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CORK Bibliography: Native Americans and Alaskan Natives

85 citations. January 2009 to present

Prepared: September 2012

Amparo P; Farr SL; Dietz PM. Centers for Disease Control and Prevention, Atlanta, Georgia. Preventing Chronic Disease 8(6): a118, 2011. (28 refs.)

The magnitude of chronic conditions and risk factors among American Indian/Alaska Native women of reproductive age is unknown. The objective of our study was to estimate this magnitude. We analyzed data for 2,821 American Indian/Alaska Native women and 105,664 non-Hispanic white women aged 18 to 44 years from the 2005 and 2007 Behavioral Risk Factor Surveillance System. We examined prevalence of high cholesterol, high blood pressure, diabetes, body mass index (kg/m(2)) >25.0, physical inactivity, smoking, excessive alcohol consumption, and frequent mental distress, and the cumulative number of these chronic conditions and risk factors (>3, 2, 1, or 0). In a multivariable, multinomial logistic regression model, we examined whether American Indian/Alaska Native race was associated with the cumulative number of chronic conditions and risk factors. American Indian/Alaska Native women, compared with white women, had significantly higher rates of high blood pressure, diabetes, obesity, smoking, and frequent mental distress. Of American Indian/Alaska Native women, 41% had 3 or more chronic conditions or risk factors compared with 27% of white women (chi(2), P < .001). After adjustment for income, education, and other demographic variables, American Indian/Alaska Native race was not associated with having either 1, 2, or 3 or more chronic conditions or risk factors. Three out of every 5 American Indian/Alaska Native women aged 18 to 44 years have 3 or more chronic conditions or risk factors. Improving economic status and education for AI/AN women could help eliminate disparities in health status.

Public Domain

Angstman S; Harris KJ; Golbeck A; Swaney G. Cultural identification and smoking among American Indian adults in an urban setting. Ethnicity & Health 14(3): 289-302, 2009. (51 refs.)

Objectives. Among American Indians (AIs), an important relationship has been theorized between cultural identification and substance abuse, including smoking. We investigated the relationship between cultural identification and smoking among AI adults. Design. Using the Orthogonal Cultural Identification Scale (OCIS), we examined the relationship between AI and White cultural identification and cigarette use in a sample of AI recruited at an urban Indian center (n=217). Results. We found that high AIs identification predicted smoker status and high White identification predicted non-smoker status when controlling for age and reservation residence. Orthogonal cultural identification status (categorized as high White/high AI, high White/low AI, low White/high AI, or low White/low AI) did not predict smoker status when controlling for age and reservation residence. OCIS item analysis revealed that positive responses to the individual OCIS items 'My family lives by the American Indian way of life,' 'I live by the American Indian way of life,' and 'I am a success in the American Indian way of life' predicted smoker status when controlling for age and reservation residence. Conclusions. Our data suggest that, among some groups of urban AIs, recreational smoking is associated with AI cultural identification.

Baldwin JA; Brown BG; Wayment HA; Nez RA; Brelsford KM. Culture and context: Buffering the relationship between stressful life events and risky behaviors in American Indian youth. Substance Use & Misuse 46(11): 1380-1394, 2011. (78 refs.)

The Sacred Mountain Youth Project was conducted to investigate risk and protective factors related to alcohol and drug use among American Indian youth. Findings indicated that stressful life events were positively associated with depressed mood, substance use, and risky behavior; cultural identity had no direct effects, but a secondary model showed that social support and protective family and peer influences were related to cultural identity. These findings suggest that the relationships between stressors and their negative sequelae are complex. Emphasis on protective processes that are culturally specific to American Indian youth may lead to effective alcohol and drug use prevention programs.

Barlow A; Mullany BC; Neault N; Davis Y; Billy T; Hastings R et al. Examining correlates of methamphetamine and other drug use in pregnant American Indian adolescents. American Indian and Alaska Native Mental Research 17(1): 1-24, 2010. (45 refs.)

American Indian and Alaska Native (AI/AN) adolescents have high rates of pregnancy, as well as alcohol, marijuana, cocaine, and, increasingly, methamphetamine (meth) use. The progression of adolescent drug use to meth use could have devastating impacts on AI communities, particularly when youth are simultaneously at risk for teen childbearing. In order to inform future prevention efforts, this study explores correlates of meth use in a sample of pregnant AI teens, with a focus on sociodemographic, familial, and cultural factors and use of other drugs.

Barnes PM; Adams PF; Powell-Griner E. QuickStats: Percentage of Adults Aged �18 Years Who Were Current Cigarette Smokers, by Race/Ethnicity --- National Health Interview Survey, United States, 2004--2008. MMWR. Morbidity and Mortality Weekly Review 59(11): 340, 2010. (1 refs.)

During 2004--2008, 20.5% of adults aged �18 years were current cigarette smokers. American Indian /Alaska Native adults (32.7%) were most likely to currently smoke cigarettes, and Asian adults (10.4%) were least likely to be current smokers.

Public Domain

Bletzer KV; Yuan NP; Koss MP; Polacca M; Eaves ER; Goldman D. Taking humor seriously: Talking about drinking in Native American focus groups. Medical Anthropology 30(3): 295- 318, 2011. (75 refs.)

Focus groups provide a source of data that highlight community ideas on a topic of interest. How interview data will be utilized varies by project. With this in mind, we identify ways that focus group data from a particular population (Native American) articulate a health issue of individual tribal concern (alcohol consumption). Taking our analytic framework from linguistics, one of the four fields of inquiry in anthropology, we examine format ties and the performance of humor as stylistic features of tribal focus groups and illustrate how linguistic devices can be used in analyzing aspects of adolescent and adult drinking. Focus group data require systematic review and analysis to identify useful findings that can lead to inquiry points to initiate collaborative work with local experts before the data can be developed and configured into effective program initiatives.

