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Onset, Comorbidity, and Predictors of Nicotine, Alcohol, and Marijuana Use Disorders Among North American Indigenous Adolescents

Abstract

North American Indigenous (i.e., American Indian and Canadian First Nations) youth experience inequities in rates of substance abuse and dependence. Despite this, few longitudinal studies examine the developmental course of substance use disorders (SUD) among community-based samples of Indigenous youth. The purpose of the study was to examine onset and predictors of nicotine dependence, alcohol use disorders, marijuana use disorders, any SUD, and multiple SUDs across the entire span of adolescence among a longitudinal sample (N = 744) of reservation/reserve Indigenous youth in the upper-Midwest of the United States and Ontario, Canada. Using discrete time survival analysis, the results show that rates of meeting criteria for SUDs by late adolescence were 22% for nicotine, 43% for alcohol, and 35% for marijuana. Peak periods of risk for new nicotine dependence and marijuana use disorder cases occurred around 14 years of age, whereas peak periods of risk for new alcohol use disorder cases emerged slightly later around 16 years of age. We found high rates of SUD comorbidity, and the cumulative probability of developing two or more SUDs during adolescence was 31%. Internalizing disorders increased the odds of nicotine dependence and multiple SUDs, while externalizing disorders increased the odds of all outcomes except nicotine dependence. Gender, age, and per capita family income were inconsistently associated with SUD onset. The findings are embedded within broader substance use patterns identified among Indigenous youth, and prevention, intervention, and treatment implications are discussed.

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Acknowledgements

The authors would like to thank Les Whitbeck and Community Research Councils for their feedback on prior drafts of the manuscript. A previous version of this paper was presented at the 2016 American Sociological Association Annual Meeting in Seattle, WA and at the 2017 Native Children’s Research Exchange in Denver, CO.

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Correspondence to Dane Hautala.

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This research was supported in part by the National Institute on Drug Abuse under grants R01DA13580 and T32DA037183, the National Institute of Mental Health under grant R01MH67281, and the National Institute on Alcohol Abuse and Alcoholism under grant R01AA020299. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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All procedures were approved by the University of Nebraska-Lincoln’s Institutional Review Board and tribal council appointed advisory boards.

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Hautala, D., Sittner, K. & Walls, M. Onset, Comorbidity, and Predictors of Nicotine, Alcohol, and Marijuana Use Disorders Among North American Indigenous Adolescents. J Abnorm Child Psychol 47, 1025–1038 (2019). https://doi.org/10.1007/s10802-018-0500-0

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Keywords

  • American Indian
  • First Nations
  • Psychiatric comorbidity
  • Substance abuse
  • Longitudinal