washingtonpost.com/news/morning-mix/wp/2014/12/12/native-american-reservations-now-free-to-legalize-marijuana/?utm_term=.249243b73bda&noredirect=on. Published December 12, 2014. Accessed December 13, 2017.
Committee on the Health Effects of Marijuana, National Academies of Sciences, Engineering, and Medicine.  The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: National Academies Press; 2017.
Snipp  CM.  The size and distribution of the American Indian population: fertility, mortality, migration, and residence. Popul Res Policy Rev. 1997;16:61-93. http://www.jstor.org/stable/40230133. Accessed April 13, 2018.
O’Malley  PM, Johnston  LD, Bachman  JG, Schulenberg  JE, Kumar  R.  How substance use differs among American secondary schools.  Prev Sci. 2006;7(4):409-420.PubMedGoogle ScholarCrossref
Henry  KL, Thornberry  TP.  Truancy and escalation of substance use during adolescence.  J Stud Alcohol Drugs. 2010;71(1):115-124.PubMedGoogle ScholarCrossref
DuPont  RL, Caldeira  KM, DuPont  HS, Vincent  KB, Shea  CL, Arria  AM.  America’s Dropout Crisis: The Unrecognized Connection to Adolescent Substance Use. Rockville, MD: Institute for Behavior and Health; 2013.
Swaim  RC, Beauvais  F, Chavez  EL, Oetting  ER.  The effect of school dropout rates on estimates of adolescent substance use among three racial/ethnic groups.  Am J Public Health. 1997;87(1):51-55.PubMedGoogle ScholarCrossref
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity


My Saved Searches

You currently have no searches saved.


My Saved Courses

You currently have no courses saved.