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CORK Bibliography: Native Americans

80 citations. January 2006 to present

Prepared: September 2008

Bezdek M; Spicer P. Maintaining abstinence in a northern plains tribe. Medical Anthropology Quarterly 20(2): 160-181, 2006. (44 refs.)

In this article, we examine how American Indian individuals with a history of alcohol dependence have been able to maintain their abstinence despite strong pressures to return to drinking. This work builds on close collaboration with individual tribal members who have resolved their problems with alcohol and community-based service providers to develop open-ended qualitative interviews. Using these, we explored bow former drinkers respond to the twin challenges raised by their former drinking associates and strong feelings that emerge when alcohol is no longer an option for coping with life's difficulties. The resolution of these challenges is central to abstinence, given the strong ties between drinking and sociality in some American Indian communities (including the one where this study was conducted) and underscores the ways in which alternate relations to alcohol can be established even within a heavy drinking cultural context. Interviews were conducted with 133 individuals from a northern plains tribe who were identified in a previous epidemiological study as having a lifetime history of alcohol dependence. Inquiry into the processes involved in the meaningful constitution of abstinence for these men and women highlights the role of religion and spirituality for some, but by no means all of these individuals and, more broadly, the emergence of what Bea Medicine has characterized as "new ways of coping," which force us to expand on leading conceptualizations of coping in the literature on problems with alcohol.

Boyd-Ball AJ; Manson SM; Noonan C; Beals J. Traumatic events and alcohol use disorders among American Indian adolescents and young adults. Journal of Traumatic Stress 19(6): 937-947, 2006. (48 refs.)

This study examined the relationship between severe traumatic events and alcohol use disorders in American Indian adolescents and young adults. Interviews of 432 adolescents and young adults who were enrolled tribal members living on or near two closely related American Indian reservations were used. Results indicated that severe trauma increased the odds of alcohol use disorders (p < .001), with the number of traumas having a dose-dependent effect. The authors conclude that trauma is associated with alcohol use disorders in this population. This study's findings yield important insights into the risks in American Indian adolescents and young adults that may result from early trauma, as well as implications for the timing and possible settings for intervention.

Choi WS; Daley CM; James A; Thomas J; Schupbach R; Segraves M et al. Beliefs and attitudes regarding smoking cessation among American Indians: A pilot study. Ethnicity & Disease 16(1): 35-40, 2006. (8 refs.)

Background: American Indians have some of the highest smoking rates in the United States. The Muscogee Nation of Oklahoma developed a culturally targeted program called "Second Wind" based on the American Cancer Society's FreshStart smoking cessation program, but it has not been formally tested. Methods: We conducted six focus groups of American Indians adult smokers at. the Haskell Health Center (Lawrence, Kansas). Focus groups assessed beliefs, attitudes, and behaviors related to smoking cessation, as well as participants' perceptions of the "Second Wind" curriculum's appropriateness and feasibility for this diverse group. Focus groups were audiotaped, transcribed, coded, and analyzed for content themes. Participants were 41 American Indians adults (63% female), 21-67 years of age. Participants smoked an average of 13 cigarettes per day, half had made a quit attempt in the past year, and 63% were daily smokers. For pharmacotherapy, most preferred the nicotine patch. Results: Focus group responses were categorized into three major themes: traditional tobacco use, quitting and quit attempts, and the "Second Wind" program. Those who reported that traditional tobacco use is important were less inclined to use tobacco recreationally. Second Wind modifications suggested by participants included increasing use of At imagery and addressing the meaning of tobacco to American Indians cultures. Conclusions: American Indian smokers are unique because of their traditional use of tobacco. Our participants felt that smoking cessation can be accomplished without discouraging traditional use of tobacco. We suggest ways to improve the "Second Wind" curriculum so that it is targeted for a heterogeneous group of American Indians smokers.

Chong J; Lopez D. Predictors of relapse for American Indian women after substance abuse treatment. American Indian and Alaska Native Mental Health Research 14(3): 24-48, 2008. (58 refs.)

The objective of this study was to describe the predictors of substance use relapse of American Indian (AI) women up to one year following substance abuse treatment. Relapse is defined as any use of alcohol or drugs in the past 30 days at the follow-up points. Data were collected from AI women in a 45-day residential substance abuse treatment program. Predictors include distal (in time) proximal (recent), and intrapersonal factors. Results indicated that intrapersonal factors showed the strongest relationship with relapse, followed by proximal and distal factors. Negative messages about using alcohol or drugs from the client's father while growing up may have had an impact on whether the client used alcohol at 6 months. Conflicts with other people and being in the company of alcohol or drug users were highly predictive of relapse. While craving was highly predictive of substance use at follow up, self-efficacy was highly predictive of no substance use. Knowledge about predictors of relapse among this population should be used as a guide toward individual treatment planning.

Chou SP; Grant BF; Dawson DA; Stinson FS; Saha T; Pickering RP. Twelve-month prevalence and changes in driving after drinking - United States, 1991-1992 and 2001-2002 (reprinted from Drug and Alcohol Dependence, vol 80, pg 223, 2005). Alcohol Research & Health 29(2): 143-151, 2006. (32 refs.)

Background: Drinking and driving has been identified as one of the most important contributors of motor vehicle fatalities. This paper addressed the existing gap in our public health knowledge regarding the current prevalence of driving after drinking and how this has changed over the past decade. Methods: Prevalence rates of drinking and driving in 2001-2002, and changes in those prevalence rates between 1991-1992 and 2001-2002, were examined in two large nationally representative surveys of the U.S. population. Results: Overall, the prevalence of driving after drinking was 2.9 percent in 2001-2002, representing approximately six million U.S. adults. This rate was about three-quarters of the rate observed in 1991-1992 (3.7 percent), reflecting a 22-percent reduction. Generally, the male-female differentials in the rate of driving after drinking decreased over the past decade. However, the sex ratios increased substantially for underaged youth over the past decade, reflecting the sharp decrease in prevalence of driving after drinking among 18- to 20-year-old women. Constant and emerging subgroups at high risk for drinking and driving included Whites, Native Americans, males, underaged young adults, and 21- to 25 year-olds. Conclusions: The results of this study highlighted the need to continue to monitor prevalence and changes in driving after drinking. Results are discussed in the context of strengthening existing prevention and intervention efforts and developing new programs with the sociodemographic differentials observed in this study in mind.

Public Domain

Clarimon J; Gray RR; Williams LN; Enoch MA; Robin RW; Albaugh B; Singleton A et al. Linkage disequilibrium and association analysis of alpha-synuclein and alcohol and drug dependence in two American Indian populations. Alcoholism: Clinical and Experimental Research 31(4): 546-554, 2007. (43 refs.)

Background: alpha-Synuclein is involved in dopaminergic neurotransmission and has been implicated in a number of neurodegenerative disorders, such as Parkinson's disease. Recent studies, in humans and in rat and monkey models, have suggested that alpha-synuclein may play a role in the development and maintenance of certain addictive disorders. Methods: Fifteen single-nucleotide polymorphisms (SNPs) in the alpha-synuclein gene (SNCA) and 1 upstream microsatellite repeat (NACP-REP1) were assayed in Southwest (SW; n=514) and Plains (n=420) American Indian populations. Patterns of linkage disequilibrium (LD) at SNCA were determined for the 2 populations and compared with Caucasian, African, and Asian populations in the HapMap database (http: www.hapmap.org). Assayed alleles and constructed haplotypes in the study populations were tested for association with 4 clinical phenotypes [alcohol dependence, alcohol use disorders, drug dependence, and drug use disorders (lifetime diagnoses)] as well as with 2 symptom count phenotypes (all 18 questions and the 8 questions diagnostic for alcohol dependence). Results: Patterns of LD at SNCA were similar in both Indian populations and were consistent with the LD structure in other populations as reflected in the HapMap database. Single allele tests revealed significant associations between 4 SNPs and drug dependence in the SW population and between 2 of those SNPs plus 2 other SNPs and drug dependence in SW males only. In the Plains population, a significant association was detected only in males between 2 SNPs and alcohol use disorders and between 1 SNP and alcohol dependence. In the SW population, 1 SNP was marginally significant with the total symptom count. However, in all cases, the support was modest and disappeared with correction for multiple comparisons. No association was found between constructed haplotypes and any of the phenotypes in either population. Conclusions: Despite modest support for association between multiple SNCA SNPs and several of the addictive disorders tested in this study, statistical significance disappeared after correction for multiple testing. Thus, our data do not support a role for a variant in the SNCA gene that contributes to alcohol or drug addiction in the 2 studied American Indian populations. Future research may focus on variants in the promoter region that could cause the changes in mRNA and protein levels observed in previous studies.

Criado JR; Ehlers CL. Electrophysiological responses to affective stimuli in southwest California Indians: Relationship to alcohol dependence. Journal of Studies on Alcohol and Drugs 68(6): 813-823, 2007. (97 refs.)

Objective: Native Americans have some of the highest rates of alcohol abuse and dependence, yet potential risk factors associated with the problem drinking seen in some tribes remain relatively unknown. The present investigation evaluated associations between the P350 and P450 components of the event-related potential (ERP) elicited by affective stimuli and potential vulnerability factors associated with risk of alcohol dependence in Southwest California (SWC) Indian adults. Method: Data from 517 Native American SWC Indian adults between the ages of 18 and 70 were used in the analyses. ERPs were collected using a task that required discrimination among faces with neutral, sad, and happy facial expressions. Results: P450 amplitudes were significantly reduced in participants who met lifetime Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria for alcohol dependence in centroparietal leads. In contrast, participants who met personal lifetime criteria for affective disorder were found to have higher P350 and P450 amplitudes in frontal leads. Neither P350 nor P450 component amplitudes were significantly altered based on a family history of alcohol dependence, a personal history of antisocial personality disorder/conduct disorder, or the presence of drug dependence other than alcohol. Conclusions: These findings suggest, in this select population, that P450 amplitudes are selectively affected by both alcohol dependence and affective disorder. However, reductions in P450 amplitude were restricted to those participants with alcohol dependence, confirming that it may be an important putative endophenotype for genetic studies of that disorder in this high-risk population.

Doolan DM; Froelicher ES. Efficacy of smoking cessation intervention among special populations: Review of the literature from 2000 to 2005. Nursing Research 55(4, Supplement S): S29-S37, 2006. (68 refs.)

The United States Public Health Service acknowledges in the 2000 Clinical Practice Guideline for Treating Tobacco Use and Dependence that certain special populations have unique needs and considerations in regard to smoking cessation interventions. In a review of the current smoking cessation literature, the following special populations were identified: women; older adults; gay, lesbian, bisexual, and transgender smokers; smokers with psychiatric diagnoses; smokers addicted to illicit drugs, alcohol, or both; American Indians and Alaska Natives; African Americans; Hispanic; and Asian Americans. Existing smoking cessation research pertaining to these special populations was assessed, and an agenda for future research is proposed in this presentation. The available smoking cessation randomized clinical trials for efficacy and other research relevant to these groups is insufficient. Recent progress has been made in research in the areas of smoking cessation and women; smokers with psychiatric diagnoses; smokers addicted to illicit drugs, alcohol, or both; and African Americans. There is, however, a paucity of research evaluating smoking cessation interventions and older adults; gay, lesbian, bisexual, and transgender smokers; American Indians and Alaska Natives; Hispanic; and Asian Americans. Further research relevant to the smoking cessation needs of these special populations can enable nurses and other healthcare providers to administer culturally adequate and efficacious smoking cessation interventions to these groups.

Doshi SR; Jiles R. Health behaviors among American Indian/Alaska native women, 1998-2000 BRFSS. Journal of Women's Health 15(8): 919-927, 2006. (37 refs.)

Background and objective: Minority populations, including American Indians and Alaska Natives (AI/AN), in the United States generally experience a disproportionate share of adverse health outcomes compared with whites. The prevalence of risk behaviors associated with these adverse health outcomes among AI/AN women is not well documented, especially for those who live outside areas serviced by Indian Health Service. We sought to describe the prevalence of selected health risk behaviors among AI/AN women, document the disparities between AI/AN women and all U. S. women, and demonstrate the efforts needed for AI/AN women to reach Healthy People 2010 goals. Methods: Age-adjusted prevalence estimates for selected sociodemographic characteristics, current smoking, obesity, lack of leisure time physical activity, and binge drinking were calculated using Behavioral Risk Factor Surveillance System (BRFSS) data from 1998 to 2000, combined. Comparisons were made between prevalence estimates for AI/AN women and all women who participated in the BRFSS and Health People 2010 goals Results: The prevalences of current smoking (27.8%) and obesity (26.8%) were significantly higher among AI/AN women than among all U. S. women. AI/AN women did not meet Healthy People 2010 goals for current smoking, obesity, leisure time physical activity, or binge drinking. Conclusions: These data highlight both disparities in health risk behaviors between AI/AN women and all U. S. women and improvements needed for AI/AN women to meet Healthy People 2010 goals. This project demonstrates the overwhelming need for culturally appropriate and accessible prevention programs to address health risk behaviors associated with the leading causes of death among urbanized AI/AN women.

