American Indian Adolescents Research Articles

Commentary: quality of alcohol, drug, and mental health services for American Indian children and adolescents.

American Indian children and adolescents suffer from a high prevalence of alcohol, drug, and mental (ADM) disorders. Unfortunately, the systems of services for these children and youth have never been able to address adequately their mental health needs. Thus, the revolutionary changes now taking place within these service systems, in particular the marked increase in the direct provision of services by Indian tribes and organizations, provides a unique opportunity to address these historical shortcomings. In this paper, we describe our existing knowledge concerning the quality of ADM services for American Indian children and adolescents and their critical sociodemographic, sociocultural, and epidemiologic contexts. We then consider the implications of these studies for improving the quality of care as well as its measurement and monitoring.

Measuring Bicultural Ethnic Identity among American Indian Adolescents

Based on the premise that ethnic identity provides a fruitful approach to exploring issues related to ethnicity, an empirically based strategy was used to develop a measure of ethnic identity among American Indian adolescents. Because American Indians live in two worlds, a bicultural approach was drawn on to measure the degree that respondents identified with Indian culture and with the mainstream or White culture. An exploratory factor analysis was used to examine the structure of ethnic identity among Indian adolescents and the resulting models were tested with confirmatory factor analysis. A scale for measuring bicultural ethnic identity was developed and the reliability and validity of the scale was assessed.

Utilization of Alcohol, Drug, and Mental Health Treatment Services Among American Indian Adolescent Detainees

To describe the relationship between psychiatric status and the use of alcohol, drug, and mental health (ADM) services among a sample of American Indian (AI) juvenile detainees. A structured diagnostic and service use interview was administered to 150 AI youths detained in a juvenile detention center located on a Northern Plains reservation. Forty percent of AI youths with a diagnosed substance use disorder and 34.1% with a diagnosed anxiety, mood, or disruptive behavior disorder reported lifetime use of services for substance use and emotional problems, respectively. While services for substance use problems were most commonly provided in residential settings, services for emotional problems were most commonly provided in outpatient settings. Traditional healers and pastoral counselors provided services to 23.7% and 29.6% of youths who received services for substance use and emotional problems, respectively. Detained youths were more likely to receive ADM services than AI adolescents living at--large in another, comparable Northern Plains reservation community. Still, the vast majority of youths in detention who suffered from psychiatric disorders did not report use of ADM services. Detention facilities serving AI adolescents need to screen carefully for the presence of psychiatric disorders and facilitate the use of ADM services.

The public health epidemiology of type 2 diabetes in children and adolescents: a case study of American Indian adolescents in the Southwestern United States

Type 2 diabetes among children and adolescents is a newly recognized disease in the United States. Because obesity and physical inactivity are increasing in children and adolescents, the prevalence of pediatric type 2 diabetes may increase and eventually become an important cause of adult morbidity and mortality. Data on type 2 diabetes in adolescents aged 15–19 years were compared between two sources: systematic population screening of the Gila River Indian Community by the National Institutes of Health (NIH), and reported cases by the Indian Health Service (IHS) from clinics in the Southwestern US. The current NIH estimate of prevalence of type 2 diabetes was much higher than the IHS estimate (5.1% vs. 0.46%). Both data sources, however, suggest a secular increase in prevalence between 1986 and 1996–97. These data are used to discuss the principles, applications, and challenges for accurate epidemiologic assessment of type 2 diabetes in children and adolescents.

In the eye of the beholder: risk and protective factors in rural American Indian and Caucasian adolescents.

This study examines how relations between risk and protective factors and psychopathology vary by ethnic group, gender, and informant. Data were collected from Caucasian and American Indian adolescents, and their teachers. Results indicate a need for interventions that reduce risk, increase protective factors, and bring about greater convergence in the perceptions of teachers and youth.

Suicide attempts among American Indian and Alaska Native youth: risk and protective factors.

