School Racial Composition as a Moderator of the Effect of Discrimination on Mental Health and Substance use Among American Indian Adolescents.

PURPOSE: To examine the relationships between individual-level perceived racial/ethnic discrimination and mental health and substance use outcomes by school-level racial composition among American Indian (AI) adolescents. METHOD: Self-reported survey data on individual-level variables come from a sample of AI adolescents (n = 510) living in or near the Cherokee Nation during the fall of 2021. School-level data come from publicly available databases. Multilevel linear and logistic regression analyses were performed to test for and examine the interaction between perceived racial/ethnic discrimination and school racial composition in relation to symptoms of anxiety and depression, past 30-day use of alcohol and marijuana, and misuse of prescription opioids. RESULTS: Adjusted analyses showed a significant interaction effect between discrimination and racial composition on anxiety symptoms, such that the effect of discrimination was more pronounced at lower % AI (10th percentile) than at more equivalently mixed (50th percentile) or higher % AI (90th percentile) school settings. No significant interactions were observed with depressive symptoms or substance use outcomes. DISCUSSION: School racial compositions of higher percentage AI may buffer the adverse effect of racial/ethnic discrimination on anxiety symptoms among AI adolescents.

Cognitive control as a potential neural mechanism of protective role of spirituality in anxiety disorders among American Indian people: An ERP study.

Research suggests that traditional cultural factors are protective against mental health conditions in American Indian (AI) populations. This study aims to determine if cognitive control is a neurocognitive mechanism of the protective role of spirituality in AI people with generalized anxiety disorder (GAD). Participants self-identified as AI (n = 52) and included individuals with GAD (n = 16) and without GAD (n = 36). Electroencephalography was collected during a stop-signal task to probe cognitive control using the P3 event-related potential. Higher levels of spirituality attenuated the processing efficiency disruption among individuals with GAD as indicated by P3 amplitudes closer to that of individuals without GAD.

Adolescent Advertising Exposure to Cannabis Products in Rural Oklahoma via Medical Dispensaries.

OBJECTIVE: We assess cannabis advertising exposure among adolescents in rural Oklahoma from medical dispensaries. METHOD: Our mixed-methods study identified medical dispensaries within a 15-minute drive time of rural Oklahoma high schools. Study staff completed observational data collection forms and took photographs of each dispensary. Quantitative data from the forms and qualitative coding of photographs were used to describe dispensary characteristics and likely advertising exposure for adolescents. RESULTS: Ninety-two dispensaries were identified across 20 rural communities. The majority presented as retail spaces (n = 71). Product (n = 22) and price promotions (n = 27) were common. Coding of dispensary photographs found that product promotions advertised cannabis use modalities, with cannabis flower being the most common (n = 15), followed by edibles (n = 9) and concentrates (n = 9). Among dispensaries with price promotions, discounts (n = 19) and prices under $10 (n = 14) were common. CONCLUSIONS: Sampled rural medical dispensaries present as retail spaces and are a likely source of adolescent cannabis advertising exposure.

Culturally Responsive Opioid and Other Drug Prevention for American Indian/Alaska Native People: a Comparison of Reservation- and Urban-Based Approaches.

There are few substance use treatment and prevention programs for AI/AN people that integrate culturally based practices with evidence-based treatment and prevention. The National Institutes of Health's (NIH's) Helping to End Addiction Long-term (HEAL) Prevention Cooperative supports two projects focused on AI/AN populations. One focuses on youth ages 15 to 20 years living within the Cherokee Nation reservation, a multicultural rural area in northeastern Oklahoma, and the second focuses on emerging adults ages 18 to 25 years living in diverse urban areas. We provide a brief overview of the two prevention trials and a case comparison across approaches using the framework of promising practices for intervention science with Indigenous communities (Whitesell et al., 2020) related to (1) integration of Indigenous and academic perspectives to respond to community needs, (2) community partnership and engagement, (3) alignment with Indigenous cultural values and practices, (4) capacity building and empowerment, (5) implementation within complex cultural contexts, and (6) tribal oversight. Overall, these two projects highlight the importance of long-standing relationships with community partners, engaging the community at all levels to ensure that programming is culturally and developmentally appropriate, and having tribal and elder oversight. These practices are key to establishing trust and building confidence in research in these communities and ensuring that research can benefit AI/AN people. These studies showcase how strong partnerships can advance health and support the conduct of rigorous science to help pinpoint optimal health solutions by identifying efficacious, culturally grounded intervention strategies. Although the sovereign status of tribes demands this type of partnership, this research serves as a model for all community research that has a goal of improving health.