Ehlers CL. Variations in ADH and ALDH in southwest California Indians. Alcohol Research & Health 30(1): 14-17, 2007. (17 refs.)

Native Americans as a group have the highest rates of alcohol-related deaths of all ethnicities in the United States, however, it remains unclear how and why a greater proportion of individuals in some Native American communities develop alcohol-related problems and alcohol use disorders (AUDs). One potential factor that can influence responses to alcohol are variations in alcohol-metabolizing enzymes. Researchers have analyzed the frequencies of variants in the alcohol-metabolizing enzymes alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) in some Native American populations. So far the studies have yielded no evidence that an ALDH2 variant, which has shown protective effects in other populations, is found in either American Indians or Alaska Natives. A variant of the ALDH1 enzyme that is encoded by the ALDH1A1 *2 allele, however, was found in a small proportion of a group of Southwest California Indians and had a protective effect against alcoholism in that population. Furthermore, a variant of the ADH1B enzyme that is encoded by the ADH1B *3 allele was found in a similar proportion of Southwest California Indians and also was associated with a protective effect. However, these findings do not explain the high prevalence of alcoholism in the tribes investigated.

Public Domain

Ehlers CL; Gilder DA; Phillips E. P3 components of the event-related potential and marijuana dependence in Southwest California Indians. (review). Addiction Biology 13(1): 130-142, 2008. (111 refs.)

Native Americans have some of the highest rates of marijuana use and abuse, yet neurobiological measures associated with addiction to marijuana in this population remain unknown. The present investigation evaluated associations between the P350 and P450 components of the event-related potential (ERP) elicited by affective stimuli, and marijuana dependence in a population of Southwest California (SWC) Indian adults. Three hundred and seventeen participants with a mean age of 30 years who were free of major Axis I and psychiatric diagnoses and antisocial personality disorder were categorized as: (1) no marijuana use disorders or other drug dependence diagnoses; (2) marijuana dependence and no other drug dependence diagnoses; and (3) marijuana dependence and other drug dependence diagnoses. ERPs were collected using a facial discrimination task that generated a late positive component with two peaks at approximately P350 and P450 milliseconds. Multivariate analyses of variance was used to detect associations between the two component peaks and the three participant groups taking into consideration age, gender and the presence of a lifetime diagnosis of alcohol dependence. Increases in the latency of both the P350 and P450 component peaks were found to be associated with the diagnosis of marijuana dependence and marijuana dependence co-morbid with other drug dependence. Women appeared to be more impacted than men are. A diagnosis of marijuana dependence was not associated with any changes in late component amplitudes. Taken together these studies suggest that marijuana dependence may be associated with delays in the evaluation and identification of emotional stimuli in SWC Indians.

Ehlers CL; Slutske WS; Gilder DA; Lau P; Wilhelmsen KC. Age at first intoxication and alcohol use disorders in southwest California Indians. Alcoholism: Clinical and Experimental Research 30(11): 1856-1865, 2006. (84 refs.)

Background: In several national surveys, a younger age of onset of first drink and/or regular drinking has been associated with a higher likelihood of the development of alcohol dependence. Some studies have suggested that age at first drink is primarily an environmentally driven variable whereas others suggest that it may be partially mediated by a general vulnerability to exhibit problem behaviors. Although Native Americans, overall, have the highest prevalence of alcohol dependence of any U.S. ethnic group, the relationship of age of onset of intoxication with alcohol dependence in Native American populations is relatively unknown. Methods: Demographic information and DSM-III-R diagnoses were obtained from 525 Southwest California (SWC) Indian adults residing on contiguous reservations. Survival analyses and Cox and logistic regression were used to investigate the relationship between age of onset of first intoxication and the development of alcohol dependence. Heritability of the age of onset of first intoxication was also determined using SOLAR. Results: Age at first intoxication was not found to be heritable in this population. Early onset of intoxication, however, was found to be significantly associated with both a shorter time to onset of alcohol dependence and increased prevalence in this population, even on taking into account several other risk factors including externalizing diagnoses. Conclusions: These data suggest that effective environmental prevention efforts at reducing underage drinking may be an important strategy to lower the prevalence of alcohol dependence in this high-risk population.

Ehlers CL; Slutske WS; Gilder DA; Lau P. Age of first marijuana use and the occurrence of marijuana use disorders in Southwest California Indians. Pharmacology, Biochemistry and Behavior 86(2): 290-296, 2007. (82 refs.)

in several national surveys a younger age of substance usage has been associated with a higher likelihood of the development of dependence. Some studies have suggested that age at first use is primarily an environmentally driven variable, whereas others suggest that it may be partially mediated by a general vulnerability to exhibit problem behaviors. Although Native Americans, overall, have the highest prevalence of substance dependence of any US ethnic group, the relationship of age of first marijuana use on the development of dependence in Native American populations is relatively unknown. Demographic information and DSM-III-R diagnoses were obtained from 525 Southwest California Indian adults residing on contiguous reservations. Multinomial logistic regression was used to investigate the relationship between age of first use and marijuana use disorders. Early marijuana use was found to be strongly associated with abuse and dependence in this population, even in the presence of several other risk factors including externalizing diagnoses. These data suggest that effective environmental prevention efforts at reducing early marijuana use may be an important strategy to lower the prevalence of use disorders in this high risk population.

Ehlers CL; Wall TL; Corey L; Lau P; Gilder DA; Wilhelmsen K. Heritability of illicit drug use and transition to dependence in Southwest California Indians. Psychiatric Genetics 17(3): 171-176, 2007. (56 refs.)

Objective: Native Americans have high rates of drug use and dependence yet little is known concerning its etiology or clinical course. These analyses were conducted to describe the heritability of the use of a variety of illicit drugs, as well as the conditional probability of transitioning from use to dependence for each drug class in a community sample of Native American men and women. Methods: The sample included 460 participants (1190 men and 270 women), recruited through community effort, from eight contiguous Indian reservations in Southern California. Participants were assessed using the Semi-Structured Assessment for the Genetics of Alcoholism. The Semi-Structured Assessment for the Genetics of Alcoholism interview retrospectively asks about the initial use and drug dependence of the following illicit drug classes: marijuana, cocaine, stimulants, sedatives, opiates, hallucinogens, and solvents. Heritability of initial use was determined using SOLAR (http: www.sfbr.orglsolarl). Results: Ninety-one percent of this select Indian population had tried at least one of the illicit drug classes. The most commonly tried substance was marijuana (88%), followed by stimulants (60%), cocaine (44%), hallucinogens (34%), and solvents (20%). The heritability of initiation of drug use ranged from 0.14 for cocaine to 0.59 for marijuana. The conditional probability of transition from initiation to drug dependence ranged from 0.66 for stimulants to 0.06 for hallucinogens. Conclusions: These findings suggest that heritability of the initiation of substance use, in Southwest California Indians, may be similar to other population samples. In this population, however, high rates of dependence on marijuana, opiates, and stimulants are seen once initiation of the use of the substance has occurred.

Ehlers CL; Wilhelmsen KC. Genomic screen for loci associated with tobacco usage in Mission Indians. BMC Medical Genetics 7(AR 9), 2006. (64 refs.)

Background: The prevalence of tobacco usage in Native American adults and adolescents is higher than any other racial or ethnic group, yet biological risk and protective factors underlying tobacco use in this ethnic group remain unknown. A genome scan for loci associated with tobacco use phenotypes was performed with data collected from a community sample of Mission Indians residing in Southwest California. Methods: A structured diagnostic interview was used to define two tobacco use phenotypes: 1) any regular tobacco usage ( smoked daily for one month or more) and 2) persistent tobacco usage ( smoked at least 10 cigarettes a day for more than one year). Heritability was determined and a linkage analysis was performed, using genotypes for a panel 791 microsatellite polymorphisms, for the two phenotypes using variance component methods implemented in SOLAR. Results: Analyses of multipoint variance component LOD scores for the two tobacco use phenotypes revealed two scores that exceeded 2.0 for the regular use phenotype: one on chromosomes 6 and one on 8. Four other loci on chromosomes 1,7,13, and 22 were found with LOD scores between 1.0 and 1.5. Two loci of interest were found on chromosomes 1 and 4 for the persistent use phenotype with LOD scores between 1.3 - 1.5. Bivariate linkage analysis was conducted at the site on chromosome 4 for persistent tobacco use and an alcohol drinking severity phenotype previously identified at this site. The maximum LOD score for the bivariate analysis for the region was 3.4, however, there was insufficient power to exclude coincident linkage. Conclusion: While not providing evidence for linkage to specific chromosomal regions these results identify regions of interest in the genome in this Mission Indian population, for tobacco usage, some of which were identified in previous genome scans of non-native populations. Additionally, these data lend support for the hypothesis that cigarette smoking, alcohol dependence and other consumptive behaviors may share some common risk and/or protective factors in this Mission Indian population.

Ehlers CL; Wilhelmsen KC. Genomic screen for substance dependence and body mass index in southwest California Indians. Genes, Brain and Behavior 6(2): 184-191, 2007. (69 refs.)

Substance abuse and obesity are health disparities that may afflict Native Americans more than some other ethnic groups. One theoretical assumption concerning Native people is that the long history of dependence on foraging and subsistence agriculture may have led to selective enrichment of traits that improve genetic fitness, so called 'thrifty' or 'fat sparing' genes. We have speculated that this same selective pressure may have enriched for genetic variants that increase the risk for consumption of alcohol and drugs of abuse. Here, we report the results of a genome scan that compared findings for two consumption phenotypes: 'any drug dependence and/or regular tobacco use' and body mass index (BMI) in southwest California (SWC) Indian families. Variance component analyses from SOLAR were used to generate log of the odds ratio (LOD) scores. Evidence for linkage was found on chromosome 6 for both the 'any drug' (LOD score = 3.3) and BMI (LOD score = 2.3) phenotypes. Bivariate analyses of the two phenotypes revealed a combined LOD score of 4.1 at that location. Additional loci on chromosomes 6, 15, 16 and 21 were found for the 'any drug' phenotype, and on chromosomes 8, 16 and 18 for BMI (LOD scores ranged between 1.2 and 2.3). These results provide suggestive evidence for linkage for substance abuse and BMI in this Mission Indian population and, furthermore, provide preliminary data suggesting that 'consumption phenotypes' may share some genetic determinants.

Enoch MA; Waheed JF; Harris CR; Albaugh B; Goldman D. Sex differences in the influence of COMT Val158Met on alcoholism and smoking in Plains American Indians. Alcoholism: Clinical and Experimental Research 30(3): 399-406, 2006. (47 refs.)

Background: Alcoholism and heavy smoking are highly comorbid and are cotransmitted in the general U.S. population; however little is known about comorbidity in American Indians. The catechol-O-methyltransferase (COMT) functional polymorphism, Val158Met, has been associated with alcoholism in Caucasians. The aims of our study were firstly to investigate patterns of alcohol and tobacco consumption and comorbidity between alcoholism and smoking in Plains American Indians and secondly to determine the influence, including sexual dimorphic effects, of COMT Val158Met and COMT haplotypes, on these behaviors. Methods: Diagnostic and Statistical Manual-III-R lifetime diagnoses were assigned to 342 community-ascertained Plains American Indians (201 women, 141 men). Lifetime drinking and smoking histories were obtained. Five COMT loci, including Val158Met, were genotyped. Haplotype-based analyses identified 1 block with 3 common haplotypes; 2 included Val158, and I had the Met158 allele. Results: The alcoholics drank heavily (12 +/- 8 drinks/drinking day) but episodically (max 10 +/- 8 d/mo). Although 62% of male alcoholics and 40% of female alcoholics were smokers (>= 10 cigarettes/d), only 12% of alcoholic men and 8% of alcoholic women smoked heavily (> 20/d). In women, the COMT Val158 allele frequency was maximal in alcoholic smokers (0.85), decreasing to 0.74 in nonalcoholic smokers, 0.67 in alcoholic nonsmokers, and 0.64 in nonalcoholic nonsmokers (chi(2) = 11.1, 3 df, p = 0.011). Women showed a main effect of Val158 on smoking (p = 0.003). Both male and female alcoholics were more likely to have at least 1 Val158 allele compared with nonalcoholics (0.95 vs 0.88, p < 0.05). Approximately 30% of all participants were long-term, nonaddicted light, social smokers (3.6 +/- 1.7 cigarettes/d); they had the same Val158Met frequencies as nonsmokers. Haplotype analyses supported the Val158Met findings; however, only 1 of the 2 Val158 haplotypes was implicated. Conclusions: Plains Indians have different smoking and drinking patterns and considerably less comorbidity between alcoholism and heavy smoking compared with the general U.S. population. Our COMT Val158Met results suggest that there may be both sex differences in the genetic origins of alcoholism and smoking in this population and overlap in genetic vulnerability to both addictions in women.