American Indians and Alaska Natives have the highest suicide rates of all ethnic groups in the United States, and suicide is the second leading cause of death for American Indian and Alaska Native youth. To identify risk and protective factors associated with suicide attempts among native male and female adolescents. The 1990 National American Indian Adolescent Health Survey. Schools of reservation communities in 8 Indian Health Service areas. Eleven thousand six hundred sixty-six 7th- through 12th-grade American Indian and Alaska native youth. Responses were compared among adolescents with and without a self-reported history of attempted suicide. Independent variables included measures of community, family, and individual characteristics. Separate analyses were conducted for boys and girls. Ever attempting suicide was reported by 21.8% of girls and 11.8% of boys. By logistic regression done on boys and girls separately, suicide attempts were associated with friends or family members attempting or completing suicide; somatic symptoms; physical or sexual abuse; health concerns; using alcohol, marijuana, or other drugs; a history of being in a special education class; treatment for emotional problems; gang involvement; and gun availability. For male and female youth, discussing problems with friends or family, emotional health, and connectedness to family were protective against suicide attempts. The estimated probability of attempting suicide increased dramatically as the number of risk factors to which an adolescent was exposed increased; however, increasing protective factors was more effective at reducing the probability of a suicide attempt than was decreasing risk factors. A history of attempted suicide was associated with several risk and protective factors. In addition to targeting youth at increased risk, preventive efforts should include promotion of protective factors in the lives of all youth in this population.

Prevalence of overweight and obesity in American Indian School children and adolescents in the Aberdeen area: a population study.

This study estimated the prevalences of overweight and obesity in American Indian children and adolescents attending schools in the Aberdeen area Indian Health Service (including SD, ND, IA, NE). Stature and weight were measured for 12559 children aged 5-17y and prevalences of overweight and obesity were determined relative to gender and age-specific national reference data for the body mass index (BMI). Those with BMI > 85th percentile were considered overweight and those with BMI > 95th percentile were considered obese. Age-adjusted prevalences of overweight were 39.1% and 38.0% for males and females, respectively, and corresponding age-adjusted prevalences for obesity were 22.0% and 18.0%, respectively. There were few regular changes in prevalences of overweight across ages for either gender, or for obesity in females. Prevalences of obesity in males increased systematically with age and exceed prevalences in females at many ages. Overweight and obesity based on elevated BMI are highly prevalent among American Indian youth. Even at the youngest school ages, overweight is more than twice as likely as national patterns and obesity is more than three times as prevalent. Primary prevention must begin very early among these children.

Prevalence of overweight and obesity in American Indian school children and adolescents in the Aberdeen area: A population study

Prevalence of overweight and obesity in American Indian school children and adolescents in the Aberdeen area: A population study

Marijuana Use Among American Indian Adolescents: A Growth Curve Analysis From Ages 14 Through 20 Years

ObjectiveTo describe the developmental course of marijuana use among a group of American Indian adolescents, aged 14 through 20 years. MethodA group of 1,766 American Indian adolescents from 3 culture groups provided repeated measures of 30-day marijuana use twice a year across a 3-year period. Linking 5 age cohorts, hierarchical linear modeling was used to model a curvilinear trajectory of marijuana use. Gender and community differences were examined as well. ResultsSupport was found for a “maturational” model of marijuana use across time: Use increased in middle adolescence, peaked in later adolescence, and began to decrease in early adulthood. Both gender and community differences in trajectories were significant as well. ConclusionsMarijuana use among American Indian adolescents follows a clear developmental trajectory. Growth curve analysis can provide an additional tool for studying the effects of interventions that may not be apparent in a traditional evaluation design. J. Am. Acad. Child Adolesc. Psychiatry, 1999, 38(1):72–78.

Denver American Indian mental health needs survey.

American Indians are at higher risk for mental health problems than other ethnic groups in the United States (Nelson, McCoy, Stetter, & Vanderwagen, 1992). Little attention has been directed towards assessing mental health problems among urban American Indians. In response to an Indian Health Service (IHS) call for proposals, this survey addressed the mental health needs of Denver urban American Indians. The purpose of the survey was to gather data from Denver American Indian adults and adolescents as well as service providers in the Denver area who work, to one degree or the other, with members of the American Indian community. These data were to provide a general idea of the breadth of mental health and other associated problems among the Denver American Indian population.

Correlates of physical and emotional health among Native American adolescents

Purpose: To examine the risk and protective factors among Native American youth that are correlated with both physical and emotional health. Methods: The study was based upon the National American Indian Adolescent Health Survey (n = 13,454), conducted using students self-categorized into a ranked variable of physical health (“poor,” “fair,” “good,” or “excellent”) and a continuous variable of emotional health based upon a nine-item unidimensional scale (overall Cronbach’s alpha of .74). Twenty-nine variables derived from resilience theory encompassing both risk and protective factors were selected. Associations with physical and emotional health were examined using linear regression analysis. Results: Identified protective factors explained approximately 30% of variance for emotional health, with family caring explaining nearly 15% of variance for both genders. The most significant associations for emotional health for females were family caring, body pride, feelings about school, and worries or concerns particularly about violence. For males, most significant protective factors included family caring, body pride, parental expectations, and type of sexual attraction. For physical health, the identified variables explained only 16% of variance for both genders. Body pride was the most significant association, explaining 10% of variance. Conclusions: Connection to family remains a consistently powerful factor in the lives of these youth. Other associations including body pride and parental expectations may help in the exploration and buffering of emotional health among American Indian youth.

