Abstract
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. 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. 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). 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.
Highlights
We have tracked rates of substance use among American Indian adolescents attending schools on or near reservations since 1974, and American Indian adolescents have consistently reported the highest levels of substance use compared with other US racial/ethnic groups.[1,2,3,4] Other studies of mostly nonreservation American Indian youths report similar results.[5,6,7] When compared with a national sample of students from Monitoring the Future (MTF), our study of data from 2009 to 2012 indicated that American Indian students reported lifetime rates of marijuana 3.4 and 1.6 times higher for 8th- and 12th-grade students, respectively.[8]
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 relative risk (RR) for grade 8 were 2.1 for alcohol, 4.2 for marijuana, and 2.4 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, 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)
Summary
We have tracked rates of substance use among American Indian adolescents attending schools on or near reservations since 1974, and American Indian adolescents have consistently reported the highest levels of substance use compared with other US racial/ethnic groups.[1,2,3,4] Other studies of mostly nonreservation American Indian youths report similar results.[5,6,7] When compared with a national sample of students from Monitoring the Future (MTF), our study of data from 2009 to 2012 indicated that American Indian students reported lifetime rates of marijuana 3.4 and 1.6 times higher for 8th- and 12th-grade students, respectively.[8]. An important consideration for American Indian youths is that, in addition to high rates of substance use, risk for substance use begins early.[9,10,11] As previously reported, we compared initiation rates of alcohol, marijuana, and inhalants between a population-based sample of reservation-based American Indian youths with white youths attending the same schools, and odds ratios for initiation comparing these 2 groups were 2.3 (95% CI, 1.5-3.4) for intoxication, 10.5 (95% CI, 6.0-18.5) for marijuana, and 1.8 (95% CI, 1.3-2.4) for inhalants, with American Indian youths more likely to initiate early use.[12]
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