Evans-Campbell T; Lindhorst T; Huang B; Walters KL. Interpersonal violence in the lives of urban American Indian and Alaska native women: Implications for health, mental health, and help-seeking. American Journal of Public Health 96(8): 1416-1422, 2006. (34 refs.)

Objective. We surveyed American Indian/Alaska Native (AIAN) women in New York City to determine the prevalence of 3 types of interpersonal violence among urban AIAN women and the behavioral health and mental health factors associated with this violence. Methods. Using a survey, we questioned 112 adult AIAN women in New York City about their experiences with interpersonal violence, mental health, HIV risk behaviors, and help-seeking. The sampling plan utilized a multiple-wave approach with modified respondent-driven sampling, chain referral, and target sampling. Results. Among respondents, over 65% had experienced some form of interpersonal violence, of which 28% reported childhood physical abuse, 48% reported rape, 40% reported a history of domestic violence, and 40% reported multiple victimization experiences. Overwhelmingly, women experienced high levels of emotional trauma related to these events. A history of interpersonal violence was associated with depression, dysphoria, help-seeking behaviors, and an increase in high-HIV risk sexual behaviors. Conclusions. AIAN women experience high rates of interpersonal violence and trauma that are associated with a host of health problems and have important implications for health and mental health professionals.

Fagan P; Moolchan ET; Lawrence D; Fernander A; Ponder PK. Identifying health disparities across the tobacco continuum. (review). Addiction 102(Supplement 2): 5-29, 2007. (179 refs.)

Aims: Few frameworks have addressed work-force diversity, inequities and inequalities as part of a comprehensive approach to eliminating tobacco-related health disparities. This paper summarizes the literature and describes the known disparities that exist along the tobacco disease continuum for minority racial and ethnic groups, those living in poverty, those with low education and blue-collar and service workers. The paper also discusses how work-force diversity, inequities in research practice and knowledge allocation and inequalities in access to and quality of health care are fundamental to addressing disparities in health. Methods: We examined the available scientific literature and existing public health reports to identify disparities across the tobacco disease continuum by minority racial/ethnic group, poverty status, education level and occupation. Findings: Results indicate that differences in risk indicators along the tobacco disease continuum do not explain fully tobacco-related cancer consequences among some minority racial/ethnic groups, particularly among the aggregate groups, blacks/African Americans and American Indians/Alaska Natives. The lack of within-race/ethnic group data and its interactions with socio-economic factors across the life-span contribute to the inconsistency we observe in the disease causal paradigm. Conclusions: More comprehensive models are needed to understand the relationships among disparities, social context, diversity, inequalities and inequities. A systematic approach will also help researchers, practitioners, advocates and policy makers determine critical points for interventions, the types of studies and programs needed and integrative approaches needed to eliminate tobacco-related disparities.

Fickenscher A; Novins DK; Manson SM. Illicit peyote use among American Indian adolescents in substance abuse treatment: A preliminary investigation. Substance Use & Misuse 41(8): 1139-1154, 2006. (50 refs.)

Few studies to date have addressed illicit (i.e., nonceremonial) peyote use among American Indians (AIs). Participants were 89 AI adolescents admitted to a tribally operated residential substance abuse treatment program (RSATP) between 1998 and 2001. The RSATP is designed to provide specialized treatment of patients with substance use and other comorbid psychiatric disorders and is infused with a culturally sensitive approach to treatment. The participants completed a series of interviews that collected information on psychiatric diagnostic status, history of substance use, and ethnic identity. The majority of participants were male (65%), did not come from a two-parent household (75%), reported a mean use of 5.4 substances, and met full criteria for a median of 2.9 substance use disorders. Of 89 clients, 10 (11.2%) reported illicit use of peyote. The vast majority of these youth (n = 8) reported using peyote only once or twice in their lifetime. Illicit peyote users did not differ from nonusers in terms of age, gender, other substance use, prevalence of either other substance abuse/dependence or other nonsubstance use psychiatric disorders. However, illicit peyote users were more likely to report low levels of social support, low levels of self-esteem, and low identification with AI culture yet comparable involvement in AI traditional practices. The results of this exploratory study suggest that illicit peyote use is uncommon among AI adolescents with serious substance abuse problems.

Fickenscher A; Novins DK; Beals J. A pilot study of motivation and treatment completion among American Indian adolescents in substance abuse treatment. Addictive Behaviors 31(8): 1402-1414, 2006. (56 refs.)

This study assessed intrinsic and extrinsic motivation toward treatment among American Indian adolescents 13-18 years old admitted to a residential substance abuse treatment program and the relationship of these measures to treatment completion. Participants completed a questionnaire regarding motivation towards treatment and a diagnostic interview. Participant treatment records were also reviewed. Being an older adolescent (16-18 years old), having higher scores on a scale measuring treatment readiness and endorsing a single question regarding concern about legal problems were all associated with treatment completion. The relationship of an additional scale measuring desire for help with substance use problems was mediated by the measure of treatment readiness. This pilot study is the first to assess the relationship of motivation toward substance abuse treatment completion among American Indian adolescents and provides preliminary evidence of the applicability of these concepts to this treatment population. These concepts and their related therapeutic approaches warrant further study in this population.

Galliher RV; Evans CM; Weiser D. Social and individual predictors of substance use for Native American youth. Journal of Child & Adolescent Substance Abuse 16(3): 1-16, 2007. (29 refs.)

Substance abuse is a primary concern for youth worldwide and increasingly so for Native American Youth. Guided by theoretical models of the socialization of substance use in children and adolescents, we conducted a preliminary examination of socialization factors specific to Native American Youth. Strong, pro-social bonds with three primary socialization sources (family, school, and peer networks) were hypothesized to facilitate child self-efficacy and refusal skills and predict drug use. Participants were 84 Native American children between the ages of 9 and 11, living on or near a northern reservation. Structural path analysis results Indicated that self-efficacy was predicted from school bonding and peer social skills, while refusal skills were predicted from parent support/involvement and school bonding. Both self-efficacy and refusal skills predicted child drug use/experimentation. This preliminary study expands the limited research available for substance abuse prevention projects specific to rural, reservation-based Native American communities.

Gilder DA; Lau P; Dixon M; Corey L; Phillips E; Ehlers CL. Co-morbidity of select anxiety, affective, and psychotic disorders with cannabis dependence in Southwest California Indians. Journal of Addictive Diseases 25(4): 67-79, 2006. (16 refs.)

Cannabis dependence is co-morbid with psychiatric disorders in general population surveys, but whether co-morbidity exists in American Indian populations is unknown. The aim of this study was to assess co-morbidity between cannabis dependence and psychiatric disorders in a community sample of Southwest California (SWC) Indians. Demographic information and DSM-III-R diagnoses, including differentiation of independent and cannabis-induced psychiatric disorders, were obtained using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) developed for the Collaborative Study on the Genetics of Alcoholism (COGA) from 513 SWC Indian adults residing on contiguous reservations. Although SWC Indians in this sample had high rates of cannabis dependence (43% in men and 24% in women), cannabis-induced psychiatric disorders each occurred in 1% or less of the sample. No significant co-morbidity with independent psychiatric disorders was found. In SWC Indians, cannabis dependence may be less etiologically related to psychiatric disorders than in the general population.

Gilder DA; Lau P; Corey L; Ehlers CL. Factors associated with remission from cannabis dependence in Southwest California Indians. Journal of Addictive Diseases 26(4): 23-30, 2007. (41 refs.)

Cannabis is the most widely used illicit substance in the United States, and rates of cannabis use disorders in some Native American samples have been reported to be higher than in the general U.S. Population. However, little is known about factors which are associated with remission from cannabis dependence in any ethnicity. Using the SSAGA, this study examined variables associated with complete remission (defined as no symptoms of dependence for 6 months or more) from DSM-III-R cannabis dependence in 159 Southwest California Indians living on contiguous reservations. Female gender, employment, having, more cannabis-induced symptoms, and a shorter duration of dependence were all associated with an increased likelihood of remission. Attention to factors associated with remission from cannabis dependence may be important in designing more effective treatment and intervention programs in this high-risk population.

Gilligan C; Sanson-Fisher R; Eades S; D'Este C. Antenatal smoking in vulnerable population groups: An area of need. Journal of Obstetrics and Gynaecology 27(7): 664-671, 2007. (49 refs.)

Antenatal smoking is a potentially preventable risk factor associated with pre-term birth and low birth weight. Rates of antenatal smoking, low birth weight, and infant mortality are all higher among the Indigenous populations than the non-Indigenous populations of Australia, Canada, New Zealand and the USA. Given this, it might be expected that publications examining smoking cessation efforts in Indigenous antenatal groups would be substantive. We examined the differences in the number and type of antenatal smoking publications for Indigenous and non-Indigenous populations across three time periods (1984-86, 1994-96 and 2004-06). Articles were classified as research studies (focusing on measurement, descriptive, or intervention studies), literature reviews, descriptions of programmes or research (with no data), or discussions. There was a significant increase in the number of publications relating to antenatal smoking among Indigenous populations in the time periods examined, but the total number of publications remained small. The number relating to general antenatal populations increased, but remained substantially lower than that relating to low birth weight. There was no increase in the proportional allocation of research articles to the intervention category in the later time period. The pattern of research output relating to antenatal smoking by mainstream or Indigenous populations is not optimal for advancement of knowledge in the field. There is a clear need for intervention-based research to allow the development of evidence-based practice for reducing the prevalence of antenatal smoking and associated health issues.

Gonzales AA; Lyson TA; Mauer KW. What does a casino mean to a tribe? Assessing the impact of casino development on Indian reservations in Arizona and New Mexico. Social Science Journal 44(3): 405-419, 2007. (14 refs.)

Using data from the 1990 and 2000 U.S. Census of Population and Housing, we examine five social and economic characteristics of individuals and households living on reservations in Arizona and New Mexico that have a casino to those that do not. This research differs in two ways from previous studies that have attempted to assess the social and economic impacts of Indian gaming. First, the unit of observation and analysis is the reservation, not a tribe. A focus on reservations allows us to assess the role casinos play in "place-based" economic development. Second, since reservations and tribes are not coterminous, we seek to differentiate the effects of casinos on the Indian population living on reservations from the effects for all reservation residents (Indians and others). The results show that casino gambling is associated with improvements in social and economic welfare for both the Indian and non-Indian populations alike. However, Indian gaming did not contribute to positive outcomes in all cases. Indeed, the effects of gaming are filtered through a myriad of structural and cultural contexts that shape who wins and who loses when a casino opens on a reservation. The implications of Indian gaming for economic development are discussed.

Horn K; McCracken L; Dino G; Brayboy M. Applying community-based participatory research principles to the development of a smoking-cessation program for American Indian teens: "Telling our story". Health Education & Behavior 35(1): 44-69, 2008. (50 refs.)

Community-based participatory research provides communities and researchers with opportunities to develop interventions that are effective as well as acceptable and culturally competent. The present project responds to the voices of the North Carolina American Indian (AI) community and the desire for their youth to recognize tobacco addiction and commercial cigarette smoking as debilitating to their health and future. Seven community-based participatory principles led to the AI adaptation of the Not On Tobacco teen-smoking-cessation program and fostered sound research and meaningful result s among an historically exploited population. Success was attributed to values-driven, community-based principles that (a) assured recognition of a community-driven need, (b) built on strengths of the tribes, (c) nurtured partnerships in all project phases, (d) integrated the community's cultural knowledge, (e) produced mutually beneficial tools/products, (f) built capacity through co-learning and empowerment, (g) used an iterative process of development, and (h) shared findings /knowledge with all partners.

Johnson JL; Gryczynski J; Wiechelt SA. HIV/AIDS, substance abuse, and hepatitis prevention needs of Native Americans living in Baltimore: In their own words. AIDS Education and Prevention 19(6): 531-544, 2007. (22 refs.)

A needs assessment funded by the Center of Substance Abuse Prevention was conducted in 2005-2006 to determine the HIV/AIDS, substance abuse, and hepatitis prevention needs of Native Americans living in Baltimore, Maryland. We used a community-based participatory approach to gain an in-depth understanding of local Native American health service needs. Community stakeholders and key informants embedded in the local Native American population were consulted at each stage of the research planning process. Two complementary methodologies (focus groups and surveys) produced a holistic assessment of the population's needs, risks, and strengths and uncovered the social and cultural contexts in which health risk behaviors unfold. The use of these methods within a participatory framework produced a more complete portrait of the service needs of the Native American population in Baltimore. Findings from this study support the necessity for future HIV/AIDS, substance abuse, and hepatitis prevention programming for urban Native Americans.