Factors associated with marijuana use among American Indian adolescents.

To examine the characteristics of marijuana users among a large sample of American Indian high school students. High school survey. Seven predominantly American Indian high schools in four communities west of the Mississippi. 1464 Indian adolescents who: (1) completed a survey in November, 1993, (2) were in grades 9 to 12, (3) were members of one of four Indian tribal groups; and (4) had a complete set of data for these analyses. Logistic regression models were developed to predict the probability of low-frequency (1-3 times over the last month) and high-frequency (11 or more times) marijuana use. Independent variables included measures of socio-demographics, stressful life events, personal characteristics and beliefs, psychiatric symptomatology and other substance use. Forty per cent of these American Indian adolescents had used marijuana at least once in the last month. The prevalence of marijuana use varied across the four tribes. Males were no more likely than females to use marijuana at a low frequency, but were more likely to use at a high frequency. The factors associated with marijuana use varied with the frequency of use and by gender. In the final multivariate models, low-frequency marijuana use among females was associated with reporting that peers encouraged alcohol use as well as use of alcohol and stimulants. Among males, low-frequency use was associated with greater positive alcohol expectancies, lower grades in school and alcohol use. While high-frequency marijuana use was associated with use of alcohol, stimulants and cocaine among females, such use was associated with higher scores on the antisocial behavior scale as well as the use of alcohol, stimulants and cocaine among males. Overall, the strongest associations were with the use of alcohol and other illicit substances. Low-frequency and high-frequency marijuana use are distinct patterns of use and have different correlates across genders. Marijuana use among American Indian adolescents is a complex phenomenon that is best understood within the context of other substance use.

Sexual orientation, sexual behaviors, and pregnancy among american indian adolescents

Purpose: A recent study found a disproportionate number of pregnancies among Euro-American lesbian and bisexual adolescents compared to heterosexual peers. American Indian adolescents have reported higher prevalence of gay/lesbian/bisexual orientations than Euro-Americans; do they also report higher prevalence of pregnancy? Methods: The study assessed prevalence of teen pregnancy and related factors by sexual orientation among sexually experienced, reservation-based American Indian adolescent males ( n = 2056) and females ( n = 1693) who participated in a national school-based survey in 1991. Self-reported orientation was classified as heterosexual, gay/lesbian/bisexual, and “unsure” of orientation. Results: Gay/bisexual males were more likely than other males to report early heterosexual intercourse (<14 years), more consistent contraception, and a higher prevalence of abuse and running away ( p < 0.05 to p < 0.0001). Likewise, lesbian/bisexual females were more likely to report early onset of heterosexual intercourse, more frequent intercourse, and running away. Sexual or physical abuse did not vary by orientation for females. Prevalence of pregnancy also did not vary by orientation (males, 18.6% gay/bisexual vs. 10.4% “unsure” vs. 11.8% heterosexual; females, 25.0% lesbian/bisexual vs. 22.1% “unsure” vs. 21.9% heterosexual). For lesbian/bisexual females, no variables were significantly associated with pregnancy history; for “unsure” females, pregnancy was associated with contraceptive frequency and early onset of heterosexual activity. For heterosexual females, age, intercourse frequency, and physical abuse were associated. For gay/bisexual males, intercourse frequency, ineffective contraception, and physical abuse were associated with involvement in a pregnancy; for “unsure” and heterosexual males, most items except ineffective contraception were related to pregnancy involvement history. Conclusions: Although prevalence of pregnancy is similar, findings show group differences in associated risk factors by sexual orientation. Interventions to reduce pregnancy among American Indian adolescents should include assessment of sexual orientation and behavioral risk factors.

Addressing trauma in substance abuse treatment with American Indian adolescents.

Substance abuse among American Indian adolescents is a serious problem that frequently continues into adulthood. Therefore, it is important to investigate all potential means of prevention and treatment of substance abuse that might improve the physical and psychological health it undermines. This paper examines the prevalence of substance abuse and its potential relationships with physical/emotional trauma or loss that occurs in American Indian adolescents' lives. The possible benefits of addressing trauma and posttraumatic stress as means of enhancing treatment is explored. An example of residential treatment that involved a focus on trauma and loss is included.