Bottorff JL; Carey J; Mowatt R; Varcoe C; Johnson JL; Hutchinson P; Sullivan D; Williams W; Wardman D. Bingo halls and smoking: Perspectives of First Nations women. Health & Place 15(4): 1014-1021, 2009. (46 refs.)

The purpose of this study was to examine bingo halls as a frequent site for exposure to secondhand cigarette smoke for First Nations women in rural communities. Thematic analysis of interviews with key informants, group discussions with young women, and observations in the study communities revealed that smoky bingo halls provided an important refuge from everyday experiences of stress and trauma, as well as increased women's risk for addiction, marginalization, and criticism. The findings illustrate how the bingo economy in isolated, rural First Nation communities influences tobacco use and secondhand smoke exposure, and how efforts to establish smoke-free bingos can be supported.

Bowen DJ; Henderson PN; Harvill J; Buchwald D. Short-term effects of a smoking prevention website in American Indian Youth. Journal of Medical Internet Research 14(3): 163-170, 2012. (23 refs.)

Background: The rate of smoking commercial tobacco products among American Indian youth is double the rate for white youth. Interventions are needed to reduce this disparity. Objective: To test the feasibility of a Web-based intervention to influence attitudes toward and intentions about smoking cigarettes among American Indian youth who attended a Native summer camp in the Northern Plains. Methods: The study website, the SmokingZine, was originally developed and tested in Canadian youth, then adapted to be appropriate for American Indian youth. We conducted a randomized controlled trial to test the influence of exposure to the adapted SmokingZine website on smoking attitudes and behaviors among American Indian youth 12-18 years of age. Participants assigned to the intervention group were given access to the website for 1 hour per day during their camp experience and asked to sign in to the site and use it. Control group participants were not given access to the site. Results: A total of 52% of intervention youth signed in to the website at least once. Among nonsmokers, intentions to try a cigarette in the intervention group declined from 16% to 0%, and increased from 8% to 25% in the control group (P < .05). Compared with the control group, youth in the intervention group were more likely to help others quit (21 percentage point change in intervention versus no change in control; P < .05) and had less positive attitudes about the drug effects of smoking (-0.19 change in intervention versus 0.67 in control; P < .05). Conclusion: These data indicate that SmokingZine needs more long-term, rigorous investigation as a way to keep American Indian youth from becoming regular smokers. Because the intervention group could use computers only 1 hour per day, increasing access might result in more visits and a greater effect of the website on smoking behaviors.

Brown RA. Crystal methamphetamine use among American Indian and White youth in Appalachia: Social context, masculinity, and desistance. Addiction Research & Theory 18(3): 250-269, 2010. (57 refs.)

Rural areas and American Indian reservations are hotspots for the use of crystal methamphetamine ('meth') in the United States, yet there is little ethnographic data describing meth use in these areas. This study draws upon 3 years of ethnographic work conducted with American Indian and White youth in Appalachia during the height of the meth epidemic. First, I show how crystal meth filled a functional niche in the lives of many young men, alleviating boredom and anomie linked to recent socioeconomic changes and changing labor opportunities, and intersecting with local understandings of masculinity and forms of military identity. Here, ethnographic and interview data converge to illustrate how social role expectations, recent socioeconomic change, and meth's pharmacological properties converge to create vulnerability to meth use in Appalachia. Next, I draw upon two American Indian narratives of desistance. These youth described recently severed social relationships and acute feelings of social isolation during the initiation of meth use. Both also described dramatic close calls with death that facilitated their eventual desistance from use, involving repaired social relationships and the establishment of new lives and hope. Comparisons with meth use in other populations and regions, including men who have sex with men in urban environments, suggest that similar motivations and contextual factors may influence meth use across diverse cultural and regional contexts. Recent interventions targeting the pathogenic aspects of masculine role socialization and ethnographic evidence on the role of social networks in desistance suggest both avenues and caveats for intervention.

Carter VB. Factors predicting placement of urban American Indian/Alaskan Natives into out-of-home care. Children and Youth Services Review 32(5): 657-663, 2010. (52 refs.)

American Indian/Alaskan Native children have disproportionately been placed into out-of-home care compared to White children in the child welfare system What were the factors that child protective set vices (CPS) workers considered when deciding to remove a child from the home? Utilizing data from the National Survey of Child and Adolescent Well-Being, this study examined out-of-home care factors for 2215 urban American Indian/Alaskan Native (AI/AN) and White children. In the urban sample, children from White families were younger and were more likely to be investigated for lack of supervision, while AI/AN families were investigated for physical neglect. In the placement regression models, urban AI/AN children came from homes where caregivers had greater alcohol, drug and mental health problems. Decisions by CPS workers to place AI/AN children may have been influenced by racial bias. A CPS system that acknowledges culture and race may reduce overrepresentation in placement. Efforts to work with AI/AN families prior to a child's removal may prove to be beneficial and less expensive.

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. The NSDUH Report: Substance Use among American Indian or Alaska Native Adolescents. (October 4, 2011). Rockville MD: Substance Abuse and Mental Health Administration, 2011. (5 refs.)