Kunitz SJ. Life-course observations of alcohol use among Navajo indians: Natural history or careers? Medical Anthropology Quarterly 20(3): 279-296, 2006. (26 refs.)

In this article, I describe changes in patterns of alcohol use and abuse among Navajo Indians from the mid-1960s to the late 1990s. The prevalence of alcohol dependence continues to be higher than in the general U.S. population, but remission is also common, as it was in the 1960s and previously. Men have substantially higher rates of alcohol dependence than women. The former engage in heavy drinking largely in response to the heavy drinking of those around them. The latter drink excessively largely as a response to psychiatric disorders, depression, and abuse by a partner or husband. As increasing numbers of people have moved to reservation and border towns, a youth culture has developed in which alcohol use is initiated by teenagers with their peers rather than, as in the past, with older kinsmen. Alcohol use has thus been freed from the constraints imposed by both isolation and family obligations.

Kunitz SJ. Risk factors for polydrug use in a Native American population. Substance Use & Misuse 43(3/4): 331-339, 2008. (13 refs.)

The Diagnostic Interview Schedule was used in 1993-1995 to collect information on the use of alcohol and other substances from 1,086 Navajo Indians living on or near their reservation in the southwestern United States. Bivariate and multivariate analyses are used to show that age of first alcohol use has declined over the past 50 years and is a significant risk factor for both alcohol dependence and polysubstance use. Limitations are noted.

Kvigne VL; Leondardson GR; Welty TK. Characteristics of fathers who have children with fetal alcohol syndrome or incomplete fetal alcohol syndrome. South Dakota Medicine 59(8): 337-340, 2006

OBJECTIVES: Determine alcohol use, referrals to treatment, receiving treatment, and medical problems related to alcohol among fathers who have children with FAS or incomplete FAS. METHODS: Fathers who had American Indian children with FAS (Study 1) or incomplete FAS (Study 2) were compared with fathers whose children did not have FAS. RESULTS: About half of case and control fathers had alcohol use and alcohol-related medical problems documented in their medical records. Case fathers were more likely to receive alcohol treatment and have injuries related to alcohol abuse. CONCLUSION: Significantly more fathers of children with FAS were referred for alcohol treatment, received alcohol treatment, experienced injuries, and had delirium tremens than control fathers. Fathers of children with incomplete FAS were significantly more likely to drink alcohol, to have received alcohol treatment, and to have alcohol-related medical problems and injuries than control fathers.

Lapidus JA; Bertolli J; McGowan K; Sullivan P. HIV-related risk behaviors, perceptions of risk, HIV testing, and exposure to prevention messages and methods among urban American Indians and Alaska Natives. AIDS Education and Prevention 18(6): 546-559, 2006. (40 refs.)

The goal of this study was to describe HIV risk behaviors, perceptions, testing, and prevention exposure among urban American Indians and Alaska Natives (AI/AN). Interviewers administered a questionnaire to participants recruited through anonymous peer-referral sampling. Chi-square tests and multiple logistic regression were used to compare HIV testing by perception of risk and risk behavior status. Of 218 respondents with seronegative or unknown HIV status, 156 (72%, 95% confidence interval [CI]: 66-78%) reported some HIV risk behavior: 57 (26%,95% CI: 20-32%) high-risk behavior, and 99 (45%,95% CI: 39-52%), potentially high-risk. Among respondents reporting high-risk behavior, 44% rated themselves at no or low risk for HIV infection. Overall, 180 respondents (83%, 95% Cl: 78-88%) had ever received an HIV test, 79 (36%, 95% CI: 31-57%) in the past year. HIV risk behaviors and perception of risk were independently associated with recent HIV testing after adjustment for gender, income, and homelessness (odds ratio [OR] = 3.6; 95% CI: 1.5-9.0 for high-risk behavior vs. no reported risk behavior, and OR: 3.2; 95'% CI: 1.3-7.6, for high vs. no perceived risk). Addressing inaccurate perception of risk may be a key to improving uptake of HIV testing among high-risk urban AI/AN.

Libby AM; Orton HD; Beals J; Buchwald D; Manson SM. Childhood abuse and later parenting outcomes in two American Indian tribes. Child Abuse & Neglect 32(2): 195-211, 2008. (53 refs.)

Objectives: To examine the relationship of childhood physical and sexual abuse with reported parenting satisfaction and parenting role impairment later in life among American Indians (AIs). Methods: AIs from Southwest and Northern Plains tribes who participated in a large-scale community-based study (n = 3,084) were asked about traumatic events and family history; those with children were asked questions about their parenting experiences. Regression models estimated the relationships between childhood abuse and parenting satisfaction or parenting role impairment, and tested for mediation by depression or substance use disorders. Results: Lifetime substance use disorder fully mediated the relationship between childhood physical abuse and both parenting satisfaction and parenting role impairment in the Northern Plains tribe. There was only partial mediation between childhood sexual abuse and parenting role impairment in the Southwest. In both tribes, lifetime depression did not meet the criteria for mediation of the relationship between childhood abuse and the two parenting outcomes. Instrumental and perceived social support significantly enhanced parenting satisfaction; negative social support reduced satisfaction and increased the likelihood of parenting role impairment. Exposure to parental violence while growing up had deleterious effects on parenting outcomes. Mothers and fathers did not differ significantly in the relation of childhood abuse experience and later parenting outcomes. Conclusions: Strong effects of social support and mediation of substance abuse disorders in the Northern Plains offer direct ways in which childhood victims of abuse could be helped to avoid negative attributes of parenting that could put their own children at risk. Practice implications: Mothers were not significantly different from fathers in the relation of abusive childhood experiences and later parenting outcomes, indicating both are candidates for interventions. Strong effects of social support offer avenues for interventions to parents. The prevalence of substance use disorders and their role as a mediator of two parenting outcomes in the Northern Plains should focus special attention on substance use treatment, especially among those who experienced childhood victimization. These factors offer direct ways in which childhood victims of abuse can be helped to avoid negative attributes of parenting that could put their own children at risk of violence.

Liddle HA; Rowe CL, eds. Adolescent Substance Abuse: Research and Clinical Advances. Cambridge: Cambridge University Press, 2006. (Chapter refs.)

This volume covers a range of issues related to adolescent substance abuse, including empirically-based treatment development protocols; how to incorporate innovative treatment models into diverse clinical settings; research advances; interventions with special populations; culturally based intervention guidelines, and recommendations for practice and policy. This edited book has 21 chapter and 33 contributors. It is organized into five sections. Following an introduction and overview of the volume, Part I considers the theoretical, empirical and methodological foundation for research in adolescent substance abuse treatment. It deals with development issues, recent methodological and statistics advances that can underpin research, and highlights a major research initiative the Cannabis Youth Treatment Intervention, and the preliminary findings. Part II examines the practice and treatment policy trends. There is attention to European research, the Drug Abuse Treatment Outcomes Studies ducted at the UCLA Drug Abuse Research Center, contextual issues that are important in adolescent care, and examines the nature of service organization in England. Part III considers the importance and approaches to comprehensive assessment and integrated treatment planning. Individual chapters consider drug therapies, developmental issues in the diagnosis of co-occurring disorders, and HIV/AIDS prevention in adolescent substance abusers. Part IV addresses evidence-based interventions. Directed initiatives examined are adolescent therapeutic communities, school-based group treatment, family and behavioral interventions, as well as cognitive-behavioral therapy with adolescents substance abuse problems. Part V considers culturally based treatments that have been developed, with a focus on family centered programs created for Native Americans and family-based treatment of Hispanic adolescents. Part VI includes a concluding chapter that examines the strides that have been made while also noting important research questions.

McFarland BH; Gabriel RM; Bigelow DA; Walker RD. Organization and financing of alcohol and substance abuse programs for American Indians and Alaska natives. American Journal of Public Health 96(8): 1469-1477, 2006. (100 refs.)

Objectives. Although American Indians and Alaska Natives have high rates of substance abuse, few data about treatment services for this population are available. We used national data from 1997-2002 to describe recent trends in organizational and financial arrangements. Methods. Using data from the Indian Health Service (INS), the Substance Abuse and Mental Health Services Administration, the National Institute on Alcohol Abuse and Alcoholism, the Henry J. Kaiser Family Foundation, and the Census Bureau, we estimated the number of American Indians served by substance abuse treatment programs that apparently are unaffiliated with either the IHS or tribal governments. We compared expected and observed IHS expenditures. Results. Half of the American Indians and Alaska Natives treated for substance abuse were served by programs (chiefly in urban areas) apparently unaffiliated with the IHS or tribal governments. INS substance abuse expenditures were roughly what we expected. Medicaid participation by tribal programs was not universal. Conclusions. Many Native people with substance abuse problems are served by programs unaffiliated with the IHS. Medicaid may be key to expanding needed resources.

Medicine B. Drinking and Sobriety among the Lakota Sioux. Walnut Creek, CA: Altamira Press, a division of Rowman & Littlefield Publishers, 2007

Where previous studies have focused primarily upon drinking styles among Indian populations, the author employing ethnographic research methods to analyze the nature of drinking and control of alcohol abuse. This study focuses upon the Lakota (Standing Rock in North and South Dakota). It examines patterns of alcohol consumption and strategies by individuals to attain a new life-style and achieve sobriety. The author also speaks to the importance of understanding specific cultural tradition. Numerous examples are provided of how Lakota men and women experience and culturally manage alcohol consumption, helping readers understand how certain undercurrents of Lakota life and culture support both alcoholism and sobriety. For example, in a culture packed with rewards for behaviors that are indicative of strong individualism, data is provided to describes how alcoholics use this value to maintain heavy drinking (on the one hand) and (on the other) to invoke it as part of their strategic determination to attain new and individual sobriety. The pattern is nearly full opposite to 12-step programs and others that call upon 'group' or 'community' sanction against alcoholism in order to 'cure' individual alcoholics. The work is organized into 8 chapters. The first chapter deals with the pervasive myth that "All Indians are drunks." Chapter two sets forth the origins of alcohol use among American Indians, followed by a chapter dealing with the more recent path and Minnewakan "magic water." Attention then turns to the Sioux social system, drinking behavior among contemporary Lakota (Sioux) Indians. The concluding chapters consider American Indian sobriety, religious renaissance and the control of alcohol, and the Lakota sun dance; and finally the patterns of sobriety among the Sioux.

Mitchell CM; Beals J; Kaufman CE; Pathways Choice Healthy Ways. Alcohol use, outcome expectancies, and HIV risk status among American Indian youth: A latent growth curve model with parallel processes. Journal of Youth and Adolescence 35(5): 729-740, 2006. (55 refs.)

Alcohol use is cited as a risk factor for exposure to HIV infection through risky sexual behavior, especially among adolescents. From Social Cognitive Theory, positive outcome expectancies about the use of alcohol have often been presented as a critical aspect of alcohol use. Yet little is known about how they might be related to different aspects of HIV risk. Using latent growth curve modeling with data from 292 American Indian youth across seven years, both alcohol use and positive expectancies increased significantly; a lower-risk group showed significantly slower increases in both. Changes in alcohol use and outcome expectancies were significantly interrelated, providing support for reciprocal influence between the two constructs. Positive alcohol outcome expectancies may provide a preventive intervention point worthy of further consideration as influencing alcohol use and lowering HIV sexual risk among adolescents.

Mitchell CM; Beals J; The Pathways of Choice Team. The development of alcohol use and outcome expectancies among American Indian young adults: A growth mixture model. Addictive Behaviors 31(1): 1-14, 2006. (29 refs.)

Adolescence is an important developmental period for understanding alcohol use. American Indian youth are a group for whom various preventive interventions focusing on alcohol use have been implemented but have not necessarily been widely successful, highlighting the need to further refine our approaches. In the work reported here, we followed 464 14- to 18-year-old American Indian youth annually for seven years. We examined the development of alcohol use and positive alcohol outcome expectancies in parallel, using growth mixture modeling to identify classes with different trajectories of alcohol use and expectancies. We found five classes; the largest (n = 198) was made up of youth who experienced increases in both alcohol use and positive outcome expectancies. Initial levels of outcome expectancies were related to subsequent changes in alcohol use, while the reverse was not true, suggesting that interventions focusing on outcome expectancies are appropriate for a substantial number of youth. However, class heterogeneity in the relationships between the two processes pointed out that changes in expectancies may not always precede changes in alcohol use. Thus, intervention design implications are discussed for the class structures.

Morris GD; Wood PB; Dunaway RG. Self-control, native traditionalism, and Native American substance use: Testing the cultural invariance of a general theory of crime. Crime & Delinquency 52(4): 572-598, 2006. (95 refs.)