Prevalence of Common Psychiatric Disorders Among American Indian Adolescent Detainees

To examine the prevalence of common psychiatric disorders among adolescents detained on a Northern Plains reservation. Prevalence data were gathered using lay interviewers administering structured diagnostic instruments based on DSM-III-R criteria to 150 youths booked into a reservation-based juvenile detention center from July 1995 through April 1996. Approximately 49% of the sample had at least one alcohol, drug, or mental health disorder; 12.7% had two disorders; and 8.7% had three or more disorders. The most common diagnoses were substance abuse/dependence (38%), conduct disorder (16.7%), and major depression (10%). Females were significantly more likely than males to have major depression and/or anxiety disorders and were significantly more likely to have three or more disorders. These rates were higher in comparison with general and Indian adolescent community samples. These American Indian adolescent detainees had a high prevalence of psychiatric disorders. Local juvenile justice systems should be vigilant for the presence of psychiatric disorders and appropriately connected with psychiatric services to address this considerable need. Careful psychiatric assessment is necessary to ensure a more coordinated community service response to juvenile delinquency.

Secondary School, Family, and Educational Risk: Comparing American Indian Adolescents and Their Peers

Adolescent self-reports of family connectedness, educational commitment, and education-related risktaking behavior were examined from a sample of over 6,000 public school students, with a focus on American Indians. Findings indicate that low family connectedness is associated with decreased educational commitment and an increased risk of absenteeism, substance use before and during school hours, and the purchase of alcohol or drugs on campus. American Indian youth report lower levels of connectedness to family and poorer educational performance than African American and Caucasian peers and engage in higher rates of risk taking. American Indian adolescents residing outside of the reservation may be vulnerable to increased familial stress and encounter cultural conflicts in mainstream educational settings.

Factor Structure and Invariance of the Orthogonal Cultural Identification Scale among American Indian and Mexican American Youth

Some theories and measures of cultural identification are based on a unidimensional continuum, requiring that, as identification with one culture increases, identification with another decreases. Others, such as multicultural theories, allow high identification with different cultures but rarely incorporate low identification. Orthogonal cultural identification theory specifies that identification with one culture can be independent of identification with another Short scales have been developed to assess orthogonal cultural identification, applicable across a variety of cultures. Comparisons of measurement models indicated that, for both Mexican American and American Indian adolescents, measures of minority and White American cultural identification are, as predicted, independent and that cultural identification is strongly rooted in the family. Although minor ethnicity differences occurred in a few higher order paths, multigroup tests indicated essential invariance of factor loadings and higher order structure across gender, grade level, and ethnic minority group.

Psychosocial Factors and Health Behaviors Associated with Inadequate Fruit and Vegetable Intake among American-Indian and Alaska-Native Adolescents

The purpose of the study was to examine fruit and vegetable intake patterns among American Indian and Alaska Native adolescents and to assess psychosocial factors and health behaviors related to inadequate consumption. The study was conducted in nonurban schools from eight Indian Health Service Areas in the U.S.A total sample of 13,454 7th- through 12th-grade American-Indian and Alaska-Native youths living on or near reservations were given, in classroom settings, a revised version of the Minnesota Adolescent Health Survey.The health questionnaire assessed fruit and vegetable consumption patterns and psychosocial variables and health-related behaviors. The results indicated that fruit and vegetable consumption was below the recommended amounts. Less than daily consumption of vegetables was reported by 30% of adolescents and less than daily consumption of fruits was reported by 20% of youths. Psychosocial and health behavior risk associated with inadequate intake included being overweight, low family connectedness, poor school achievement, poor perceived health status, and tobacco use. Our study shows that fruit and vegetable consumption is low among American-Indian and Alaska-Native youths. More attention needs to be placed on developing culturally appropriate interventions to promote healthy eating patterns and addressing factors related to inadequate intake.

Psychosocial Factors Associated with Alcohol Use Among Young Adolescent American Indians and Whites

ABSTRACT Empirical analyses comparing the precursors of adolescent alcohol use between American Indian and white adolescents are rare. This cross-sectional study compares psychosocial factors associated with past-year and heavy alcohol use among 6th and 8th grade white (N = 2226; 2203) and American Indian (N = 105; 98) students. Differential associations of 10 intraindividual, interpersonal, and social environmental risk factors and alcohol use among American Indians and whites were compared. Risk factors for past-year alcohol use and heavy drinking were largely similar between American Indians and whites. Alcohol use may begin earlier in American Indian adolescents suggesting that prevention efforts to delay onset may need to begin earlier for this population.

Social support as a modifier of depressive signs among American Indian adolescents with physical abuse histories

Social support as a modifier of depressive signs among American Indian adolescents with physical abuse histories