Postpartum Depression in a Community Sample of American Indian Mothers.

American Indian (AI) mothers experience high rates of postpartum depression (PPD). We evaluated the factor structure of the Edinburgh Postnatal Depression Scale (EPDS) among AI mothers from a rural AI serving health system. We also investigated potential associations between EPDS scores and selected psychosocial factors (n = 315). Exploratory Factor Analysis (n = 157) showed that a one-factor structure best fits the data. A Confirmatory Factor Analysis was then conducted to examine the fit of the one-factor model (n = 158). Goodness-of-fit statistics showed overall poor model fit (RMSEA = .13) which may be suggestive of an indicator of depression among Natives not detected by the EPDS. Results of the multiple regression analysis were non-significant. The findings demonstrated that while the EPDS measured aspects of PPD, there may be additional aspects of depression specific to the AI women in our sample not captured by the EPDS. Limitations and directions for future research are discussed.

Five recommendations for using large-scale publicly available data to advance health among American Indian peoples: the Adolescent Brain and Cognitive Development (ABCD) StudySM as an illustrative case.

American Indian and Alaska Native (AIAN) populations have suffered a history of exploitation and abuse within the context of mental health research and related fields. This history is rooted in assimilation policies, historical trauma, and cultural loss, and is promulgated through discrimination and disregard for traditional culture and community knowledge. In recognition of this history, it is imperative for researchers to utilize culturally sensitive approaches that consider the context of tribal communities to better address mental health issues for AIAN individuals. The public availability of data from large-scale studies creates both opportunities and challenges when studying mental health within AIAN populations. This manuscript has two goals; first, showcase an example of problematic use of Adolescent Brain Cognitive Development (ABCD) StudySM data to promulgate stereotypes about AIAN individuals and, second, in partnership with collaborators from Cherokee Nation, we provide five recommendations for utilizing data from publicly available datasets to advance health research in AIAN populations. Specifically, we argue for the consideration of (1) the heterogeneity of the communities represented, (2) the importance of focusing on AIAN health and well-being, (3) engagement of relevant communities and AIAN community leaders, (4) consideration of historical and ongoing injustices, and (5) engagement with AIAN regulatory agencies or review boards. These recommendations are founded on principles from broader indigenous research efforts emphasizing community-engaged research and principles of Indigenous Data Sovereignty and Governance.

Methodological Strategies for Prospective Harmonization of Studies: Application to 10 Distinct Outcomes Studies of Preventive Interventions Targeting Opioid Misuse.

The Helping to End Addiction Long-Term (HEAL) Prevention Cooperative (HPC) is rapidly developing 10 distinct evidence-based interventions for implementation in a variety of settings to prevent opioid misuse and opioid use disorder. One HPC objective is to compare intervention impacts on opioid misuse initiation, escalation, severity, and disorder and identify whether any HPC interventions are more effective than others for types of individuals. It provides a rare opportunity to prospectively harmonize measures across distinct outcomes studies. This paper describes the needs, opportunities, strategies, and processes that were used to harmonize HPC data. They are illustrated with a strategy to measure opioid use that spans the spectrum of opioid use experiences (termed involvement) and is composed of common "anchor items" ranging from initiation to symptoms of opioid use disorder. The limitations and opportunities anticipated from this approach to data harmonization are reviewed. Lastly, implications for future research cooperatives and the broader HEAL data ecosystem are discussed.

Theory, Measurement, and Psychometric Properties of Risk and Protective Factors for Drug Misuse Among Adolescents Living on or near the Cherokee Nation Reservation.

