Risk and 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 the onset and escalation of use are needed. The risk and promotive factors approach to substance use prevention is a well-established framework for identifying the timing and targets for prevention initiatives. This study aimed to develop predictive models for the usage of cannabis using 22 salient risk and promotive factors. Models were developed using data from a cross-sectional study and further validated using data from a separate longitudinal study with three measurement occasions (baseline, 6-month follow-up, 1-year follow-up). Application of the model to longitudinal data showed an acceptable performance contemporaneously but waning prospective predictive utility over time. Despite the model's high specificity, the sensitivity was low, indicating an effective prediction of non-users but poor performance in correctly identifying users, particularly at the 1-year follow-up. This divergence can have significant implications. For example, a model that misclassifies future adolescent cannabis use could fail to provide necessary intervention for those at risk, leading to negative health and social consequences. Moreover, supplementary analysis points to the importance of considering change in risk and promotive factors over time.

Nicotine use among reservation-area American Indian adolescents compared with a national sample.

BACKGROUND: Past research has found significant nicotine use disparities for reservation-area American Indian adolescents when compared to national levels. However, adolescent nicotine use has changed markedly, with reduced smoking and rapid increases in nicotine vaping. This study presents 2021-2022 prevalence estimates of tobacco product use, perceived harm and availability for reservation-area American Indian youth, with comparisons to the Monitoring the Future (MTF) national study. METHODS: Participants were 8th, 10th and 12th grade students. American Indian data were 33 reservation-area schools in 2021-2022 (n=2420); MTF data were 308 schools in Spring 2022 (n=31,438). Measures were lifetime, 30-day cigarette smoking, smokeless tobacco use, and nicotine vaping; past-year nicotine vaping; daily smoking; perceived harmfulness and availability of these tobacco products. Prevalence and 95% confidence intervals were computed by grade. RESULTS: Estimated prevalence of lifetime, monthly and daily cigarette smoking among American Indian 8th and 10th graders was higher than national levels. Nicotine vaping prevalence was similar between samples. American Indian students were less likely to report tobacco product use poses great risk, but also less likely to report tobacco products are easily available. CONCLUSIONS: Although estimated smoking prevalence among American Indian 8th and 10th graders was higher than national levels, prevalence appears lower than reported in earlier studies, suggesting declining disparities. Prevalence of nicotine vaping among reservation-area American Indian adolescents generally mirrors the national population; however, a lower percentage reported regular nicotine vaping poses a serious risk. This discrepancy suggests a need for prevention and intervention efforts culturally tailored for this population.

Can High and Consistent School-Related Protective Factors Prevent Cannabis Use Among American Indian Middle School Students?

BACKGROUND: High cannabis use rates among American Indian (AI) adolescents necessitate the identification of factors that protect against early cannabis initiation. METHODS: Data collected from 279 AI middle school students attending reservation-based schools in 2018 and 2019 were analyzed. Three waves of data, with approximately 6 months between each, were used. A repeated measures latent class analysis examined a school-related protective factor index over three waves. The predictive power of lifetime cannabis use on school protection class membership was estimated, along with differences in past month cannabis use at follow-up 2 across school protection classes while holding baseline use constant. RESULTS: Four school protection classes were identified: high, moderate, low, and declining protection. Abstinence at baseline was associated with an increased odds of membership in the high protection class compared to the moderate and low protection classes. Students with consistent and high school protection throughout middle school were significantly less likely to report past month cannabis use at follow-up 2 compared to other classes. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Maintaining a high level of school protection throughout middle school substantially lowers the odds of cannabis use among AI adolescents. CONCLUSIONS: Interventions to promote school-related protective factors in this population are essential and should be designed and tested.

Protective factors in the relationship between perceived discrimination and risky drinking among American Indian adolescents.