Using a sample of White and Native American high school students, the authors provide a test of (a) self-control theory's invariance thesis and (b) native traditionalism as an explanation of Native American substance use. Self-control significantly influenced all forms of substance use when controlling for race and in race-specific analyses. However z tests by race revealed that self-control is a stronger predictor of marijuana and serious drug use among Native Americans. Beyond this simple comparison across groups, the authors control for native traditionalism (as a proxy for cultural variation) among the Native American respondents. In doing so, self-control remained a consistent predictor of their substance use. Although these findings largely support the invariance thesis of self-control, the racial difference related to marijuana and serious drug use poses a theoretical challenge. With regard to native traditionalism, results suggest that those most attached to their native traditions engage in greater substance use.

Morton DJ; Garrett M; Reid J; Wingard DL. Current smoking and type 2 diabetes among patients in selected Indian health service clinics, 1998-2003. American Journal of Public Health 983(3): 560-565, 2008. (37 refs.)

Objectives. In non-American Indian/Alaska Native groups, current smoking prevalence is similar for those with or without diabetes (26%) We analyzed current smoking prevalence in American Indian/Alaska Natives by diabetes status. Methods. Data were extracted from Indian Health Service clinic visit information from 1998 to 2003. After consolidation into unique patient records, the sample comprised 71221 patients aged 14 years or older with both diabetes and current smoking information. Results. Cross-sectional results indicated that diabetic American Indian/Alaska Natives were significantly more likely than those without diabetes to be current smokers (29.8% vs 18.8%; P<.01). Smoking rates were 2 to 3 times higher among diabetic American Indians and Alaska Natives for each age category (P<.001), and current smokers with diabetes were more likely than nonsmokers to have glycosylated hemoglobin A(1c) levels at 8.0% or higher (P<.05). Conclusions. American Indian/Alaska Natives with diabetes at all sites and age categories were found to smoke at significantly higher rates than those without diabetes. Smoking cessation programs should target diabetic patients to more effectively prevent complications and promote successful management of diabetes in American Indians/Alaska Natives.

Novins DK; Fickenscher A; Manson SM. American Indian adolescents in substance abuse treatment: Diagnostic status. Journal of Substance Abuse Treatment 30(4): 275-284, 2006. (67 refs.)

The goal of this study was to describe the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) psychiatric disorders among a sample of American Indian adolescents in residential substance abuse treatment. Data on 89 Al adolescents admitted to a tribally operated residential substance abuse treatment program were collected. Participants reported using a mean of 5.26 substances; 20% percent met DSM-IV criteria for four or more substance use disorders. Marijuana abuse/dependence was the most common substance use disorder (84.3%). Eighty-two percent met criteria for at least one DSM-IV nonsubstance use disorder, the most common of which was conduct disorder (74.2%). These results suggest strong diagnostic parallels between these American Indian adolescents and their non-American Indian counterparts who have participated in similar studies, including the considerable diagnostic complexity that was common among the participants in this study. These diagnostic patterns suggest that emerging practices for treating substance-abusing adolescents that have been developed for use With non-American Indian adolescents warrant consideration for use with American Indian youths.

O'Connell JM; Novins DK; Beals J; Whitesell N; Libby AM; Orton HD; AI-SUPERPFP Team. Childhood characteristics associated with stage of substance use of American Indians: Family background, traumatic experiences, and childhood behaviors. Addictive Behaviors 32(12): 3142-3152, 2007. (13 refs.)

The purpose of this analysis is to examine childhood characteristics associated with stage of substance use in adulthood in two American Indian (AI) populations. Data were drawn from an epidemiologic study of two AI reservation populations for persons age 18-44 years (n = 2070). We used descriptive and multivariate analysis to examine correlates of four mutually exclusive stages of substance use: lifetime abstinence (Stage 0), use of alcohol only (Stage 1A), use of marijuana/inhalants with or without alcohol (Stage 1B), and use of other illicit drugs with or without the previously listed substances (Stage 2). Problematic substance use by parents, younger age of first substance use, initiating substance use with a drug (with or without alcohol), and adolescent conduct problems were associated with higher stage substance use. Persons who experienced sexual abuse, witnessed family violence, or experienced other traumatic events before the age of 18 were more likely to be at Stage 1B than Stage 1A

O'Connell J; Novins DK; Beals J; Croy C; Baron AE; Spicer P; American Indian Service Utilization. The relationship between patterns of alcohol use and mental and physical health disorders in two American Indian populations. Addiction 101(1): 69-83, 2006. (73 refs.)

Aims: First, define alcohol use categories among two reservation-based American Indian (AI) populations based on the relationship between alcohol consumption and dependence. Secondly. examine associations between the alcohol use categories and other indicators of health status. Design, participants and measurements Epidemiological data on 1287 AIs aged 18-57 years who consumed alcohol during the past year. CHAID tree analysis, a hierarchical partitioning method, was used to analyze alcohol quantity (highest number of drinks consumed during I day) and frequency (number of days drank during the past month) data to define quantity-frequency categories distinguished by differing rates of alcohol dependence. Multivariate analyses assessed relationships between the alcohol use categories thus identified and a number of health outcomes. Findings: People who reported drinking 12 or more drinks during I day and more than 4 days a month had the highest prevalence of alcohol dependence. Among the males who drank > 18 drinks the prevalence was 42.12% and among females who drank 12 or more drinks, 44.58%. The prevalence among males who drank > 18 drinks yet drank less frequently was also high (24.06%). Although findings differed by gender, drinkers in the highest risk category for alcohol dependence were most likely to report drug use disorders, mood/anxiety disorders, alcohol-related physical disorders and lower quality of life. Conclusions: The quantity thresholds defined to identify AIs at highest risk for alcohol dependence in this study differed by gender and were higher than typically reported for non-AIs. They are consistent with previous findings regarding the pattern of high-quantity, low-frequency alcohol consumption among AIs residing on reservations.

Oetzel J; Duran B; Jiang YZ; Lucero J. Social support and social undermining as correlates for alcohol, drug, and mental disorders in American Indian women presenting for primary care at an Indian health service hospital. Journal of Health Communication 12(2): 187-206, 2007. (72 refs.)

The purpose of this study was to determine the relationship of two types of social support (emotional and instrumental) and two types of social undermining (critical appraisal and isolation) with five categories of alcohol, drug, or mental disorders (ADM; any mood, any anxiety, any substance abuse, any disorder, and two or more disorders) in 169 American Indian women presenting for primary care at an Indian Health Service facility. Social support and social undermining are often treated as opposite poles, but in fact they are distinct factors with independent effects. The findings illustrate that social support and undermining variables have a significant relationship with ADM outcomes even when controlling for confounding demographic variables. Any substance abuse was associated with all four social variables, while two or more disorders were associated with instrumental support and isolation. Any anxiety (isolation), any mood (critical appraisal), and any disorder (isolation) were each associated with one social variable. Overall, social undermining appears to have a stronger relationship with mental health than with social support.

Office of Applied Studies. The NSDUH Report: Past Month Cigarette Use among Racial and Ethnic Groups. Issue 30. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (5 refs.)

This report, an issue in an occasional series of reports based upon data collected by the National Survey on Drug Use and Health, focuses upon cigarette use among racial and ethnic minorities. While smoking declined in the US between 2002 and 2004, there remains variations in rates among racial and ethnic groups. In the 2002-2004 period, the rates of cigarette smoking in the past month among those age 12 and older, were highest among American Indians and Alaska Natives (34.8%), those who identify themselves as of two or more races (34.6) and lowest among Asian-Ameriancs (13.4%). Among Asians, Koreans reported the higest rate of smoking, at 24/9% and Chinese the lowest at 7.5%. Among Hispanics, Cubans and Puerto Ricans are more likely to be daily smokers than Central or South Americans and Mexicans. Informatioon is also provided on the average number of cigarettes smoker per day for various ethnic groups and rates of daily smoking/

Office of Applied Studies. The DASIS Report. American Indian/Alaska Native Substance Abuse Treatment Services: 2004. Issue December 9, 2005. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (3 refs.)

This report is based on data gathered by the National Survey of Substance Abuse Treatment Services (N-SSATS) that gathers information on over 13,000 treatment facilities. Among these are 383 facilities specifically directed to American Indicians and Alaska Natives, of these about three-quarter are fun by either Tribal Governments or the Indian Health Service. Of these facilities, most had a primary substance abuse foucs. There is data provided on the the presence of special programs within the facility intended to serve a distinct sub-set of peoples, for example, women, co-occcurring disorders, women, seniors, etc. There is also a breakdown about the types of services offered: assessment and diagnosis, individual therapy, group therapy, aftercare counseling, family counseling, and relapse prevention groups. Nationally, thirty-two States had at least one program for native peoples. There is data on the number of facilities by State, and also information about the different sources of payment.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report. Substance Use and Substance Use Disorders among American Indians and Alaska Natives. (January 19, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (4 refs.)

Data from SAMHSA's 2002, 2003, 2004, and 2005 National Surveys on Drug Use and Health were combined to calculate annual averages in order to make reliable estimates comparing substance use and substance use disorders by American Indians and Alaska Natives with substance use and substance disorders by the overall group of persons from other racial backgrounds. Rates of past year use disorders were higher among American Indians and Alaska Natives than members of other racial groups for alcohol, illicit drug use, marijuana, cocaine, and hallucinogen use disorders. Although in the past year American Indians and Alaska Natives were less likely than persons of other racial backgrounds to have used alcohol (60.8% vs. 65.8%), they were more likely to have an alcohol use disorder (10.7% vs. 7.6%). For illicit drug use, however, in the past year, American Indians and Alaska Natives were more likely than persons of other racial backgrounds both to have used an illicit drug (18.4% vs. 14.6%) and to have an illicit drug use disorder (5.0% vs. 2.9%).

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report. Illicit Drug Use by Race/Ethnicity in Metropolitan and Non-Metropolitan Counties: 2004 and 2005. (June 21, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (6 refs.)

SAMHSA's National Survey of Drug Use and Health provides data on past month use of the following: any illicit drug, marijuana, and nonmedical use of prescription type drugs by race/ethnicity. This report also presents these by metropolitan status. Among whites and Hispanics: past month use of any illicit drug, marijuana, or nonmedical prescription drugs was lowest in non metropolitan areas than in any other area. Among blacks: past month use of any illicit drug or marijuana was lowest in non metropolitan areas than in any other area but nonmedical prescription drug use was highest in non metropolitan areas. Among American Indians/Alaska Natives: past month use of any illicit drug or nonmedical prescription drug use was lowest in large metropolitan areas than in any other area but marijuana use was lowest in non metropolitan areas.

Public Domain

Olson LM; Wahab S. American Indians and suicide: A neglected area of research. Trauma, Violence, & Abuse 7(1): 19-33, 2006. (50 refs.)

Suicide is a major public health problem for American Indians in the United States. Published studies indicate that American Indians experience the highest rate of suicide of all ethnic groups in the United States. This article synthesizes the epidemiology and risk factors associated with suicide among American Indians, barriers to research, prevention, mental-health services, and recommendations for research and practice. The authors' recommendations arise from the current literature as well as interviews with practitioners and academics in the field of suicide prevention. The authors present significant substantive and methodological issues that inform research on suicide in American Indian communities, as well as existing contemporary interventions. Overall, socioeconomic characteristics, substance abuse, barriers to mental health services and acculturation play a role in the occurrence of suicide in American Indian communities. These findings suggest suicide is an important public health problem that needs to be addressed for American Indians.

O'Malley SS; Robin RW; Levenson AL; Wolf IG; Chance LE; Hodgkinson CA et al. Naltrexone alone and with sertraline for the treatment of alcohol dependence in Alaska Natives and non-natives residing in rural settings: A randomized controlled trial. Alcoholism: Clinical and Experimental Research 32(7): 1271-1283, 2008. (90 refs.)

Background: Access to specialty alcoholism treatment in rural environments is limited and new treatment approaches are needed. The objective was to evaluate the efficacy of naltrexone alone and in combination with sertraline among Alaska Natives and other Alaskans living in rural settings. An exploratory aim examined whether the Asn40Asp polymorphism of the mu-opioid receptor gene (OPRM1) predicted response to naltrexone, as had been reported in Caucasians. Methods: Randomized, controlled trial enrolling 101 Alaskans with alcohol dependence, including 68 American Indians/Alaska Natives. Participants received 16 weeks of either (1) placebo (placebo naltrexone + placebo sertraline), (2) naltrexone monotherapy (50 mg naltrexone + sertraline placebo) and (3) naltrexone + sertraline (100 mg) plus nine sessions of medical management and supportive advice. Primary outcomes included Time to First Heavy Drinking Day and Total Abstinence. Results: Naltrexone monotherapy demonstrated significantly higher total abstinence (35%) compared with placebo (12%, p = 0027) and longer, but not statistically different, Time to First Heavy Drinking Day (p = 0.093). On secondary measures, naltrexone compared with placebo demonstrated significant improvements in percent days abstinent (p = 0.024) and drinking-related consequences (p = 0.02). Combined sertraline and naltrexone did not differ from naltrexone alone. The pattern of findings was generally similar for the American Indian/Alaska Native subsample. Naltrexone treatment response was significant within the group of 75 individuals who were homozygous for OPRM1 Asn40 allele. There was a small number of Asp40 carriers, precluding statistical testing of the effect of this allele on response. Conclusions: Naltrexone can be used effectively to treat alcoholism in remote and rural communities, with evidence of benefit for American Indians and Alaska Natives. New models of care incorporating pharmacotherapy could reduce important health disparities related to alcoholism.