A team of tribe-based behavioral health specialists and university-based researchers partnered to implement a cluster randomized trial for the prevention of drug misuse among adolescents attending public high schools on or near the Cherokee Nation Reservation in northeastern Oklahoma. The conceptual framework, which guided intervention and measurement design for the trial, incorporates indigenous knowledge and worldviews with empirically-based frameworks and evidence-based practices. Our goal is to serve multicultural youth, families, and schools and to provide a model of effective strategies for wide dissemination. This paper presents the conceptual model, survey design, and psychometric properties of scales to measure risk and protective factors for substance misuse. The survey includes common measures drawn from the PhenX Toolkit on substance use patterns-adolescent module, measured with standard items from the Monitoring the Future (MTF) study and items harmonized across ten NIH-funded research projects with diverse samples of youth. In our trial, brief (20-minute) self-report questionnaires were administered to 10th grade students in fall 2021 (n = 919, 87% response rate) and spring 2022 (n = 929, 89% response rate) in 20 participating high schools on or near the Cherokee Nation Reservation. The sample primarily fell into the following three categories of race/ethnicity identification: only American Indian (AI-only, 29%), AI and another race/ethnicity (AI+, 27%), and only White (35%). Results indicate that risk and protective factor scales were reliably and validly measured with 10 scales and 10 subscales. There were minimal differences between youth who identified as AI only, AI+, and White only, especially for the main scales, which provide confidence in the interpretation of trial outcomes across demographic groups. Study results may not be generalizable to AI/AN youth who live and attend school in more homogenous reservation lands, or alternatively, live in large diverse metropolitan areas.

Perceived Racial/Ethnic Discrimination and Depressive Symptoms among Adolescents Living in the Cherokee Nation.

The objective of this study was to examine the longitudinal relationship between perceived racial/ethnic discrimination and depressive symptoms among adolescents living in the Cherokee Nation, as well as the potential moderating roles of race and social support. Self-reported survey data were analyzed from a sample of high school students (n = 1,622) who identified as American Indian only, American Indian and White, and White only. Compared to students who reported no discrimination on the basis of race, those who reported ever having experienced discrimination scored, on average, 1.62 units higher on the depressive symptoms scale six months later (p = .0001, 95% CI: 0.90, 2.33), while adjusting for age, race, gender, baseline depressive symptoms, enrollment in a free/reduced-price lunch program, and social support. Discrimination intensity did not significantly predict depressive symptoms among those reporting some frequency of discrimination. Race and social support did not modify either effect. These findings may inform development of interventions to promote mental health among American Indian adolescents.

Study protocol for a cluster randomized trial of a school, family, and community intervention for preventing drug misuse among older adolescents in the Cherokee Nation.

BACKGROUND: The national opioid crisis has disproportionately burdened rural White populations and American Indian/Alaska Native (AI/AN) populations. Therefore, Cherokee Nation and Emory University public health scientists have designed an opioid prevention trial to be conducted in rural communities in the Cherokee Nation (northeast Oklahoma) with AI and other (mostly White) adolescents and young adults. Our goal is to implement and evaluate a theory-based, integrated multi-level community intervention designed to prevent the onset and escalation of opioid and other drug misuse. Two distinct intervention approaches-community organizing, as implemented in our established Communities Mobilizing for Change and Action (CMCA) intervention protocol, and universal school-based brief intervention and referral, as implemented in our established Connect intervention protocol-will be integrated with skill-based training for adults to strengthen social support for youth and also with strategic media. Furthermore, we will test systems for sustained implementation within existing organizational structures of the Cherokee Nation and local schools and communities. This study protocol describes the cluster randomized trial, designed to measure implementation and evaluate the effectiveness on primary and secondary outcomes. METHODS: Using a cluster randomized controlled design and constrained randomization, this trial will allocate 20 high schools and surrounding communities to either an intervention or delayed-intervention comparison condition. With a proposed sample of 20 high schools, all enrolled 10th grade students in fall 2021 (ages 15 to 17) will be eligible for participation. During the trial, we will (1) implement interventions through the Cherokee Nation and measure implementation processes and fidelity, (2) measure opioid and other drug use and secondary outcomes every 6 months among a cohort of high school students followed over 3 years through their transition out of high school, (3) test via a cluster randomized trial the effect of the integrated CMCA-Connect intervention, and (4) analyze implementation costs. Primary outcomes include the number of days during the past 30 days of (1) any alcohol use, (2) heavy alcohol use (defined as having at least four, among young women, or five, among young men, standard alcoholic drinks within a couple of hours), (3) any marijuana use, and (4) prescription opioid misuse (defined as "without a doctor's prescription or differently than how a doctor or medical provider told you to use it"). DISCUSSION: This trial will expand upon previous research advancing the scientific evidence regarding prevention of opioid and other drug misuse during the critical developmental period of late adolescent transition to young adulthood among a sample of American Indian and other youth living within the Cherokee Nation reservation. TRIAL REGISTRATION: ClinicalTrials.gov NCT04839978 . Registered on April 9, 2021. Version 4, January 26, 2022.

Emotional Availability as a Moderator of Stress for Young Children and Parents in Two Diverse Early Head Start Samples.