INTRODUCTION: The relationship between perceived discrimination and risky drinking among American Indian (AI) youth is understudied, and the potential protective factors that may buffer this association are unknown. Therefore, the objective of this study was to examine protective factors across individual, family, school, peer, and cultural domains of the social ecology that might attenuate the relationship between perceived discrimination and risky drinking among AI adolescents. METHOD: Data were from the Substance Use Among American Indian Youth Study (Swaim and Stanley, 2018, 2021). AI youth who have used alcohol in their lifetime (n = 2516 within 62 schools) had an average age of 15.16 years (SD = 1.75) and 55.5% were female. Five sets of linear regressions were conducted. Risky drinking was regressed on demographic variables, alcohol use frequency, perceived discrimination, one protective factor (religiosity, parental monitoring, peer disapproval of alcohol use, school engagement, and ethnic identity), and one two-way interaction between perceived discrimination and the protective factor. RESULTS: Prevalence of risky drinking among lifetime drinkers was 40.1%. There were positive associations between perceived discrimination and risky drinking in all models (Bs range from.20 to.23; p <.001). Parental monitoring had a negative association with risky drinking (B = -0.255, p <.001). Religiosity was the only statistically significant moderator (B = -0.08, p = 0.01), indicating that religiosity weakened the relation between perceived discrimination and risky drinking. CONCLUSIONS: Religiosity may represent an important protective factor that could help guide efforts to prevent risky drinking in the face of discrimination among AI adolescents.

Intersecting sex and American Indian identity moderates school and individual correlates of binge drinking among reservation-area adolescents.

Reservation-area American Indian (AI) youth demonstrate higher rates of binge drinking (BD) than their non-AI peers. However, individual and school-level differences in BD disparities between reservation-area AI/non-AI female and male adolescents remain unexamined. This study applies an Intersectional framework to examine risk and protective factors of BD among reservation-area youth at the intersection of their sex and AI identities. A nationally representative sample of adolescents (N = 14,769; Mage = 14.6, 49% female; 61% AI) attending 103 reservation-serving schools completed a survey between 2015 and 2019. Multilevel modeling was used to examine differences in risk and protective factors of BD between AI and non-AI male and female adolescents. Our findings indicate that the effects of student and school-level risk and protective factors on adolescents' BD are driven primarily by sex within AI and non-AI groups. Implications for future confirmatory research and tailoring school-based prevention programs are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Comparison of COVID-19 Outcomes Between Reservation-Area American Indian and U.S. National Students.

Introduction: This study presents data from 2 population-based surveys of youth (reservation-area American Indian adolescents and U.S. adolescents) on self, family, and friend morbidity and changes in substance use and negative impacts during COVID-19. Methods: Data were obtained in spring 2021 from surveys of American Indian students living on or near reservations (8th grade, n=398; 10th grade, n=367; 12th grade, n=290) and national students from Monitoring the Future (8th grade, n=11,446; 10th grade, n=11,792; 12th grade, n=9,022). The main outcomes were COVID-19 testing, perceived morbidity/mortality, substance-use changes, and emotional changes during COVID-19. Results: The American Indian sample had a greater proportion of testing (e.g., American Indian 8th grade: 58.1% [95% CI=48.6, 68.8]; Monitoring the Future 8th grade: 43.6% [95% CI=39.8, 47.5]) and friend/family hospitalization (e.g., American Indian 8th grade: 36.2% [95% CI=26.2, 47.5]; Monitoring the Future 8th grade: 11.9% [95% CI=10.6, 13.3]). Across grades, greater proportions of the national sample reported increased anxiety, anger, boredom, loneliness, depression, worry, and trouble concentrating, whereas greater proportions of reservation-area American Indians reported decreased anxiety, loneliness, and depression. Conclusions: Findings indicate that reservation-area American Indian youth experienced unique health consequences 1 year into the COVID-19 pandemic compared with national students, illustrating the need for American Indian-specific COVID-19 public health monitoring and response.

The relationship between depressed affect, parental monitoring, and sex on cannabis use among American Indian youth.

