Prevention Science

, Volume 18, Issue 5, pp 545–554 | Cite as

Exploration of Pathways to Binge Drinking Among American Indian Adolescents

  • Mary F. CwikEmail author
  • Summer Rosenstock
  • Lauren Tingey
  • Cleve Redmond
  • Novalene Goklish
  • Francene Larzelere-Hinton
  • Allison Barlow


Binge drinking is a serious public health problem among American Indian adolescents, yet few theoretical models specific to this population and type of problematic drinking have been tested. The White Mountain Apache Tribe has begun surveillance of binge drinking and a related line of research to inform tailored prevention efforts. The goal of this paper is to use structural equation modeling to understand the relationships between different individual, family, peer, and cultural factors that predict or protect against binge drinking behavior among Apache adolescents ages 10–19 years old. A cross-sectional case–control study was completed with N = 68 Apache adolescents who required medical attention due to a recent binge event (past 90 days) and N = 55 controls with no lifetime history of binge drinking. The hypothesized model was estimated with Mplus using the WLSMV robust least squares estimator. In the final model, stressful life events were related to family functioning and peer relationships. In turn, family functioning affected peer relationships and adolescent impulsivity, which were both associated with greater risk of binge drinking. The path between peer relationships and having engaged in binge drinking was statistically significant for those expressing lower cultural identity, but not for those reporting higher cultural identity. Findings suggest preventive interventions should emphasize teaching coping skills to manage life stressors and handle impulsivity, strengthening families, and changing peer dynamics with social network-based approaches as well as social skill training. The model highlights the potentially important role of culture in strengthening positive peer relationships to reduce binge drinking risk.


American Indian Binge drinking Adolescent 


Compliance with Ethical Standards

We are grateful to the national Native American Research Centers in Health initiative, through which grant support was received for this project from the National Institute of General Medical Science and Indian Health Service (grant U26IHS300414; Principal Investigator, Mary F. Cwik, PhD).

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict Of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Society for Prevention Research 2017

Authors and Affiliations

  • Mary F. Cwik
    • 1
    Email author
  • Summer Rosenstock
    • 1
  • Lauren Tingey
    • 1
  • Cleve Redmond
    • 2
  • Novalene Goklish
    • 1
  • Francene Larzelere-Hinton
    • 1
  • Allison Barlow
    • 1
  1. 1.Center for American Indian HealthJohns Hopkins UniversityBaltimoreUSA
  2. 2.Iowa State UniversityAmesUSA

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