Positive parent-child relationship quality is critical for buffering children from the effects of stress on development. It is thus vital to develop interventions that target parent-child relationship quality for families experiencing stress. We examined the moderating role of parent-child relationship quality (as measured by parental emotional availability [EA]) in the intergenerational association between parental adverse childhood experiences (ACEs) and their young children's hair cortisol concentrations (HCCs)-a physiological marker of cumulative hypothalamic pituitary adrenal (HPA)-axis activity. Using data from 127 parent-child dyads collected by two of six ACF-funded Buffering Toxic Stress consortium sites, we tested interaction effects of parental ACEs with parental EA on young children's (Mage = 18.38, SDage = 7.10) HCC. Results revealed curvilinear main effects such that higher parental ACEs were significantly associated with greater HCC and stronger associations occurred at higher levels of parental ACEs. However, this association was moderated by parental EA. Thus, among children with higher parental history of ACEs, children of parents with higher EA had lower HCC compared to children of parents with lower EA. These findings provide support for the risk-buffering and risk-exacerbating role of parent-child relationship quality (e.g., EA) for the transmission of parents' early life adversity on their children's HPA-axis activity, documented here in a racially and ethnically diverse sample of children and parents served by Early Head Start. Findings suggest that intervention and prevention efforts targeting stress response in children of mothers with childhood adversity should also support parents in building an emotionally available relationship with their children.

For the Good of the Community: Considering the Impact of Evidence-Based Treatment Adaptation on Tribal Communities.

Ongoing discussions among tribal communities, professionals, and mental health organizations have centered on the question of whether evidence-based interventions require adaptations to improve mental health outcomes among American Indian communities. Continued efforts to address these questions have resulted in the development of novel, culturally-grounded interventions, adapted interventions, use of original standard protocols, and/or limited use of evidence-based treatments. Consequently, mental health services in tribal communities may be highly variable from one community to another and the effectiveness of services relatively unknown. The current paper explored the state of the literature on adaptations and their utility among American Indian communities and the broader ethnic minority community. Considerations for the various impacts on tribal communities are presented and recommendations for researchers and practitioners are also discussed.

CONNECT: Implementation of a School-Based Alcohol Screening and Brief Intervention for Youth in the Cherokee Nation.

BACKGROUND: There is growing optimism regarding the use of screening and brief intervention (SBI) to identify and reduce risk behaviors during adolescence. However, understanding successful SBI implementation remains unclear. We previously reported the effects of CONNECT, a school-based SBI, on reducing the primary outcome, the rate of monthly alcohol use among primarily American Indian (AI) and White high school students in the Cherokee Nation. In this paper, we describe the design and implementation process for CONNECT. METHOD: CONNECT was designed to reduce alcohol use with 2 key strategies: (1) SBI with motivational interviewing (MI), implemented by a school-based CONNECT coach, and (2) a media campaign. RESULTS: Implementation results indicate that during each semester of the 2-1/2 years, between 73% and 100% of eligible students had at least one 15-minute meeting with a CONNECT coach. Postcards and posters with positive communication tips for parents were displayed in CONNECT communities. No statistically significant differences occurred between the CONNECT and control groups on the hypothesized intermediate outcomes. CONCLUSIONS: We describe implementation of a universal, school-based, culturally adapted SBI that was effective in reducing alcohol use among youth living in the Cherokee Nation. Schools provide an important context for universal delivery of SBI interventions, such as CONNECT, for diverse adolescent populations, including AI youth.

Effects of Alcohol Interventions on Other Drug Use in the Cherokee Nation.

OBJECTIVES: To evaluate effects of 2 alcohol prevention interventions-Communities Mobilizing for Change on Alcohol (CMCA), a community organizing intervention designed to reduce youth alcohol access, and CONNECT, an individual-level screening and brief intervention approach-on other drug use outcomes. METHODS: We conducted a community intervention trial with quarterly surveys over 3 years (2012-2015) of high school students living within the jurisdictional service area of the Cherokee Nation in Oklahoma. We used generalized estimating equations and linear probability models to examine intervention spillover effects on other drug use. RESULTS: We found significant reductions in drug use other than alcohol attributable to CMCA and CONNECT. CMCA was associated with a 35% reduction in chewing tobacco use, a 39% reduction in marijuana use, and a 48% reduction in prescription drug misuse. CONNECT was associated with a 26% reduction in marijuana use and a 31% reduction in prescription drug misuse. CONCLUSIONS: Nonalcohol drug use was consistently reduced as a result of 2 theoretically and operationally distinct alcohol prevention strategies. Evaluations of alcohol prevention efforts should continue to include other drug use to understand the broader effects of such interventions.