This report examines substance use among non- Hispanic American Indian or Alaska Native adolescents (hereafter referred to as "American Indian or Alaska Native adolescents") aged 12 to 17, using combined data from the 2004 to 2009 National Surveys on Drug Use and Health (NSDUHs). The report presented here is one in a series of reports intended to describe adolescent substance use within racial and ethnic subpopulations. Compared with the national average for adolescents aged 12 to 17, American Indian or Alaska Native adolescents had higher rates of past month cigarette use (16.8 vs. 10.2%), marijuana use (13.8 vs. 6.9%), and nonmedical use of prescription type drugs (6.1 vs. 3.3%). The higher rates of substance use among American Indian or Alaska Native adolescents compared with national averages also were generally found among males, females, and across age groups. Among adolescents aged 15 to 17, the rate of nonmedical use of prescription-type drugs in the past month among American Indians or Alaska Natives was higher than the national average (8.5 vs. 4.4%)

Public Domain

Cheadle JE; Whitbeck LB. Alcohol use trajectories and problem drinking over the course of adolescence: A study of North American indigenous youth and their caretakers. Journal of Health and Social Behavior 52(2): 228-245, 2011. (73 refs.)

This study investigated the links between alcohol use trajectories and problem drinking (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition abuse/dependence) using five waves of data from 727 North American Indigenous adolescents between 10 and 17 years from eight reservations sharing a common language and culture. Growth mixture models linking fundamental causes, social stressors, support, and psychosocial pathways to problem drinking via alcohol use trajectories over the early life course were estimated. Results indicated that 20 percent of the adolescents began drinking at 11 to 12 years of age and that another 20 percent began drinking shortly thereafter. These early drinkers were at greatly elevated risk for problem drinking, as were those who began drinking at age 13. The etiological analysis revealed that stressors (e.g., perceived discrimination) directly and indirectly influenced early and problem alcohol use by decreasing positive school attitudes while increasing feelings of anger and perceived delinquent friendships. Girls were found to be at risk independently of these other factors.

Daley CM; Greiner KA; Nazir N; Daley SM; Solomon CL; Braiuca SL et al. All nations breath of life: Using community-based participatory research to address health disparities in cigarette smoking among American Indians. Ethnicity & Disease 20(4): 334-338, 2010. (21 refs.)

Using a community-based participatory research (CBPR) approach, we developed the All Nations Breath of Life smoking cessation program and pilot-tested it in urban and reservation communities. The program combines weekly in-person group support sessions with individual telephone calls using motivational interviewing. All sessions include discussion of sacred tobacco and information about quitting and health. We have assessed the scientific validity, cultural-appropriateness, and readability of our program materials and found them to be adequate; participant satisfaction is high. The program shows promise for improving quit rates among American Indians, who have the highest smoking rates and lowest quit rates of any ethnic group. Our preliminary self-report data show quit rates of 65% at program completion and 25% at six months post-baseline.

Dickens DD; Dieterich SE; Henry KL; Beauvais F. School bonding as a moderator of the effect of peer influences on alcohol use among American Indian adolescents. Journal of Studies on Alcohol and Drugs 73(4): 597-603, 2012. (34 refs.)

Objective: Previous research suggests that substance use among American Indian youth is associated with disproportionate rates of morbidity and substance misuse. Additional work to understand risk and protective factors for alcohol use is needed. The current study examined the role of school bonding in buffering the effect of peer alcohol use on a student's own alcohol use among American Indian adolescents. Method: The present study is part of a larger examination of alcohol use among American Indian youth. Survey data were collected from middle and high school students during the 2009-2010 and 2010-2011 school years from 37 school districts in the United States. The sample consisted of 2,582 students ages 11-19 years: 1,606 were younger than 16, and 976 were age 16 or older. All students self-identified as American Indian or Alaskan Native. The sample was approximately equally divided by gender (49% male). Results: For all students, peer alcohol use was a risk factor for (a) lifetime alcohol use and (b) level of alcohol use among users. School bonding was associated with a lower likelihood of lifetime alcohol use for adolescents younger than age 16 and a lower level of use among users for all adolescents. School bonding emerged as a protective factor that buffers against peer alcohol use among adolescent alcohol users younger than 16. Conclusions: Results of the study demonstrate the influence of exposure to alcohol-using peers and the protective role of school bonding on alcohol use among American Indian adolescents. Implications for prevention are discussed.

Dickerson DL; Johnson CL. Mental health and substance abuse characteristics among a clinical sample of urban American Indian/Alaska Native Youths in a large California metropolitan area: A descriptive study. Community Mental Health Journal 48(1): 56-62, 2012. (40 refs.)

This study analyzes descriptive data among a clinical sample of American Indian/Alaska Native (AI/AN) youths receiving mental health services in a large California metropolitan area. Among 118 urban AI/AN youths, mood disorders (41.5%) and adjustment disorder (35.4%) were the most common mental health diagnoses. Alcohol (69.2%) and marijuana (50.0%) were the most commonly used substances. Witnessing domestic violence (84.2%) and living with someone who had a substance abuse problem (64.7%) were reported. The majority of patients demonstrated various behavior and emotional problems. Enhancing culturally relevant mental health and substance abuse treatment and prevention programs for urban AI/AN youth is suggested.

Dickerson DL; O'Malley SS; Canive J; Thuras P; Westermeyer J. Nicotine dependence and psychiatric and substance use comorbidities in a sample of American Indian male veterans. Drug and Alcohol Dependence 99(1-3): 169-175, 2009. (30 refs.)

Background: American Indians and Alaska Natives have the highest rates of nicotine dependence in the U.S. However, studies analyzing associations between nicotine dependence and psychiatric and substance use disorders in these groups have been limited. Methods: This study analyzes the co-occurrence current and lifetime DSM-III-R nicotine dependence with psychiatric and substance use disorders in a Community sample of 490 American Indian male veterans. Results: Lifetime nicotine dependence (23.3%) was associated with all lifetime disorders studied, including alcohol use and drug use disorders, and anxiety disorders, PTSD, pathological gambling and antisocial personality disorder. Current nicotine dependence was present in 19% affective, of the sample and significantly associated with current affective aid gambling disorder. Conclusions: Substantial co-morbidity exists between nicotine dependence and other Substance abuse and psychiatric disorders among this sample of American Indian male veterans, particularly for lifetime diagnoses. Screening for all psychiatric disorders among American Indian/Alaska Native smokers may be warranted. Although these results are similar to those observed among the general U.S. population, unique risk factors exist among American Indians/Alaska Natives which may require further attention. Specific public health and clinical interventions to reduce the rate of nicotine dependence among American Indians/Alaska Natives are recommended.