Osilla KC; Lonczak HS; Mail PD; Larimer ME; Marlatt GA. Regular tobacco use among American Indian and Alaska Native adolescents: An examination of protective mechanisms. Journal of Ethnicity in Substance Abuse 6(3/4): 143-153, 2007

American Indian and Alaska Native (AIAN) adolescents use tobacco at earlier ages and in larger quantities compared to nonAIAN peers. Regular tobacco use was examined against five protective factors (peer networks supportive of not using drugs, college aspirations, team sports, playing music, and volunteerism). Participants consisted of 112 adolescents between the ages of 13 and 19 who participated in a study testing the efficacy of a life-skills program aimed at reducing substance-related consequences. Findings indicated that, with the exception of prosocial peer networks and volunteerism, each of the above factors was significantly associated with a reduced probability of being a regular tobacco user. Gender differences were notable. These results hold important treatment implications regarding the reduction and prevention of tobacco use among AIAN youth.

Osilla KC; Lonczak HS; Mail PD; Larimer ME; Marlatt GA. Regular tobacco use among American Indian and Alaska Native adolescents: An examination of protective mechanisms. Journal of Ethnicity in Substance Abuse 6(3/4): 143-153, 2007

Prussing E. Reconfiguring the empty center: Drinking, sobriety, and identity in Native American women's narratives. Culture, Medicine and Psychiatry 31(4): 499-526, 2007. (65 refs.)

Although anthropologists have paid little attention to popular American psychological discourse about addiction and recovery, the cultural politics of its engagement by Native North American communities warrant closer examination. By ethnographically contextualizing personal narratives, this paper describes how addiction/recovery discourse has been selectively engaged by younger generations of women in a northern Plains reservation community. Sobriety is not only a therapeutic transformation but also a socially negotiated identity change in this community and, therefore, engages ongoing local identity politics. Many community members evaluate the legitimacy of claims to Native identity by essentializing boundaries between Native and non-Native, as well as between past and present-a discursive convention that O'Nell has called "the rhetoric of the empty center" (Disciplined Hearts: History, Identity and Depression in an American Indian Community. Berkeley: University of California Press, 1996, p. 55). Yet by selectively appropriating elements of addiction/recovery discourse, younger women in the 1990s increasingly positioned emotional experience and expression as central arbiters of the legitimacy of Native identity. In so doing, they reconfigured the rhetoric of the empty center, eliciting both controversy and support from the larger community. This analysis highlights new dimensions of the social life of addiction/recovery discourse in contemporary Native North America, and calls for increased ethnographic attention to how localized cultural politics can orient the ways in which communities engage therapeutic discourses.

Radin SM; Neighbors C; Walker PS; Walker RD; Marlatt GA; Larimer M. The changing influences of self-worth and peer deviance on drinking problems in urban American Indian adolescents. Psychology of Addictive Behaviors 20(2): 161-170, 2006. (75 refs.)

This study explored the changing relations among self-worth, peer deviance, and alcohol-related problems in a sample of 224 urban-dwelling, American Indian adolescents. Data were collected annually at 7 time points to test a proposed mediational model. As expected, peer deviance mediated the relation between low self-worth and alcohol-related problems in younger adolescents: however, this relation did not hold as participants became older. In older adolescents, low self-worth and peer deviance directly and independently contributed to alcohol problems. Possible explanations for and implications of these findings are discussed in terms of developmental changes during adolescence.

Rafferty SM. Evidence of early tobacco in northeastern North America? Journal of Archaeological Science 33(4): 453-458, 2006. (33 refs.)

While tobacco use was a widespread and important social practice among Native Americans during the Historic Period, the prehistoric origins of the practice are poorly understood. Smoking pipes significantly predate botanical evidence of tobacco in Eastern North America. A promising technique for addressing this problem is gas chromatography/mass spectroscopy (GC/MS) analysis to identify nicotine or related compounds in smoking pipe residues. GUMS analysis of a smoking pipe dating to approximately 300 B.C. from the Boucher Site, a Middlesex-complex site from Vermont, has produced evidence of nicotine decay products. This is interpreted as evidence for an Early Woodland Period origin for tobacco use in Eastern North America. The cultural and chronological implications of this finding are discussed.

Rayle AD; Kulis S; Okamoto SK; Tann SS; LeCroy CW; Dustman P et al. Who is offering and how often? Gender differences in drug offers among American Indian adolescents of the Southwest. Journal of Early Adolescence 26(3): 296-317, 2006. (44 refs.)

This exploratory study examined gender differences in the patterns of drug offers among a sample of 71 American Indian middle school students. Participants responded to an inventory of drug-related problem situations specific to the cultural contexts of Southwestern American Indian youth. They were asked to consider the frequency of drug offers from specific groups in their social networks and the difficulty associated with refusing drugs from various offerers. The results indicated that female and mate American Indian youth differ in the degree of exposure to drug offers and the degree of perceived difficulty in handling such offers. Even after controlling for differences in age, grade level, socioeconomic status, family structure, and residence on a reservation, girls reported significantly more drug offers from friends, cousins, and other peers than did boys. Compared to boys, girls also reported a significantly higher sense of difficulty in dealing with drug offers from all sources.

Ringwalt C; Bliss K. The cultural tailoring of a substance use prevention curriculum for American Indian youth. Journal of Drug Education 36(2): 159-177, 2006. (82 refs.)

In this article we discuss the importance of the cultural tailoring (CT) of classroom-based prevention curricula to ensure their relevance to, and increase their receptivity by, racial and ethnic minority adolescent populations. Following a review of the pertinent literature, we develop an integrated model of CT that conceptualizes such adaptations into "superficial/peripheral," "deep structure/sociocultural," and "evidential," and subclassifies the first of these into "language" and "images." We then describe the results of the application of this model post hoc to the adaptation of a specific alcohol use prevention curriculum, "Protecting You/Protecting Me," to enhance its suitability for youth in three American Indian tribes in Nebraska. We conclude with a discussion of the adequacy of the model of CT we developed and the potential challenges and benefits of subjecting other curricula to this process.

Scott JD; Garland N. Chronic liver disease in Aboriginal North Americans. (review). World Journal of Gastroenterology 14(29): 4607-4615, 2008. (71 refs.)

A structured literature review was performed to detail the frequency and etiology of chronic liver disease (CLD) in Aboriginal North Americans. CLD affects Aboriginal North Americans disproportionately and is now one of the most common causes of death. Alcoholic liver disease is the leading etiology of CLD, but viral hepatitis, particularly hepatitis C, is an important and growing cause of CLD. High rates of autoimmune hepatitis and primary biliary cirrhosis (PBC) are reported in regions of coastal British Columbia and southeastern Alaska. Non-alcoholic liver disease is a common, but understudied, cause of CLD. Future research should monitor the incidence and etiology of CLD and should be geographically inclusive. In addition, more research is needed on the treatment of hepatitis C virus (HCV) infection and non-alcoholic fatty liver disease (NAFLD) in this population.

Silmere H; Stiffman AR. Factors associated with successful functioning in American Indian youths. American Indian and Alaska Native Mental Health Research 13(3): 23-47, 2007. (56 refs.)

This study examines environmental and cultural factors related to successful functioning in a stratified random sample of 401 American Indian youths. The success index included seven indicators: good mental health, being alcohol-and drug-free, absence of serious misbehavior, clean police record, good grades, positive psychosocial functioning, and positive behavior and emotions. Family satisfaction was positively related to overall successful functioning, whereas misbehaving peers, living in a dysfunctional neighborhood, and experiencing child abuse had an inverse relationship with success.

Simoni JM; Walters KL; Balsam KF; Meyers SB. Victimization, substance use, and HIV risk behaviors among gay/bisexual/two-spirit and heterosexual American Indian men in New York City. American Journal of Public Health 96(12): 2240-2245, 2006. (51 refs.)

Objectives. Our primary aims were to identify differences on the basis of sexual orientation in victimization, substance use, and HIV risk behaviors and to examine associations among these variables in American Indian men. Our secondary aims included describing condom-use attitudes, beliefs about HIV/AIDS in the Indian community, HIV knowledge, HIV status, and preference for and access to HIV prevention services in this population. Methods. A survey was mailed to all members of an American Indian community organization in New York City. Results. The 20 men self-identifying as gay, two-spirit, or bisexual (hereafter, "two-spirit") were more likely to report being victimized and engaging in HIV risk behaviors than the 51 heterosexual respondents, although they reported comparable levels of recent substance use. Overall, victimization was associated with lifetime HIV risk behaviors (even after control for sexual orientation) but not with substance use or unsafe sex in the past 12 months. The percentage of HIV infection was surprisingly high (10% of two-spirit men and 6% of heterosexual men). Conclusions. Two-spirit men are a vulnerable population whose victimization must be understood within an appropriate historical and political context.

Smith SM; Stinson FS; Dawson DA; Goldstein R; Huang B; Grant BF. Race/ethnic differences in the prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine 36(7): 987-998, 2006. (42 refs.)

Background. Very few large national epidemiologic surveys have examined the prevalence of psychiatric disorders among Asians and Native Americans due to small sample sizes. Very little is also known about the co-occurrences between substance use disorders and mood and anxiety disorders among these two minority groups and how their rates compare to Whites. Blacks, and Hispanics. Method. Analyses were based on a large (n = 41093) nationally representative survey of the adult (18+ years), U.S. population Supplemented by a group quarters sampling frame. Prevalences and associations of major DSM-IV mood, anxiety an substance use disorders were examined among all major race/ethnic subgroups of the population. Results. Twelve-month rates of most mood, anxiety and substance use disorders were generally greatest among Native Americans and lowest among Asians. For most race/ethnic subgroups, alcohol and drug dependence, but not abuse, were significantly associated with mood disorders. With few exceptions, there were no significant associations between alcohol and drug abuse and anxiety disorders. In contrast. alcohol dependence was associated with most anxiety disorders among Whites, Blacks and Asians. but not among Native Americans. Conclusions. The 12-month prevalence of substance use, mood, and anxiety disorders varied greatly across the five major race/ethnic subgroups of the population. Twelve-month co-occurrence of substance use disorders and mood and anxiety disorders was pervasive among all race/ethnic subgroups. Future research is also needed to understand race/ethnic differentials in prevalence and co-occurrence of these disorders with a particular focus on factors that may give rise to them.

Spear S; Crevecoeur DA; Rawson RA; Clark R. The rise in methamphetamine use among American Indians in Los Angeles County. American Indian and Alaska Native Mental Health Research 14(2): 1-15, 2007. (24 refs.)

A preliminary review of substance abuse treatment admission data from 2001-2005 was conducted to explore the use of methamphetamine among American Indians in treatment programs funded by Los Angeles County. Comparisons were made between primary methamphetamine users and users whose primary drug was a substance other than methamphetamine. In that period, the number of American Indians reporting methamphetamine as their primary drug in Los Angeles County significantly increased, particularly among females.

Spicer P; Bezdek M; Manson SM; Beals J. A program of research on spirituality and American Indian alcohol use. Southern Medical Journal 100(4): 430-432, 2007. (12 refs.)

In this brief report we summarize a pattern of findings that has emerged from our research on American Indian (AI) alcohol use and spirituality. With funds from the National Institute of Alcohol Abuse and Alcoholism and the Fetzer Institute (AA 13 053; P. Spicer, PI) we have used both epidemiologic and ethnographic methods to develop a more complete understanding of the role that spirituality and religion play in changes in drinking behavior among American Indians. We begin by first situating the importance of research on spirituality in the more general literature on the American Indian experience with alcohol before highlighting our published findings in this area. We then close with some speculation about possible next steps in this research program to address what remains one of the most compelling sources of health disparities in the first nations of the United States.

Spillane NS; Smith GT. A theory of reservation-dwelling American Indian alcohol use risk. (review). Psychological Bulletin 133(3): 395-418, 2007. (193 refs.)