Communities mobilizing for change on alcohol (CMCA): secondary analyses of a randomized controlled trial showing effects of community organizing on alcohol acquisition by youth in the Cherokee nation.

AIMS: We evaluated the effects of a community organizing intervention, Communities Mobilizing for Change on Alcohol (CMCA), on the propensity of retail alcohol outlets to sell alcohol to young buyers without age identification and on alcohol acquisition behaviors of underage youth. DESIGN: Random assignment of community to treatment (n = 3) or control (n = 2). Student surveys were conducted four times per year for 3 years; the cohort was in 9th and 10th grades in the 2012-13 academic year. Alcohol purchase attempts were conducted every 4 weeks at alcohol retailers in each community (31 repeated waves). SETTING: The Cherokee Nation, located in northeastern Oklahoma, USA. PARTICIPANTS: A total of 1399 high school students (50% male; 45% American Indian) and 113 stores licensed to sell alcohol across five study communities. INTERVENTION: Local community organizers formed independent citizen action teams to advance policies, procedures and practices of local institutions in ways to reduce youth access to alcohol and foster community norms opposed to teen drinking. MEASUREMENTS: Perceptions regarding police enforcement and perceived difficulty of and self-reported actual acquisition of alcohol from parents, adults, peers and stores. FINDINGS: Alcohol purchases by young-appearing buyers declined significantly, an 18 [95% confidence interval (CI) = 3, 33] percentage-point reduction over the intervention period. Student survey results show statistically significant differences in the trajectory of perceived police enforcement, increasing 7 (4, 10) percentage points, alcohol acquisition from parents, decreasing 4 (0.1, 8) percentage points, acquisition from 21+ adults, decreasing 6 (0.04, 11) percentage points, from < 21 peers decreasing 8 (3, 13) percentage points and acquisition from stores decreasing 5 (1, 9) percentage points. CONCLUSIONS: A community organizing intervention, Communities Mobilizing for Change on Alcohol (CMCA), is effective in reducing the availability of alcohol to underage youth in the United states. Furthermore, results indicate that the previously reported significant effects of CMCA on teen drinking operate, at least in part, through effects on alcohol access.

Multilevel Prevention Trial of Alcohol Use Among American Indian and White High School Students in the Cherokee Nation.

OBJECTIVES: To evaluate the effectiveness of a multilevel intervention designed to prevent underage alcohol use among youths living in the Cherokee Nation. METHODS: We randomly assigned 6 communities to a control, Communities Mobilizing for Change on Alcohol (CMCA; a community-organizing intervention targeting alcohol access) only, CONNECT (a school-based universal screening and brief intervention) only, or a combined condition. We collected quarterly surveys 2012-2015 from students starting in 9th and 10th grades and ending in 11th and 12th grades. Response rates ranged from 83% to 90%; 46% of students were American Indian (of which 80% were Cherokee) and 46% were White only. RESULTS: Students exposed to CMCA, CONNECT, and both showed a significant reduction in the probability over time of 30-day alcohol use (25%, 22%, and 12% reduction, respectively) and heavy episodic drinking (24%, 19%, and 13% reduction) compared with students in the control condition, with variation in magnitude of effects over the 2.5-year intervention period. CONCLUSIONS: CMCA and CONNECT are effective interventions for reducing alcohol use among American Indian and other youths living in rural communities. Challenges remain for sustaining intervention effects.

Effects of context expectation on prospective memory performance among older and younger adults.

This experiment examined the impact of context expectation on prospective memory (PM) performance among older and younger adults. Participants responded to PM target words embedded in an ongoing lexical decision task (LDT). Older and younger adults performed similarly on the PM task. Regardless of age, PM was significantly better for participants in the correct context expectation condition and significantly worse in the incorrect context expectation condition relative to participants who held no expectations about the context in which targets would appear. Participants' LDT response latencies were used to assess cost of the PM task to the ongoing task. Latencies were discernibly longer in the LDT block where the PM targets were expected compared to the block where they were not expected. The findings provide new information about how context can be used to support PM aging and suggest that contextual information can be equally beneficial for older and younger adults.

Early Trajectories of Alcohol and Other Substance Use Among Youth From Rural Communities Within the Cherokee Nation.