Dickerson DL; Spear S; Marinelli-Casey P; Rawson R; Li LB; Hser YI. American Indians/Alaska Natives and substance abuse treatment outcomes: Positive signs and continuing challenges. Journal of Addictive Diseases 30(1): 63-74, 2011. (30 refs.)

Limited information is known with regard to substance abuse treatment outcomes among AI/ANs. Data retrieved from the Treatment System Impact (TSI) project and Methamphetamine Treatment Project (MTP) were used to compare treatment measures between a sample of AI/ANs and a matched comparison group. Our results revealed no significant differences between AI/ANs and the matched comparison group in treatment outcomes at 12-months post-treatment based on legal, employment, medical, and psychiatric measures. AI/ANs also received more family-related services (29.9% vs. 17.1%) and abuse-related services (21.3% vs. 7.6%). Addressing barriers to receiving substance abuse treatment and enhancing screening methods for AI/ANs are suggested.

DiGiacomo M; Davidson PM; Abbott PA; Davison J; Moore L; Thompson SC. Smoking cessation in indigenous populations of Australia, New Zealand, Canada, and the United States: Elements of effective interventions. (review). International Journal of Environmental Research and Public Health 8(2): 388-410, 2011. (76 refs.)

Indigenous people throughout the world suffer a higher burden of disease than their non-indigenous counterparts contributing to disproportionate rates of disability. A significant proportion of this disability can be attributed to the adverse effects of smoking. In this paper, we aimed to identify and discuss the key elements of individual-level smoking cessation interventions in indigenous people worldwide. An integrative review of published peer-reviewed literature was conducted. Literature on smoking cessation interventions in indigenous people was identified via search of electronic databases. Documents were selected for review if they were published in a peer-reviewed journal, written in English, published from 1990-2010, and documented an individual-level intervention to assist indigenous people to quit smoking. Studies that met inclusion criteria were limited to Australia, New Zealand, Canada, and the USA, despite seeking representation from other indigenous populations. Few interventions tailored for indigenous populations were identified and the level of detail included in evaluation reports was variable. Features associated with successful interventions were integrated, flexible, community-based approaches that addressed known barriers and facilitators to quitting smoking. More tailored and targeted approaches to smoking cessation interventions for indigenous populations are required. The complexity of achieving smoking cessation is underscored as is the need to collaboratively develop interventions that are acceptable and appropriate to local populations.

D'Silva J; Schillo BA; Sandman NR; Leonard TL; Boyle RG. Evaluation of a tailored approach for tobacco dependence treatment for American Indians. American Journal of Health Promotion 25(5, Supplement S): S66-S69, 2011. (10 refs.)

Purpose. Evaluate a tailored approach for tobacco dependence treatment for American Indians. Design. A single-group design evaluation of a culturally specific curriculum for tobacco dependence treatment was implemented. Baseline assessment, program utilization, and 90-day follow-up interview data were analyzed. Setting. Fond du Lac Reservation in rural Minnesota and Mashkiki Waakaaigan Pharmacy in Minneapolis, Minnesota. Subjects. American Indian adults (N = 317). Intervention. Four 1-hour individual or group sessions of behavioral counseling paired with pharmacotherapy. Measures. Demographic variables, program satisfaction, and tobacco use behaviors. Analysis. Descriptive statistics; for abstinence, a smoking = missing analysis was used, assuming all nonrespondents were still smoking. Results. Sixty-three percent of participants completed the program. The 90-day follow-up response rate was 47%. Of those who completed, 47% reported abstinence at the 90-day follow-up. Missing = smoking analysis yielded a 21.8% quit rate. Continuing smokers cut their daily smoking by half from 17 to eight cigarettes, 88% reported an increase in self-efficacy for their next quit, and 44% planned to quit within 30 days. Conclusion. Evidence-based tobacco dependence treatment programs tailored to be culturally specific have the potential to significantly affect the burden of tobacco-related disparities among American Indians.

Duran B; Oetzel J; Parker T; Malcoe LH; Lucero J; Jiang YZ. Intimate partner violence and alcohol, drug, and mental disorders among American Indian women from southwest tribes in primary care. American Indian And Alaska Native Mental Health Research 16(2): 11-27, 2009. (57 refs.)

The relationship of intimate partner violence (IPV) with mental disorders was investigated among 234 American Indian/Alaska Native female primary care patients. Results indicated that unadjusted prevalence ratios for severe physical or sexual abuse (relative to no IPV) were significant for anxiety, PTSD, mood, and any mental disorder. Adjusted prevalence ratios showed severe physical or sexual IPV to be associated with any mood disorder. Patterns of IPV and mental health have implications for detection and service utilization.

Ehlers CL; Gilder DA; Gizer IR; Wilhelmsen KC. Heritability and a genome-wide linkage analysis of a Type II/B cluster construct for cannabis dependence in an American Indian community. Addiction Biology 14(3): 338-348, 2009. (85 refs.)