BACKGROUND AND OBJECTIVES: American Indian (AI) adolescents report higher rates of cannabis use than national US adolescents. Previous study examined interactive relationships between depressed affect and family factors on AI adolescent alcohol use. These factors have not been investigated for cannabis use. We examined whether parental monitoring dampened risk for cannabis use due to depressed affect, and potential moderation by sex. METHODS: We measured cannabis use, depressed affect, parental monitoring, and sex among reservation area AI youth among students in grades 7-12 attending 45 schools. We used censor-inflated regression models to identify parental monitoring as a moderator of the relationship between depressed affect and cannabis use. RESULTS: In the logistic portion of censor-inflated models, level of depressed affect and parental monitoring significantly related to last 30-day cannabis use. Higher levels of parental monitoring at lower levels of depressed affect related to lower likelihood of cannabis use. Female students had greater likelihood of endorsing cannabis use at higher levels of depressed affect. In the linear portion of the censor-inflated regression models, sex and level of parental monitoring significantly related to cannabis use frequency. Male students endorsed more frequent cannabis use while higher levels of parental monitoring related to lower frequency of use. DISCUSSION AND CONCLUSIONS: Parental monitoring may dampen the effect of depressed affect on cannabis use among AI youth on reservations. SCIENTIFIC SIGNIFICANCE: Future interventions should foster skill-building prevention efforts directed at coping with depression, along with parental training for effective monitoring. Special attention to AI female adolescents may be indicated.

Family ties: examining family functioning and alcohol use among American Indian youth.

Purpose: This study aims to examine a second-order latent variable of family functioning built from two established protective factors for American Indian (AI) youth, i.e. family cohesion and parental monitoring. This study then examines if family functioning is related to alcohol use frequency or age of initiation for AI youth. Additionally, this study examines if family functioning served as a moderator for the risk factor of peer alcohol use. Design/methodology/approach: Data came from the 2021 Our Youth, Our Future survey. Participants were 4,373 AI adolescents from Grades 6-12 across the contiguous USA. Structural equation modeling (SEM) was used to test the latent variable of family functioning. Structural paths and interaction terms between peer use and family functioning were added to the SEM to explore direct and moderating effects. Findings: Family cohesion and parental monitoring were best represented by a second-order latent variable of family functioning, which was related to later initiation and lower alcohol use frequency. Practical implications: The findings regarding the initiation of alcohol use may be applicable to prevention programs, with family functioning serving as a protective factor for the initiation of alcohol use. Programs working toward alcohol prevention may be best served by focusing on family-based programs. Originality/value: The latent variable of family functioning is appropriate for use in AI samples. Family functioning, which is an inherent resilience factor in AI communities, was shown to be protective against harmful alcohol use behaviors.

Self-reported Illness Experiences and Psychosocial Outcomes for Reservation-Area American Indian Youth During COVID-19.

Importance: Impacts of COVID-19 on reservation-area American Indian youth are unknown and may be substantial owing to the significant COVID-19 morbidity and mortality experienced by American Indian populations. Objective: To measure self-reported illness experiences and changes in psychosocial factors during the COVID-19 pandemic among reservation-area American Indian youth. Design, Setting, and Participants: This cross-sectional study included a random sample of US schools on or near US Indian reservations during Spring 2021, stratified by region, with students in grades 6 to 12 completing cross-sectional online surveys. All enrolled self-identifying American Indian students in grades 6 to 12 attending the 20 participating schools were eligible to be surveyed; participants represented 60.4% of eligible students in these schools. Data were analyzed from January 5 to July 15, 2022. Exposures: Onset of the COVID-19 pandemic. Main Outcomes and Measures: Outcomes of interest were COVID-19 self-reported illness outcomes for self and family and close friends; perceived changes in family and friend relationships, school engagement, social isolation, and other psychological factors since the COVID-19 pandemic began; and worry over COVID-19-related health outcomes. Results: A total of 2559 American Indian students (1201 [46.9%] male; 1284 [50.2%] female; 70 [2.7%] another gender; mean [SD] 14.7 [8.9] years) were included in the analysis. Approximately 14% of the sample reported having had a test result positive for SARS-CoV-2 infection (14.3% [95% CI, 11.4%-17.6%]), a higher rate than for all cases nationally at the time of the survey. Regarding prevalence of COVID-19 among family and close friends, 75.4% (95% CI, 68.8%-80.9%) of participants reported having at least 1 family member or friend who had contracted COVID-19, while 27.9% (95% CI, 18.8%-39.3%) of participants reported that at least 1 family member or close friend had died of COVID-19. Regarding psychosocial impacts, COVID-19 was associated with strained friend relationships (eg, 34.0% [95% CI, 28.4%-40.0%] of students reported worry over losing friends), lower school engagement, and less social connectedness (eg, 62.2% [95% CI, 56.7%-67.4%] of students reported feeling less socially connected to people), although more than 60% of students also reported feeling no change or a decrease in negative emotions. Males were less likely to report perceived negative impacts, especially for negative emotions such as sadness (29.2% [95% CI, 23.3%-35.9%] of males vs 46.1% [95% CI, 43.9%-48.3%] of females reported feeling more sad) and anxiety (21.8% [95% CI, 18.2%-25.8%] of males vs 39.2% [95% CI, 34.1%-44.6%] of females reported feeling more anxious). Conclusions and Relevance: This cross-sectional study provides novel insight into the perceived experiences of reservation-area American Indian youth, a population at uniquely elevated risk of poor health status and health care access, during the COVID-19 pandemic. Although mortality and morbidity rates from COVID-19 were high on American Indian reservations, student reports of psychosocial impacts were complex and suggest many students were resilient in the face of the pandemic. These findings could be used to understand and address the challenges facing American Indian youth due to the pandemic and to guide future research that examines the factors and processes associated with the reported outcomes.