OBJECTIVE: This research examines gender and racial/ethnic differences in substance use trajectories during early adolescence among American Indian and non-Native adolescents. METHOD: Substance use trajectories were evaluated among 684 adolescents (50% female, 51% American Indian) across five assessments over 9th and 10th grades. Youth were drawn from six rural towns within the Cherokee Nation, a nonreservation tribal jurisdiction that includes a high proportion of American Indians embedded within a predominantly White population. Past-month substance use was based on self-report and was dichotomized into "used" versus "did not use," with the exception of alcohol, which was trichotomized into "none," "1 or 2 days," or "3-30 days." RESULTS: Using growth mixture modeling with full-information maximum-likelihood estimation, we determined that between two and three different trajectory classes best described the data for each substance. Males had a higher probability compared with females of following a trajectory of chewing tobacco use (20% vs. 6%, respectively) and using multiple substances (24% vs. 19%, respectively). Females had a higher probability compared with males of following a trajectory of prescription drug misuse (11% vs. 6%, respectively). Individuals who followed trajectories of alcohol use or heavy drinking were also more likely to follow trajectories of other substance use. CONCLUSIONS: Identifying gender and racial/ethnic differences in patterns of substance use at this stage of development will inform gender-sensitive and ethnically sensitive prevention programs targeting specific substance use. These results will be particularly informative given the lack of evidence regarding trajectories of substance initiation within largely American Indian populations.

Alcohol Sales to Youth: Data from Rural Communities Within the Cherokee Nation.

Access to alcohol among individuals under 21 years of age continues to be a public health concern with approximately 5000 youth deaths attributable to alcohol each year (US Department of Health and Human Services 2007). To date, there is no research on youth access to alcohol from commercial sources within rural communities with large populations of Native American families. We evaluated commercial access to alcohol by underage-appearing female confederates in 4 rural towns within the Cherokee Nation, a non-reservation tribal jurisdiction that includes a high proportion of Native Americans embedded within a predominately White population. Alcohol purchase attempts were conducted approximately every 4 weeks on 10 occasions for a total of 997 alcohol purchase attempts. In addition to purchase attempt outcome, we collected data on characteristics of the outlets and clerks. Alcohol was sold to confederates without use of age identification on 23 % of all purchase attempts. Across repeated attempts, 76 % of outlets sold alcohol to a confederate at least once. Males and younger clerks were more likely to sell alcohol to the confederates. Grocery stores and gas stations were more likely to sell alcohol to the confederate than liquor stores, but this effect was no longer significant once seller age was accounted for in a multivariable model. Three out of 4 outlets sold alcohol to young-appearing buyers at least once across repeated attempts. Results reinforce the continuing need for regular enforcement of laws against selling alcohol to minors.

Fifteen-minute comprehensive alcohol risk survey: reliability and validity across American Indian and White adolescents.

OBJECTIVE: American Indians (AIs) suffer from significant alcohol-related health disparities, and increased risk begins early. This study examined the reliability and validity of measures to be used in a preventive intervention trial. Reliability and validity across racial/ethnic subgroups are crucial to evaluate intervention effectiveness and promote culturally appropriate evidence-based practice. METHOD: To assess reliability and validity, we used three baseline surveys of high school students participating in a preventive intervention trial within the jurisdictional service area of the Cherokee Nation in northeastern Oklahoma. The 15-minute alcohol risk survey included 16 multi-item scales and one composite score measuring key proximal, primary, and moderating variables. Forty-four percent of the students indicated that they were AI (of whom 82% were Cherokee), including 23% who reported being AI only (n = 435) and 18% both AI and White (n = 352). Forty-seven percent reported being White only (n = 901). RESULTS: Scales were adequately reliable for the full sample and across race/ethnicity defined by AI, AI/White, and White subgroups. Among the full sample, all scales had acceptable internal consistency, with minor variation across race/ethnicity. All scales had extensive to exemplary test-retest reliability and showed minimal variation across race/ethnicity. The eight proximal and two primary outcome scales were each significantly associated with the frequency of alcohol use during the past month in both the cross-sectional and the longitudinal models, providing support for both criterion validity and predictive validity. For most scales, interpretation of the strength of association and statistical significance did not differ between the racial/ethnic subgroups. CONCLUSIONS: The results support the reliability and validity of scales of a brief questionnaire measuring risk and protective factors for alcohol use among AI adolescents, primarily members of the Cherokee Nation.