Subtyping of substance dependence disorders holds promise for a number of important research areas including phenotyping for genetic studies. characterizing clinical course, and matching treatment and prevention strategies. This study sought to investigate whether a dichotomous construct similar to Babor's Types A/B and Cloninger's Types I/II for alcohol dependence can be identified for cannabis dependence in a Native American sample. In addition, heritability of this construct and its behavior in a genetic linkage analyses were evaluated. Information on cannabis use and dependence symptoms and other psychiatric disorders was obtained using the Semi-Structured Assessment for the Genetics of Alcoholism from a community sample of 606 American Indians. Hierarchical average linkage and K means cluster analysis was used, and a three-cluster solution was found to generate the best separation of variables. Ninety-one per cent of cannabis-dependent participants fell into one of the two subtypes: Type A/I cluster (n = 114, 56%) and Type B/II cluster (n = 70, 35%). Heritability (estimated using Sequential Oligogenic Linkage Analysis Routines) was only significant for the Type B/II cluster (h(2) = 0.44, SE = 0.18. P < 0.01). Evidence for linkage was found for the Type B/II cluster (versus no diagnosis) on chromosome 1.6 [at 139 centimorgans (cM), Log of the Odds (LOD) score = 4.4], and on chromosome 19 (at 74 cM. LOD score = 6.4). Regions of interest for this phenotype (LOD > 1.5) were also located on chromosomes 14, 21, 22. These findings suggest that a Type B/II cannabis dependence phenotype can be identified in this population and that it is in part heritable and linked to areas of the genome identified previously for drug dependence phenotypes in this population as well as in other studies.

Ehlers CL; Gizer IR; Schuckit MA; Wilhelmsen KC. Genome-wide scan for self-rating of the effects of alcohol in American Indians. Psychiatric Genetics 20(5): 221-228, 2010. (87 refs.)

Objective: This study's aims were to map loci linked to self-rating of the effects of alcohol and to determine if there was overlap with loci mapped earlier for other substance dependence phenotypes in an American Indian community at high risk for substance dependence. Methods: Each participant gave a blood sample and completed a structured diagnostic interview using the Semi Structured Assessment for the Genetics of Alcoholism. Retrospective report of responses to alcohol during the FIRST FIVE TIMES they had ever drank alcohol was estimated from the Self-Rating of the Effects of Alcohol (SRE) questionnaire for each participant. Genotypes were determined for a panel of 791 micro-satellite polymorphisms in 381 members of multiplex families using SOLAR. Results Analyses of multipoint variance component Log of Odds (LOD) scores, for the FIRST FIVE TIMES phenotype, revealed two loci that had a LOD score greater than 3.0 on chromosomes 6 and 9. In addition, three locations were identified with LOD scores above 2.0 on chromosomes 10, 12, 17. Conclusion: These results corroborate the importance of regions on chromosome 6 and 9 highlighted in earlier segregation studies in this and other populations for substance dependence-related phenotypes, as well as an area on chromosome 10 earlier identified for the FIRST FIVE TIMES phenotype in the collaborative study on the genetics of alcoholism. These studies additionally lend further support the construct that the SRE may represent an important endophenotype associated with alcohol and other substance dependence.

Ehlers CL; Gizer IR; Gilder DA; Wilhelmsen KC. Linkage analyses of stimulant dependence, craving, and heavy use in American Indians. American Journal of Medical Genetics. Part B: Neuropsychiatric Genetics 156B(7): 772-780, 2011. (115 refs.)

Amphetamine-type substances are the second most widely used illicit drugs in the United States. There is evidence to suggest that stimulant use (cocaine and methamphetamine) has a heritable component, yet the areas of the genome underlying these use disorders are yet to be identified. This study's aims were to map loci linked to stimulant dependence, heavy use, and craving in an American Indian community at high risk for substance dependence. DSM diagnosis of stimulant dependence, as well as indices of stimulant "craving," and "heavy use," were obtained using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). Genotypes were determined for a panel of 791 micro-satellite polymorphisms in 381 members of multiplex families using SOLAR. Stimulant dependence, stimulant "craving," and "heavy stimulant use," were all found to be heritable. Analyses of multipoint variance component LOD scores, failed to yield evidence of linkage for stimulant dependence. For the stimulant "craving" phenotype, linkage analysis revealed a locus that had a LOD score of 3.02 on chromosome 15q25.3-26.1 near the nicotinic receptor gene cluster. A LOD score of 2.05 was found at this same site for "heavy stimulant use." Additional loci with LOD scores above 2.00 were found for stimulant "craving" on chromosomes 12p13.33-13.32 and 18q22.3. These results corroborate the importance of "craving" as an important phenotype that is associated with regions on chromosome 12, 15, and 18, that have been highlighted in prior segregation studies in this and other populations for substance dependence-related phenotypes.

Ehlers CL; Phillips E; Gizer IR; Gilder DA; Wilhelmsen KC. EEG spectral phenotypes: Heritability and association with marijuana and alcohol dependence in an American Indian community study. Drug and Alcohol Dependence 106(2): 101-110, 2010. (134 refs.)

Native Americans have some of the highest rates of marijuana and alcohol use and abuse, yet neurobiological measures associated with dependence on these substances in this population remain unknown. The present investigation evaluated the heritability of spectral characteristics of the electroencephalogram (EEG) and their correlation with marijuana and alcohol dependence in an American Indian community. Participants (n = 626) were evaluated for marijuana (MJ) and alcohol (ALC) dependence, as well as other psychiatric disorders. EEGs were collected from six cortical sites and spectral power determined in five frequency hands (delta 1.0-4.0 Hz, theta 4.0-7.5 Hz, alpha 7.5-12.0 Hz, low beta 12.0-20.0 Hz and high beta/gamma 20-50 Hz). The estimated heritability (112) of the EEG phenotypes was calculated using SOLAR, and ranged from 0.16 to 0.67. Stepwise linear regression was used to detect correlations between MJ and ALC dependence and the spectral characteristics of the EEG using a model that took into account: age, gender, Native American Heritage (NAH) and a lifetime diagnosis of antisocial personality and/or conduct disorder (ASPD/CD). Increases in spectral power in the delta frequency range, were significantly correlated with gender (p < 0.001) and marijuana dependence (p < 0.003). Gender, age, NAH and ASPD/CD were all significantly (p < 0.001) correlated with theta, alpha and beta band power, whereas alcohol dependence (p < 0.01), gender (p < 0.001), and ASPD/CD (p < 0.001) were all correlated with high beta/gamma band power. These data suggest that the traits of EEG delta and high beta/gamma activity are correlated with MJ dependence and alcohol dependence, respectively, in this community sample of Native Americans.