Profiles of Ecosystemic Resilience and Risk: American Indian Adolescent Substance Use during the First Year of the COVID-19 Crisis.

The COVID-19 pandemic has caused an unprecedented disruption to the lives of American Indian (AI) adolescents. While reservation-area AI youth already have a higher risk of substance use (SU) compared to their non-AI peers, COVID-19 stressors likely exacerbated this risk. However, COVID-19-specific and general resilience factors may have buffered against increased SU over the course of the pandemic. Using a person-centered, ecosystemic framework of resilience, we used latent profile analysis to identify ecosystemic resilience profiles indicated by general and COVID-19-specific risk and resilience factors, then examined inter-profile changes in alcohol and cannabis use after the onset of the COVID-19 pandemic from the spring of 2020 to the spring of 2021. The sample was 2218 reservation-area AI adolescents (7-12th grade; schools = 20; Mage = 15, SD = 1.7; 52% female). Four profiles emerged: Average Risk and Resilience, High Resilience, Low Resilience, and High Risk. Adolescents with a High-Risk profile demonstrated increases in alcohol and cannabis use, while High Resilience youth demonstrated decreases. These findings support the hypothesized COVID-19-specific ecosystemic resilience profiles and the application of a person-centered ecosystemic framework to identify which AI adolescents are most likely to experience substance use changes during a life-altering crisis like COVID-19.

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.

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.

Correlates of solitary alcohol and cannabis use among American Indian adolescents.

BACKGROUND: Solitary substance use, or using substances while alone, is common among adolescents but understudied. This is the first study to examine solitary substance use among American Indian (AI) adolescents. The objective was to examine correlates of solitary alcohol use and solitary cannabis use that occur within the individual, family, school, peer, and cultural domains of the social ecology. METHOD: Data were from the 2009-2013 Drug Use Among Young American Indians Study, a cross-sectional cohort study. Two sets of hierarchical logistic regressions were conducted to examine solitary alcohol use (getting drunk) among lifetime alcohol users (n = 2082; Mage = 15.12 years; SD = 1.68; 54.2% female) and solitary cannabis use among lifetime cannabis users (n = 2085; Mage = 14.99 years; SD = 1.69; 50.5% female), including adjustment for level of substance involvement. RESULTS: Prevalence of solitary alcohol use among lifetime drinkers was 24.9%. Among lifetime cannabis users, 53.6% reported solitary cannabis use. Regression analyses for solitary alcohol use showed statistically significant positive associations with coping motive, descriptive norms, violent behavior, depression, peer models for use, and (unexpectedly) peer sanctions against use and a negative association with family sanctions against use. Regression analyses for solitary cannabis use showed statistically significant positive associations with coping motive, violent behavior, and peer models for use and a negative association with family sanctions against use. CONCLUSIONS: Solitary alcohol and cannabis use are prevalent among AI adolescents and might, in particular, reflect attempts to cope with adversity. Findings could help guide the development of screening and prevention efforts.