The authors present a theory for understanding risk for problem drinking among reservation-dwelling American Indians. The theory offers an overall framework for understanding the risk process for this group. It considers the distinction between factors that influence mean levels of American Indian problem drinking and factors that influence individual differences in American Indian drinking. It proposes important contextual differences between reservation-dwelling American Indians and Caucasians that may help explain the higher mean levels of American Indian problem drinking. The theory further holds that, within the high mean level of problem drinking characteristic of many American Indian reservations, individual differences in problem drinking can be explained by very similar personality and learning factors as those that influence problem-drinking levels for other ethnic groups.

Steinman KJ. High school students' misuse of over-the-counter drugs: A population-based study in an urban county. Journal of Adolescent Health 38(4): 445-447, 2006. (9 refs.)

A survey of high school students (n = 39,345) found 4.7% occasionally misuse over-the-counter drugs (i.e., to get high) and an additional 2.1% reported misuse during the past month. Misuse was more common among older white and Native American youths and was associated with depressive affect and other substance use, especially alcohol and illicit drugs.

Steinman KJ; Hu Y. Substance use among American Indian youth in an eastern city. Journal of Ethnicity in Substance Abuse 6(1): 15-29, 2007

This study represents one of the first efforts to examine substance use among American Indian (AI) youth in an Eastern city. As part of a school-based study in metropolitan Columbus, Ohio, 596 self-identified AI youth (grades 6-12) completed surveys describing their use of alcohol, cigarettes, smokeless tobacco, marijuana and inhalants. Net of gender, grade and family structure, AI youth were more likely than their white peers to regularly use most substances while overall prevalence resembled estimates from studies of urban AI youth in the Western United States. These findings highlight the complex interactions of geography, identity and risk behavior among ethnic minority adolescents.

Steinman KJ; Hu Y. Substance use among American Indian youth in an eastern city. Journal of Ethnicity in Substance Abuse 6(1): 15-29, 2007

Stinson FS; Ruan WJ; Pickering R; Grant BF. Cannabis use disorders in the USA: Prevalence, correlates and co-morbidity. Psychological Medicine 36(10): 1447-1460, 2006. (93 refs.)

Background. The purpose of this study was to present 12-month and lifetime estimates of the prevalence, sociodemographic and clinical correlates, and psychiatric co-morbidity of DSM-IV cannabis abuse and dependence. Method. Data were derived from a large nationally representative survey (n = 43 093) of US adults. Results. The prevalence of 12-month and lifetime DSM-IV cannabis abuse (1(.)1% and 7(.)2%) exceeded the corresponding rates of cannabis dependence (0(.)3% and 1(.)3%). Being male, Native American, widowed/separated/divorced, and residing in the West increased the odds whereas being Black, Asian or Hispanic decreased the odds of cannabis abuse and dependence. Cannabis dependence was significantly associated with low income. Ages of onset for both cannabis use disorders occurred in adolescence and the majority of individuals with these disorders remained untreated. Co-morbidity was high between cannabis use disorders and other Axis I and II disorders. Conclusions. Cannabis use disorders continue to present a widespread and serious personal and public health problem. Native Americans were found to have high rates of cannabis use disorders, warranting closer attention to the mental health needs of this subgroup. Associations between cannabis abuse and dependence and Axis I and II disorders were strong, signaling the need for more comprehensive assessment of individuals with cannabis use disorders. Further controlled treatment studies are needed, especially among co-morbid individuals, in view of growing evidence of the adverse personal, medical and societal impacts of cannabis use disorders in the.

Szlemko WJ; Wood JW; Thurman PJ. Native Americans and alcohol: Past, present, and future. Journal of General Psychology 133(4): 435-451, 2006. (64 refs.)

Native Americans have higher rates of alcohol use, frequency of use, and increased rates of fetal alcohol syndrome, compared with other ethnic groups (J. Hisnanick, 1992; P. A. May, 1996; J. M. Wallace et al., 2003). High prevalence rates of alcohol misuse among Native Americans must be understood in light of their unique history, which has resulted in trauma and exposure to many risk factors for problem alcohol use. Many risk factors have been identified in the general population; however, only some of these risk factors have been examined among Native American populations. The unique history and world view of Native Americans mean that, often, risk factors operate differently from the way they do in other populations. The authors discuss interventions and promising treatments.

Tann SS; Yabiku ST; Okamoto SK; Yanow J. TriADD: The risk for alcohol abuse, depression, and diabetes multimorbidity in the American Indian and Alaska native population. American Indian and Alaska Native Mental Health Research 14(1): 1-23, 2007. (52 refs.)

This study examined the risk for alcoholism, diabetes, and depression (triADD) in American Indian/Alaska Native (AI/AN) populations in the U. S. Using the Behavioral Risk Factor Surveillance System, a series of descriptive statistics and regression models were used to examine the interrelationships among these disorders in AI/AN populations. Despite a small sample size, results indicate that AI/ANs are at elevated risk for the individual and combined presence of triADD (OR = 12.5) when compared to the White population. These findings indicate the need for further investigation and prevention focused on effective, culturally appropriate interventions with these populations.

Venner KL; Feldstein SW. Natural history of alcohol dependence and remission events for a Native American sample. Journal of Studies on Alcohol 67(5): 675-684, 2006. (52 refs.)

Objective: Examining the progression of a disorder cross-culturally may help distinguish elements common to addictions from those that are differentially shaped by culture. This study sought to construct a combined sequence of both problem emergence and recovery efforts with Native Americans. Method: In a cross-sectional sample, 44 adult Native Americans (61% men) who had resolved alcohol dependence completed face-to-face interviews at a research center. The Alcohol Related Behaviors Survey and the Change Effort Card-sorts along with measures of alcohol involvement and current quality of life were administered. Results: This sample's sequence of alcohol-related events was compared to that reported for Jellinek's historical white male sample (r(s) = .46 p = .001), a recent Navajo sample (r(s) =.33, p =.024), and a recent Mission Indian sample (r(s) =.28,p = .24). This sample's sequence of change efforts was compared to that in the Navajo sample (r(s) =.3 3, p = .182). Conclusions: Despite the small sample size precluding generalizability, there was greater concordance between this intertribal sample and Jellinek's white male sample than between this sample and a Mission Indian sample, indicating both cross-cultural and intracultural variation. In addition, change efforts begin during the development of alcohol problems rather than waiting until the person "hits bottom," as suggested by previous research. Integrating the pathology of substanceuse disorders with the process of resolving those disorders extends our understanding of the course of alcohol dependence.

Villanueva M; Tonigan JS; Miller WR. Response of Native American clients to three treatment methods for alcohol dependence. Journal of Ethnicity in Substance Abuse 6(2): 41-48, 2007

Objective: It is well-documented that American Indians suffer disproportionately high rates of alcohol use disorders as well as correspondingly high rates of alcohol based mortality, health, and social problems. Despite these health disparities, anecdotal evidence continues to guide alcohol treatment approaches in Indian Country, in part due to a dearth of clinical trials with Native Americans. Project MATCH, a multisite clinical trial, included 25 Native Americans (1.4% of the total sample) whowere randomized to three psychosocial treatments. Based on cultural compatibility, our a priori hypothesis was that Native Americans in Motivational Enhancement Therapy (MET) would fare better than those assigned either to Cognitive Behavioral Therapy (CBT) or to Twelve-step Facilitation (TSF). Method: Of 25 Native Americans in Project MATCH, 23 (92%) were interviewed at all six assessment points. Four ANOCOVA's were computed to investigate possible differential treatment response. Results: Despite a small sample, Native Americans assigned to MET reported significantly less drinking intensity relative to those assigned to CBT or TSF, with the highest proportion of abstinent days and lowest drinking intensity at both proximal and distal follow-ups. Conclusions: These findings suggest a differentially better response to MET than to TSF or to CBT among Native Americans with alcohol dependence. Although this is, to date, the largest randomized trial of treatments for alcohol dependence in Native Americans, the findings require replication.

Villanueva M; Tonigan JS; Miller WR. Response of Native American clients to three treatment methods for alcohol dependence. Journal of Ethnicity in Substance Abuse 6(2): 41-48, 2007

Walls ML; Johnson KD; Whitbeck LB; Hoyt DR. Mental health and substance abuse services preferences among American Indian people of the northern Midwest. Community Mental Health Journal 42(6): 521-535, 2006. (25 refs.)

This study examines factors that influence preferences between traditional cultural and western mental health and substance use associated care among American Indians from the northern Midwest. Personal interviews were conducted with 865 parents/caretakers of tribally enrolled youth concerning their preferences for traditional/cultural and formal healthcare for mental health or substance abuse problems. Adults strongly preferred traditional informal services to formal medical services. In addition, formal services on reservation were preferred to off reservation services. To better serve the mental health and substance abuse treatment needs of American Indians, traditional informal services should be incorporated into the current medical model.

Walls ML; Whitbeck LB; Hoyt DR; Johnson KD. Early-onset alcohol use among Native American youth: Examining female caretaker influence. Journal of Marriage and the Family 69(2): 451-464, 2007. (58 refs.)

This article investigates the influence of female caretaker substance use on early-onset youth drinking among Native American families in the Northern Midwest. Data include 603 Native American families, with reports from female caretakers and youths aged 10 - 13 years. Two potential caretaker influences are taken into account: adolescent modeling of caretaker behaviors and the effects of caretaker substance abuse on parenting. Results of bivariate and path analysis provide support for the influence of caretaker substance use on adolescent drinking from both perspectives; these effects vary, however, depending on the type or degree of adult substance use, or both.

Watt JP; O'Brien KL; Benin AL; Mccoy SI; Donaldson CM; Reid R et al. Risk factors for invasive pneumococcal disease among Navajo adults. American Journal of Epidemiology 166(9): 1080-1087, 2007. (24 refs.)

Invasive pneumococcal disease (IPD) is 3-5 times more common among Navajo adults than in the general US population. The authors conducted a case-control study to identify risk factors for IPD among Navajo adults. Navajos aged >= 18 years with IPD were identified through prospective, population-based active laboratory surveillance (December 1999-February 2002). Controls matched to cases on age, gender, and neighborhood were selected. Risk factors were identified through structured interviews and medical record reviews. The authors conducted a matched analysis based on 118 cases and 353 controls. Risk factors included in the final multivariable analysis were chronic renal failure (odds ratio (OR) = 2.6, 95% confidence interval (Cl): 0.9, 7.7), congestive heart failure (OR = 5.6, 95% Cl: 2.2, 14.5), self-reported alcohol use or alcoholism (OR = 2.9, 95% Cl: 1.5, 5.4), body mass index (weight (kg)/height (m)(2)) <5th (OR = 3.2, 95% Cl: 1.0, 10.6) or >95th (OR = 2.8, 95% Cl: 1.0, 8.0) percentile, and unemployment (OR = 2.6, 95% Cl: 1.2, 5.5). The population attributable fractions were 10% for chronic renal failure, 18% for congestive heart failure, 30% for self-reported alcohol use or alcoholism, 6% for body mass index, and 20% for unemployment. Several modifiable risk factors for IPD in Navajos were identified. The high prevalence of renal failure, alcoholism, and unemployment among Navajo adults compared with the general US population may explain some of their increased risk of IPD.

Whitbeck LB; Hoyt D; Johnson K; Chen XJ. Mental disorders among parents/caretakers of American Indian early adolescents in the Northern Midwest. Social Psychiatry and Psychiatric Epidemiology 41(8): 632-640, 2006. (30 refs.)

Background. This study reports prevalence and comorbidty of five DSM-III-R diagnoses (alcohol abuse, alcohol dependence, drug abuse, major depressive episode, and generalized anxiety disorder) among American Indian and Canadian First Nations parents/caretakers of children aged 10-12 years from the Northern Midwest United States and Canada. Lifetime prevalence rates were compared to adults in the National Comorbidity Survey (NCS) and Southwest and Northern Plains cultures from the AI-SUPERPFP study. Method. Native interviewers used computer-assisted personal interviews to administer the University of Michigan Composite International Diagnostic Interview (UM-CIDI) to 861 tribally enrolled parents and caretakers (625 females; 236 males) of 741 tribally enrolled children aged 10-12 years. Fathers/male caretakers ranged in age from 21 years to 68 years with an average age of 41 years; mothers/female caretakers ranged in age from 17 years to 77 years with an average of 39 years. Results. About three-fourths (74.6%) of the adults met lifetime criteria for one of the five disorders; approximately one-third (31.6%) met lifetime criteria for two or more of the five disorders. Prevalence of the substance use disorders was higher than those in the general population (NCS); prevalence of internalizing disorders (major depressive disorder and generalized anxiety disorder) was very similar to those in the general population. Prevalence rates for alcohol abuse among the Northern Midwest adults were higher than those reported for Southwest and Northern Plains Tribes, but rates of alcohol dependency were very similar across cultures. Conclusions. The higher prevalence rates for some mental disorders found for the Northern Midwest are discussed in terms of potential method variance. The Northern Midwest results reflect unique patterns of psychiatric disorders in the ubiquity of substance abuse disorders and the co-occurrence of substance abuse disorders with internalizing disorders. Reducing lifetime occurrences of substance abuse disorders would have an enormous positive impact on the mental health of this population.