Elton-Marshall T; Leatherdale ST; Burkhalter R. Tobacco, alcohol and illicit drug use among Aboriginal youth living off-reserve: Results from the Youth Smoking Survey. Canadian Medical Association Journal 183(8): E480- E486, 2011. (16 refs.)

Background: Despite the high prevalence of smoking among Aboriginal youth, there is a paucity of research related to tobacco use and other risk behaviours among Aboriginal youth living off-reserve in Canada. We used data from the national Youth Smoking Survey to characterize non-traditional tobacco use, exposure to second-hand smoke, and alcohol and drug use among Aboriginal youth living off-reserve. We examined whether these youth were at increased health risk compared with non-Aboriginal youth. Methods: We examined cigarette smoking behaviour, use of other tobacco products, use of alcohol and other drugs, and exposure to second-hand smoke among 2620 Aboriginal youth living off-reserve and 26 223 non-Aboriginal youth in grades 9 to 12 who participated in the 2008/09 Youth Smoking Survey. Results: The prevalence of current smoking among the Aboriginal youth was more than double that among non-Aboriginal youth (24.9% v. 10.4%). Aboriginal youth also had a higher prevalence of regular exposure to second-hand smoke at home (37.3% v. 19.7%) and in cars (51.0% v. 30.3%). Aboriginal youth were more likely than non-Aboriginal youth to be current smokers, to be regularly ex posed to second-hand smoke, to have tried marijuana and other illicit drugs, and to en gage in binge drinking. They were less likely than non-Aboriginal youth to have tried to quit smoking. Interpretation: Current national estimates of smoking, and alcohol and illicit drug use among youth underestimate the prevalence of these behaviours among Aboriginal youth living off-reserve. Our findings highlight the need for culturally appropriate prevention and cessation policies and programs for this at-risk population.

Ewing SWF; Venner KL; Mead HK; Bryan AD. Exploring racial/ethnic differences in substance use: A preliminary theory-based investigation with juvenile justice-involved youth. BMC Pediatrics 11: article 71, 2011. (65 refs.)

Background: Racial/ethnic differences in representation, substance use, and its correlates may be linked to differential long-term health outcomes for justice-involved youth. Determining the nature of these differences is critical to informing more efficacious health prevention and intervention efforts. In this study, we employed a theory-based approach to evaluate the nature of these potential differences. Specifically, we hypothesized that (1) racial/ethnic minority youth would be comparatively overrepresented in the juvenile justice system, (2) the rates of substance use would be different across racial/ethnic groups, and (3) individual-level risk factors would be better predictors of substance use for Caucasian youth than for youth of other racial/ethnic groups. Methods: To evaluate these hypotheses, we recruited a large, diverse sample of justice-involved youth in the southwest (N = 651; M age = 15.7, SD = 1.05, range = 14-18 years); 66% male; 41% Hispanic, 24% African American, 15% Caucasian, 11% American Indian/Alaska Native). All youth were queried about their substance use behavior (alcohol, marijuana, tobacco, illicit hard drug use) and individual-level risk factors (school involvement, employment, self-esteem, level of externalizing behaviors). Results: As predicted, racial/ethnic minority youth were significantly overrepresented in the juvenile justice system. Additionally, Caucasian youth reported the greatest rates of substance use and substance-related individual-level risk factors. In contrast, African American youth showed the lowest rates for substance use and individual risk factors. Contrary to predictions, a racial/ethnic group by risk factor finding emerged for only one risk factor and one substance use category. Conclusions: This research highlights the importance of more closely examining racial/ethnic differences in justice populations, as there are likely to be differing health needs, and subsequent treatment approaches, by racial/ethnic group for justice-involved youth. Additionally, this study highlights the need for timely, empirically supported (developmentally and cross-culturally) substance abuse interventions for all justice-involved youth.

Faseru B; Daley CM; Gajewski B; Pacheco CM; Choi WS. A longitudinal study of tobacco use among American Indian and Alaska Native tribal college students. BMC Public Health 10: 617, 2010. (36 refs.)

Background: American Indians (AI) have the highest smoking rates of any ethnic group in the US (40.8%), followed most closely by African Americans (24.3%) and European Americans (23.6%). AI smokers also have more difficulty quitting smoking compared to other ethnic groups, evidenced by their significantly lower quit ratios, and are among the least successful in maintaining long term abstinence. While health disparities like these have existed for years among AI, the epidemiology of smoking and nicotine dependence has not been optimally described among this underserved population. Our overarching hypothesis is that the susceptibility of AI to cigarette smoking and nicotine dependence and its consequences has both an underlying nicotine metabolism component as well as psychosocial, cultural, and environment causes. We are well-positioned to explore this issue for the first time in this population. Our objective is to establish a cohort of AI tribal college/university students to determine the predictors of smoking initiation (non-use to experimentation), progression (experimentation to established use), and cessation (established use to cessation). Much of what is known about the process of smoking initiation and progression comes from quantitative studies with non-Native populations. Information related to smoking use among AI tribal college/university (TCU) students is entirely unknown and critically needs further investigation. This study will be the first of its kind among AI college students who are at the highest risk among all ethnic groups for tobacco dependence. Methods/design: First year students at Haskell Indian Nations University in Kansas will be recruited over four consecutive years and will be surveyed annually and repeatedly through year 5 of the study. We will use both longitudinal quantitative surveys and qualitative focus group methods to examine key measures and determinants of initiation and use among this high risk group.