Be under your own influence: Effectiveness of a Culturally-Adapted drug prevention campaign targeting Reservation-Dwelling American Indian youth.

Be Under Your Own Influence (BUYOI) is a previously validated school-based intervention designed to delay adolescent substance use (SU) initiation. This study examined the effectiveness of a culturally-adapted version of BUYOI in delaying SU initiation among reservation-dwelling American Indian (AI) youth. Five reservation-based middle schools participated. Three schools were randomly assigned to receive BUYOI-AI (N = 321), and two schools served as controls (N = 176). Beginning in 7th grade, all participating students completed four assessments over the study period. Discrete time hazard models estimated the effects of BUYOI on students' risk of initiating alcohol, alcohol intoxication and marijuana before the end of 8th grade. AI students exposed to BUYOI had a lower risk of initiating alcohol use or intoxication, though sex moderated the effect on intoxication. These findings provide preliminary support for the effectiveness of a culturally-adapted version of BUYOI in delaying AI youth's first-time alcohol use and intoxication.

Opioid Misuse Among American Indian Adolescents.

Objectives. To present data for opioid misuse among US reservation-based American Indian (AI) adolescents and to compare these data with national rates from Monitoring the Future (MTF).Methods. Data were from a national sample of 33 schools participating in a substance use epidemiological survey of reservation-based AI adolescents during 2018 and 2019. Participants were 8th-, 10th-, and 12th-grade AI students (n = 1592). Measures included 12-month and 30-day use of OxyContin, Vicodin, heroin, and narcotics. We computed prevalence and compared it with MTF national prevalence.Results. Across grades, AI youths demonstrated significantly greater past 12-month and 30-day opioid use relative to a national sample. Significant absolute differences in 12-month and 30-day prevalence levels ranged from 1.6% (8th-grade heroin) to 4.7% (12th-grade narcotics) and from 1.6% (12th-grade narcotics) to 1.8% (12th-grade heroin), respectively.Conclusions. Opioid misuse prevalence levels were significantly greater for reservation-based AI adolescents relative to national prevalence levels.Public Health Implications. Findings suggest that implementation of evidence-based efforts, adapted or developed to be culturally appropriate, should be significantly increased in tribal communities, along with policies to address the unique social, economic, and health issues they face.

Early onset of cannabis use and alcohol intoxication predicts prescription drug misuse in American Indian and non-American Indian adolescents living on or near reservations.

BACKGROUND: Prescription drug misuse (PDM) is a growing issue within the American Indian (AI) population, especially in younger populations. OBJECTIVES: This study estimates relationships between PDM and early initiation (prior to 14 yrs) of cannabis use and alcohol intoxication for a national sample of AI and non-AI adolescents attending schools on or near reservations. METHOD: Participants were 2580 students (50.2% female; 58.1% AI), ages 15-18, attending schools located on or near an AI reservation. Four models of PDM were estimated: 1) demographic variables; 2) demographics plus cannabis use initiation status; 3) demographics plus alcohol intoxication initiation status; and 4) all variables. All analyses were conducted using multilevel modeling. RESULTS: Results indicated that early onset of cannabis use and alcohol intoxication were individually significant predictors of PDM for AI and non-AI adolescents, with odds ratios (OR) of 47.00 for cannabis (p <.01) and 35.73 (p <.01) for intoxication and with no significant differences by race (AI vs. non-AI). Results also indicated a greater likelihood of PDM when a student was an early initiator of both cannabis use and intoxication than when they were one or the other. Finally, there was a significantly greater association between cannabis use and PDM (ORearlycannabis = 24.95, p <.01) than between intoxication and PDM (ORearlyintoxication = 3.98, p <.01) when both predictors were in the model. CONCLUSIONS: These findings suggest that for AI and non-AI youth who have some shared living experience, early initiation of cannabis use and alcohol intoxication are risk factors that are similarly related to PDM and that targeting early initiation for both groups of adolescents is critical in prevention of PDM.

