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How do substance use rates among American Indian youths compare with rates among national US adolescents?
Lifetime and last-30-day substance use rates and relative risk were significantly higher for nearly all substances among American Indian youths.
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.
American Indian adolescents attending schools on or near reservations are historically at high risk for substance use.
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.
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.
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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 (firstname.lastname@example.org).
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.
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