Forcehimes AA; Venner KL; Bogenschutz MP; Foley K; Davis MP; Houck JM et al. American Indian methamphetamine and other drug use in the Southwestern United States. Cultural Diversity & Ethnic Minority Psychology 17(4): 366-376, 2011. (37 refs.)

To investigate the extent of methamphetamine and other drug use among American Indians (AIs) in the Four Corners region, we developed collaborations with Southwestern tribal entities and treatment programs in and around New Mexico. We held nine focus groups, mostly with Southwestern AI participants (N = 81) from three diverse New Mexico communities to understand community members, treatment providers, and clients/relatives views on methamphetamine. We conducted a telephone survey of staff (N = 100) from agencies across New Mexico to assess perceptions of methamphetamine use among people working with AI populations. We collected and analyzed self-reported drug use data from 300 AI clients/relatives who completed the Addiction Severity Index (ASI) in the context of treatment at three diverse addiction treatment programs. Each focus group offered a unique perspective about the effect of drugs and alcohol on each respective community. Though data from the phone surveys and ASIs suggested concerning rates of methamphetamine use, with women more adversely affected by substance use in general, alcohol was identified as the biggest substance use problem for AI populations in the Southwest. There appears to be agreement that methamphetamine use is a significant problem in these communities, but that alcohol is much more prevalent and problematic. There was less agreement about what should be done to prevent and treat methamphetamine use. Future research should attend to regional and tribal differences due to variability in drug use patterns, and should focus on identifying and improving dissemination of effective substance use interventions.

Friese B; Grube JW; Seninger S; Paschall MJ; Moore RS. Drinking behavior and sources of alcohol: Differences between Native American and white youths. Journal of Studies on Alcohol and Drugs 72(1): 53-60, 2011. (40 refs.)

Objective: We investigated drinking behavior and sources of alcohol among Native American and White youths, as well as how underage drinking behavior and sources of alcohol may be related to environmental factors. Method: Survey data from a sample of 18,916 youths (8th, 10th, and 12th grades) from Montana were analyzed using hierarchical linear modeling. Survey data were supplemented with county-level economic and census data. Results: Native American youths were more likely than White youths to report drinking and heavy episodic drinking and initiate drinking at a younger age. Native Americans were less likely than Whites to get alcohol from home or from someone younger than age 21 but were more likely to get it from other social sources or through theft from a store. Living in a county with more Native Americans was inversely related to access to alcohol for both White and Native American youths, as well as reduced lifetime, 30-day, and heavy episodic drinking. Living in a county with more single-parent households was positively related to lifetime drinking, 30-day drinking, heavy episodic drinking, and increased access to alcohol through someone younger than age 21 or a stranger. Median income was negatively related to lifetime drinking and ease of access to alcohol and was positively related to accessing alcohol from home without permission, theft, or purchase with a fake ID. Conclusions: Because Native American and White youths have different drinking patterns and obtain alcohol from different sources, strategies to prevent alcohol problems in these groups should take these differences into consideration.

Fu SS; Burgess DJ; van Ryn M; Rhodes K; Widome R; Ricards JJ et al. Smoking-cessation strategies for American Indians: Should smoking-cessation treatment include a prescription for a complete home smoking ban? American Journal of Preventive Medicine 39(6, supplement 1): S56-S65, 2010. (65 refs.)

Background: The prevalence of cigarette smoking is particularly high among American Indian communities in the Upper Midwest. Purpose: To evaluate the predictors of smoking cessation among a population-based sample of American Indians in the Upper Midwest during a quit attempt aided with nicotine replacement therapy (NRT). Methods: This study used the subsample of American Indian adults (n=291, response rate=55.4%) from a cohort study of smokers engaging in an aided NRT quit attempt. Eligible participants filled an NRT prescription between July 2005 and September 2006 through the Minnesota Health Care Programs (e. g., Medicaid). Administrative records and follow-up survey data were used to assess outcomes approximately 8 months after the NRT fill date. This analysis was conducted in 2009-2010. Results: Approximately 33% of American Indian respondents trying to quit smoking reported complete home smoking bans. Adoption of a complete home smoking ban and greater perceived advantages of NRT were cross-sectionally associated with 7-day smoking abstinence in univariate and multivariate analyses. Consistent with previous research, older age was a significant predictor of 7-day abstinence. Having a history of clinician-diagnosed anxiety in the past year was associated with decreased likelihood of 7-day abstinence in the unadjusted analysis, but not significant in multivariate analyses. Conclusions: Results of this study suggest potential modifiable targets of interventions for future research to help American Indians quit smoking: (1) improved delivery of behavioral interventions to increase the intensity of smoking cessation treatment; (2) promotion and adoption of complete home smoking bans; and (3) education to increase awareness of the benefits of NRT.

Garrett MT; Torres-Rivera E; Brubaker M; Portman TAA; Brotherton D; West-Olatunji C et al. Crying for a vision: The Native American sweat lodge ceremony as therapeutic intervention. Journal of Counseling and Development 89(3): 318-325, 2011. (35 refs.)

The Native American sweat lodge ceremony or sweat therapy is being used increasingly in various medical, mental health, correctional, and substance abuse treatment centers serving both Native and non-Native clients. This article explores the sweat lodge ceremony's background, elements of Native American spirituality, origin story, cultural symbolism, prayer, and contemporary use. Current evidence of effectiveness and therapeutic benefits is presented, then implications for integrating the sweat lodge ceremony as a complementary counseling approach are discussed.