Comparing cannabis use motive item performance between American Indian and White youth.

OBJECTIVE: There is limited research on the motives for engaging in cannabis use for American Indian (AI) youth. The purpose of this study was to explore the differences in cannabis use motives between White and AI youth. METHOD: This study used data from youth living on or near reservations who currently use cannabis and identify as White (n = 156) or AI (n = 922). Students completed a survey containing a measure of cannabis use motives that included coping, recreation, and expansion motives. Eight items, four coping and four recreational/expansion, were evaluated using Item Response Theory. Multi-group analyses were conducted to assess the differences in item functioning between White and AI youth. RESULTS: Three of the four items in the four-item coping model and four items in the recreational/enhancement model exhibited meaningful differential item functioning (DIF). Results suggest that AI youth were more likely to endorse coping reasons for use while White youth were more likely to endorse recreational/expansion reasons for use. CONCLUSIONS: This study provides preliminary evidence that AI and White youth meaningfully differ in their likelihood to endorse coping, recreational, and expansion reasons for cannabis use. These findings highlight the importance of attending to differences between AI and White youth substance use motives, especially when developing culturally competent intervention and prevention strategies.

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.

Risk and Protective Factors of Current Opioid Use Among Youth Living on or Near American Indian Reservations: An Application of Machine Learning.

Opioid use among youth, particularly among American Indian (AI) youth, is rising, resulting in a large number of accidental overdoses and deaths. In order to develop effective prevention strategies, we need to use exploratory data analysis to identify previously unknown predictors of opioid use among youth living on or near reservations. The present study is an application of Machine Learning, a type of exploratory data analysis, to the Our Youth, Our Future epidemiological survey (N = 6482) to determine salient risk and protective factors for past 30-day opioid use. The Machine Learning algorithm identified 11 salient risk and protective factors. Importantly, highest risk was conferred for those reporting recent cocaine use, having ever tried a narcotic other than heroin, and identifying as American Indian. Protective factors included never having tried opioids other than heroin, infrequent binge drinking, having fewer friends pressuring you to use illicit drugs, initiating alcohol use at a later age, and being older. This model explained 61% of the variance in the training sample and, on average, 24% of the variance in the bootstrapped samples. Taken together, this model identifies known predictors of 30-day opioid use, for example, recent substance use, as well as unknown predictors including being AI, Snapchat use, and peer encouragement for use. Notably, recent cocaine use was a more salient predictor of recent opioid use than lifetime opioid use.

Predictors of Substance Use Latent Classes Among American Indian Youth Attending Schools On or Near Reservations.

BACKGROUND AND OBJECTIVES: Identical latent classes of substance use for 7 to 8 grade and 9 to 12 grade American Indian (AI) youth living on or near reservations suggest that patterns of substance use are established early among these youth. This study examines relationships of substance-related factors to latent class membership and whether these relationships differ by grade group. METHODS: In-school surveys were administered to 1503 7 to 8 grade and 1995 9 to 12 grade students from 46 schools on or near reservations during the 2009/2010 to 2012/2013 school years. Four-class latent class models of substance use were specified and five classes of substance-related factors (peers, substance availability, perceived harm, family, early initiation), plus grade level and gender, were evaluated as predictors. RESULTS: For 7 to 8 grade students, substance-related factors differentiated nonusers from users, while for 9 to 12 graders, these factors also differentiated types of users. Early initiation and peer factors were strongly related to class membership, while other factors were less strongly related. DISCUSSION AND CONCLUSIONS: Early initiation of alcohol or marijuana is strongly related to being in a substance-using class for AI youth. Because these youth tend to initiate use earlier that other US youth, prevention resources should be targeted to reaching them and their families before age 12. SCIENTIFIC SIGNIFICANCE: Predictors of latent classes of substance use were identified for reservation-based AI youth. While the classes were identical for 7 to 8 grade and 9 to 12 grade youth, predictors varied across grade group, which may inform how best to develop prevention efforts unique to middle and high school AI youth.