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Trajectories of Substance Use Among Young American Indian Adolescents: Patterns and Predictors

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Abstract

Substance use often begins earlier among American Indians compared to the rest of the United States, a troubling reality that puts Native youth at risk for escalating and problematic use. We need to understand more fully patterns of emergent substance use among young American Indian adolescents, risk factors associated with escalating use trajectories, and protective factors that can be parlayed into robust prevention strategies. We used growth mixture modeling with longitudinal data from middle-school students on a Northern Plains reservation (Wave 1 N = 381, M age at baseline = 12.77, 45.6 % female) to identify subgroups exhibiting different trajectories of cigarette, alcohol, and marijuana use. We explored how both risk (e.g., exposure to stressful events, deviant peers) and protective (e.g., positive parent–child relationships, cultural identity) factors were related to these trajectories. For all substances, most youth showed trajectories characterized by low rates of substance use (nonuser classes), but many also showed patterns characterized by high and/or escalating use. Across substances, exposure to stress, early puberty, and deviant peer relationships were associated with the more problematic patterns, while strong relationships with parents and prosocial peers were associated with nonuser classes. Our measures of emergent cultural identity were generally unrelated to substance use trajectory classes among these young adolescents. The findings point to the importance of early substance use prevention programs for American Indian youth that attenuate the impact of exposure to stressful events, redirect peer relationships, and foster positive parent influences. They also point to the need to explore more fully how cultural influences can be captured.

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Notes

  1. We initially included a third control variable—adult substance use problems. Cheadle and colleagues found strong relationships between adult substance use and adolescents’ trajectories of early use (Cheadle and Sittner Hartshorn 2012; Cheadle and Whitbeck 2011). As anticipated, the effects of adult substance use problems on class membership were strong and significant, especially for alcohol and marijuana use (odds ratios ranged from 1.35 to 4.18). However, the inclusion of this variable had only a trivial impact on the direction and magnitude of associations between class membership and the other covariates, and missing data on the adult substance use variable resulted in the loss of approximately 100 cases from each analysis. Therefore, we chose to exclude adult substance use from the analyses reported here in order to preserve power and precision for the remaining parameter estimates.

  2. Youth’s responses to the socioeconomic items generally converged with reports from a subsample of parents in this population, although youth tended to underestimate financial hardship relative to their parents (except for reports of food stamps, which were nearly identical). Given this correspondence, combined with the fact that only a small subsample of parents provided data, we chose to present the socioeconomic data reported by youth rather than parents.

  3. We evaluated both continuous and categorical models for the cigarette use outcome. Fit statistics for the one- and two-class categorical models were somewhat improved over the corresponding continuous models. However, we encountered estimation problems with the three- and four-class categorical models. As such, we chose to use the continuous models, which permitted exploration of a larger number of classes.

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Acknowledgments

We thank the schools and the tribal community in which these data were collected for their ongoing support, and the parents, guardians, and youth who gave so generously of their time to complete the surveys. We are grateful for the thoughtful guidance of the EAST Council, our community advisory board, who provided invaluable insights into the interpretation of findings within the local context. This project reflects the dedicated work of project staff, led by Jennifer Desserich, Angela Sam, and Cindy Wheeler, without whom the extensive data collection necessary to this longitudinal project would not have been possible. We appreciate Jacob Cheadle’s input on our analytic design. This research was funded by the National Institute on Drug Abuse (R01 DA027665) and the National Institute of Mental Health (R01 MH069086).

Author contributions

NRW contributed to the conception and design of the study; assisted with the acquisition, analysis, and interpretation of the data; and participated in the preparation of the manuscript. NLA assisted with the analysis and interpretation of data; and participated in the preparation of the manuscript. CEK, CBC, CS, EMK, and CMM contributed to the conception and design of the study; assisted with the acquisition, analysis, and interpretation of the data; and contributed to the intellectual content of the manuscript. ACM contributed to the intellectual content of the manuscript. All authors read and gave final approval of the manuscript.

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Correspondence to Nancy Rumbaugh Whitesell.

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Whitesell, N.R., Asdigian, N.L., Kaufman, C.E. et al. Trajectories of Substance Use Among Young American Indian Adolescents: Patterns and Predictors. J Youth Adolescence 43, 437–453 (2014). https://doi.org/10.1007/s10964-013-0026-2

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