Whitbeck LB; Yu M; Johnson KD; Hoyt DR; Walls ML. Diagnostic prevalence rates from early to mid-adolescence among indigenous adolescents: First results from a longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry 47(8): 890-900, 2008. (37 refs.)

Objective: Investigate change in prevalence rates for mental and substance abuse disorders between early and mid-adolescence among a cohort of indigenous adolescents. Method: The data are from a lagged, sequential study of 651 indigenous adolescents from a single culture in the northern Midwest U0nited States and Canada. At waves 1 (ages 10-12 years) and 4 (ages 13-15 years), one adult caretaker and one tribally enrolled adolescent completed a computer-assisted personal interview that included Diagnostic Interview Schedule for Children-Revised assessment for 11 diagnoses. Multivariate analyses investigate effects of wave 1 adolescent diagnosis and wave 1 biological mother diagnosis (University of Michigan Composite International Diagnostic Interview) on wave 4 diagnostic outcomes. Results: The findings show a increase in prevalence rates for substance abuse disorders and conduct disorders between ages 10 and 12 years and 13 and 15 years among indigenous adolescents, with these disorders affecting more than one fourth of the children. The rate of lifetime conduct disorder is about twice that expected in general population studies (23.4% versus 5%-10%), and the rate of lifetime substance abuse disorder (27.2%) is three times that reported in the 2004 National Survey on Drug Use and Health (9.4%) for individuals 12 years or older. Prevalence rates for any single mental or substance use disorder (44.8 lifetime) for the 13- to 15-year-olds are similar to the lifetime prevalence rates reported in the National Comorbidity Survey-Replication (46.4%) for individuals 18 years and older. Conclusions: A mental health crisis exists on the indigenous reservations and reserves that participated in this study. Current service systems are overwhelmed and unable to meet the demands placed upon them.

Whitesell NR; Beals J; Mitchell CM; Novins DK; Spicer P; Manson SM et al. Latent class analysis of substance use: Comparison of two American Indian reservation populations and a national sample. Journal of Studies on Alcohol 67(1): 32-43, 2006. (23 refs.)

Objective: Our goal was to carefully examine disparities in substance use between two American Indian reservation communities and a national sample. We sought to identify characteristic patterns of use-both across and within samples-that could be used to inform intervention efforts aimed at reducing disparities. Method: Latent class analyses were used to identify subgroups within each sample that were characterized by distinctive patterns of use of alcohol and eight drugs; the use patterns and prevalence of subgroups were then compared across samples. American Indian data were from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP; N = 2,647), which comprised participants from two distinct cultural groups in the Southwest (SW; n = 1,244; 57% female) and Northern Plains (NP; n = 1,443; 52% female). National data were from the public use file of the 1999 National Household Survey of Drug Abuse (NHSDA; N = 39,152; 52% female). Results: Four classes of lifetime users (abstainers, primarily alcohol users, primarily alcohol and marijuana users, and polysubstance users) and three classes of past-year users (abstainers, primarily alcohol users, and alcohol and drug users) were identified in each sample (SW NP, NHSDA). Despite consistency in classes of users found across these samples, there were notable sample differences in class prevalence. The modal class for lifetime use, for example, was primarily alcohol users in the SW and NHSDA, and primarily alcohol and marijuana use in the NP. The concordance of lifetime and past-year use classes also varied across the three samples, and examination of past-year abstainers in conjunction with lifetime-use class suggested potentially important differences in the stability of substance-use patterns over time. Conclusions: Our findings highlight the utility of latent class techniques for understanding substance use, comparing substance use across populations and identifying key points of intervention, prevention, and treatment within different communities.

Whitesell NR; Beals J; Mitchell CM; Keane EM; Spicer P; Turner RJ. The relationship of cumulative and proximal adversity to onset of substance dependence symptoms in two American Indian communities. Drug and Alcohol Dependence 91(2/3): 279-288, 2007. (44 refs.)

The proximal and distal effects of adversity on the onset of symptoms of substance dependence during adolescence were explored in two culturally distinct American Indian (AI) reservation communities (Northern Plains and Southwest). Data (N=3084) were from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP). The age-related risk of symptom onset increased gradually from age 11 through age 16, remained relatively high through age 18, then declined rapidly. Both tribe and gender were related to onset of dependence symptoms; men and Northern Plains tribal members were at greatest risk and Southwest women were at particularly low risk of symptom onset across adolescence. For all tribe and gender groups, both proximal and cumulative distal experiences of adversity were associated with substantially increased risk of symptom onset. The relationship of adversity to onset of substance dependence symptoms remained strong when previous symptoms of psychiatric disorder and childhood conduct problems were considered. These findings suggest that efforts to help children and adolescents in AI communities develop constructive mechanisms for coping with adversity may be especially valuable in substance dependence prevention.

Willsie SK; Foreman MG. Disparities in lung cancer: Focus on Asian Americans and Pacific Islanders, American Indians and Alaska Natives, and Hispanics and Latinos. Clinics in Chest Medicine 27(3): 441-+, 2006. (77 refs.)

Significant population changes in the United States are expected over the next few decades. The changing demographics inclusive of native and newly native individuals will significantly impact health care because racial and ethnic groups vary widely in their risks for disease and approach to medical care. For lung cancer specifically, racial and ethnic groups differ in smoking habits, metabolism of nicotine, presentation, stage at diagnosis, treatment received, and outcomes. This article summarizes current information on lung cancer for American and Pacific Islanders, American Indians and Alaska natives, and Hispanics and Latinos with an emphasis on tobacco use, epidemiologic issues surrounding acculturation and assimilation, genetic epidemiology, and disparities in treatment outcomes.

Winters KC; DeWolfe J; Graharn D; Cyr WS. Screening American Indian youth for referral to drug abuse prevention and intervention services. Journal of Child & Adolescent Substance Abuse 16(1): 39-52, 2006. (20 refs.)

The development and psychometric properties of a brief screening tool for use with American Indian Youth suspected of abusing substances is described. The Indian Health Service-Personal Experience Screening Questionnaire (IHS-PESQ) is a brief questionnaire that screens for drug abuse problem severity, response distortion tendencies, and psychosocial risk factors. The psychometric properties of the problem severity scale are favorable when tested in reservation-based American Indian students (grades 6-12). The paper also describes the role of the IHS-PESQ within a prevention, intervention and treatment referral system designed for American Indian youth.

Wood DS; Gruenewald PJ. Local alcohol prohibition, police presence and serious injury in isolated Alaska Native villages. Addiction 101(3): 393-403, 2006. (49 refs.)

To consider the effects of alcohol prohibition and police presence upon serious injury in isolated Alaska Native villages. We compared rates of injury attributed to assault, self-harm, motor vehicle collisions and 'other causes' between villages with or without local prohibition and between villages with or without local police. Negative binomial regression was used to assess the relative effects of prohibition and police presence upon serious injury rates net of potential confounders. A total of 132 isolated Alaska Native villages between the years 1991 through 2000. Serious injury was measured using Alaska Trauma Registry and Alaska Bureau of Vital Statistics death certificate records. Local option election records were used to classify cases as occurring in wet or dry villages and police deployment records were used to classify cases as occurring in villages with or without local police. Village-level statistics from the 1990 and 2000 US censuses were used in the negative binomial regression analyses. Villages that prohibited alcohol had lower age-adjusted rates of serious injury resulting from assault, motor vehicle collisions and 'other causes'. Dry villages with a local police presence had a lower age-adjusted rate of serious injury caused by assault. Controlling for the relative effects of village isolation, access to alcohol markets and local demographic structures, local prohibition was associated with lower rates of assault injuries and 'other causes' injuries while local police presence was associated with lower rates of assault injuries. Residents of isolated Alaska Native villages are safer when they prohibit alcohol. A local police presence in dry villages provides further reduction of the incidence of assault.

Woodall WG; Delaney HD; Kunitz SJ; Westerberg VS; Zhao HW. A randomized trial of a DWI intervention program for first offenders: Intervention outcomes and interactions with antisocial personality disorder among a primarily American-Indian sample. Alcoholism: Clinical and Experimental Research 31(6): 974-987, 2007. (51 refs.)

Background: Randomized trial evidence on the effectiveness of incarceration and treatment of first-time driving while intoxicated (DWI) offenders who are primarily American Indian has yet to be reported in the literature on DWI prevention. Further, research has confirmed the association of antisocial personality disorder (ASPD) with problems with alcohol including DWI. Methods: A randomized clinical trial was conducted, in conjunction with 28 days of incarceration, of a treatment program incorporating motivational interviewing principles for first-time DWI offenders. The sample of 305 offenders including 52 diagnosed as ASPD by the Diagnostic Interview Schedule were assessed before assignment to conditions and at 6, 12, and 24 months after discharge. Self-reported frequency of drinking and driving as well as various measures of drinking over the preceding 90 days were available at all assessments for 244 participants. Further, DWI rearrest data for 274 participants were available for analysis. Results: Participants randomized to receive the first offender incarceration and treatment program reported greater reductions in alcohol consumption from baseline levels when compared with participants who were only incarcerated. Antisocial personality disorder participants reported heavier and more frequent drinking but showed significantly greater declines in drinking from intake to posttreatment assessments. Further, the treatment resulted in larger effects relative to the control on ASPD than non-ASPD participants. Conclusions: Nonconfrontational treatment may significantly enhance outcomes for DWI offenders with ASPD when delivered in an incarcerated setting, and in the present study, such effects were found in a primarily American-Indian sample.

Yabiku ST; Rayle AD; Okamoto SK; Marsiglia FF; Kulis S. The effect of neighborhood context on the drug use of American Indian youth of the southwest. Journal of Ethnicity in Substance Abuse 6(2): 181-204, 2007

This study examined neighborhood effects on the drug use of American Indian youth of the Southwest. We compared these effects with American Indian and non-American Indian youth in order to examine the universality of neighborhood disorganization as a risk factor for drug use. Neighborhood level variables included unemployment, poverty, education, and violent crime rate. Results indicated that American Indian youth were not as adversely affected by these neighborhood factors. American Indian youth may possess cultural characteristics that protect them from the adverse effects of neighborhood disorganization, including close familial relationships and ethnic pride. Culturally competent practice with American Indian youth may best be implemented through the enhancement of relational and cultural strengths as described in the literature.

Yabiku ST; Rayle AD; Okamoto SK; Marsiglia FF; Kulis S. The effect of neighborhood context on the drug use of American Indian youth of the southwest. Journal of Ethnicity in Substance Abuse 6(2): 181-204, 2007

Yu M; Stiffman AR. Culture and environment as predictors of alcohol abuse/dependence symptoms in American Indian youths. Addictive Behaviors 32(10): 2253-2259, 2007. (16 refs.)

This study utilizes Bronfenbrenner's ecological model (1979) to examine multiple and interactive environmental (familial, social, and cultural) predictors of adolescent alcohol abuse/dependence symptoms. A stratified random sample of 401 American Indian youths was interviewed in 2001. The findings showed that family members' substance problems, peer misbehaviors, and participation in generic cultural activities positively predicted adolescent alcohol symptoms. Conversely, cultural pride/spirituality predicted fewer alcohol symptoms, and, importantly, religious affiliation moderated the effects of problematic peers and family members on adolescent alcohol symptoms. The findings suggest further study of intervention and prevention efforts regarding the benefits from consideration of the complex relationships among multiple environmental variables.

Yuan NP; Koss MP; Polacca M; Goldman D. Risk factors for physical assault and rape among six native American tribes. Journal of Interpersonal Violence 21(12): 1566-1590, 2006. (50 refs.)

Prevalence and correlates of adult physical assault and rape in six Native American tribes are presented (N = 1,368). Among women, 45% reported being physically assaulted and 14% were raped since age 18 years. For men, figures were 36% and 2%, respectively. Demographic characteristics, adverse childhood experiences, adulthood alcohol dependence, and cultural and regional variables were assessed. Using logistic regression, predictors of physical assault among women were marital status, an alcoholic parent, childhood maltreatment, and lifetime alcohol dependence. Predictors of sexual assault among women were marital status, childhood maltreatment, and lifetime alcohol dependence. Among men, only childhood maltreatment and lifetime alcohol dependence predicted being physically assaulted. Tribal differences existed in rates of physical assault (both sexes) and rape (women only). The results underscore the problem of violence victimization among Native Americans and point to certain environmental features that increase risk of adulthood physical and sexual assault. Implications for tribe-specific interventions are discussed.