Gone JP; Trimble JE. American Indian and Alaska Native mental health: Diverse perspectives on enduring disparities. (review). Annual Review of Clinical Psychology 8: 131-160, 2012. (165 refs.)

As descendants of the indigenous peoples of the United States, American Indians and Alaska Natives (AI/ANs) have experienced a resurgence in population and prospects since the beginning of the twentieth century. Today, tribally affiliated individuals number over two million, distributed across 565 federally recognized tribal communities and countless metropolitan and nonreservation rural areas. Although relatively little evidence is available, the existing data suggest that AI/AN adults and youth suffer a disproportionate burden of mental health problems compared with other Americans. Specifically, clear disparities have emerged for AI/AN substance abuse, posttraumatic stress, violence, and suicide. The rapid expansion of mental health services to AI/AN communities has, however, frequently preceded careful consideration of a variety of questions about critical components of such care, such as the service delivery structure itself, clinical treatment processes, and preventive and rehabilitative program evaluation. As a consequence, the mental health needs of these communities have easily outpaced and overwhelmed the federally funded agency designed to serve these populations, with the Indian Health Service remaining chronically understaffed and underfunded such that elimination of AI/AN mental health disparities is only a distant dream. Although research published during the past decade has substantially improved knowledge about AI/AN mental health problems, far fewer investigations have explored treatment efficacy and outcomes among these culturally diverse peoples. In addition to routine calls for greater clinical and research resources, however, AI/AN community members themselves are increasingly advocating for culturally alternative approaches and opportunities to address their mental health needs on their own terms.

Gray JS; Carter PM. Growing our own: Building a native research team. Journal of Psychoactive Drugs 44(2): 160-165, 2012. (11 refs.)

In 2006, American Indian/Alaska Natives (AI/AN) made up less than 1% of the science, engineering and health doctorates in the U.S. Early introduction of AI/AN students to research and continued opportunities are necessary to develop successful AI/AN researchers who can better serve their communities. This team was developed to form a cohort of American Indian students, staff and faculty interested in research and becoming researchers. Since implementation, the program grew from one student to over 20 AI students ranging from freshmen just entering college to doctoral students working to complete their dissertations. This article highlights the team growth, increasing structure, student needs and the faculty and staff involved. It further addresses the support and educational aspects of growing an ongoing, multidisciplinary research team committed to ethical research in Native communities. The team addresses substance use prevalence, the relationship of substance abuse to other mental health diagnoses, and treatment issues. The team includes weekly team meetings, a Blackboard site on the Internet that is populated with resources and focused on sharing materials and information, a weekly journal club discussion of research articles, and collaborative discussions on each project and the barriers and challenges that need to be addressed to move forward.

Gryczynski J; Johnson JL. Challenges in public health research with American Indians and other small ethnocultural minority populations. Substance Use & Misuse 46(11): 1363-1371, 2011. (57 refs.)

As a result of the historical legacy of conquest, colonization, and cultural destruction, indigenous peoples often represent just a small segment of the population in many countries throughout the world. In the United States, American Indians/Alaska Natives are not only one of the smallest minority groups in the nation, but are also very culturally diverse. Disparities in health outcomes often occur along racial and ethnic lines, and culture can play an important role in shaping health behavior. Research on the distribution and patterning of disease and risk behaviors among population subgroups is critical for advancing evidence-based public health policy and practice. This article provides a brief overview of key challenges in conducting behavioral health research with American Indians at both community and population levels. Many of the issues raised also apply to other small ethnocultural minority groups.

Gryczynski J; Johnson JL. Special issue on Native Americans and substance use: Introduction. Substance Use & Misuse 46(11): 1359-1362, 2011. (20 refs.)

Henderson PN; Kanekar S; Wen Y; Buchwald D; Goldberg J; Choi W; Okuyemi KS et al. Patterns of cigarette smoking initiation in two culturally distinct American Indian tribes. American Journal of Public Health 99(11): 2020-2025, 2009. (49 refs.)

Objectives. To better understand patterns of initiation among American Indians we examined age-related patterns of smoking initiation during adolescence and young adulthood in 2 American Indian tribes. Methods. We used log-rank comparison and a Cox proportional hazard regression model to analyze data from a population-based study of Southwest and Northern Plains American Indians aged 18 to 95 years who initiated smoking by age 18 years or younger. Results. The cumulative incidence of smoking initiation was much higher among the Northern Plains Indians (47%) than among the Southwest Indians (28%; P<.01). In the Southwest, men were more likely than women to initiate smoking at a younger age (P<.01); there was no such difference in the Northern Plains sample. Northern Plains men and women in more recent birth cohorts initiated smoking at an earlier age than did those born in older birth cohorts. Southwest men and women differed in the pattern of smoking initiation across birth cohorts as evidenced by the significant test for interaction (P=.01). Conclusion. Our findings underscore the need to implement tobacco prevention and control measures within American Indian communities.

Henry KL; McDonald JN; Oetting ER; Walker PS; Walker RD; Beauvais F. Age of onset of first alcohol intoxication and subsequent alcohol use among urban American Indian adolescents. Psychology of Addictive Behaviors 25(1): 48-56, 2011. (48 refs.)

The objective was to assess the effect of early onset intoxication on subsequent alcohol involvement among urban American Indian youth. The data come from the American Indian Research (AIR) project, a panel study of urban Indian youth residing in King County, Washington. Data were collected annually from the adolescent and his/her primary caregiver from the 1988-89 school year to the 1996-97 school year, providing a total of nine waves of data. Early intoxication (by age 14) was related to delinquency, family history of alcohol abuse or dependence, poverty, broken family structure, less family cohesiveness, and more family conflict. The effects of these characteristics were, therefore, partialed out in testing effects of early intoxication on later alcohol involvement. Two-part latent growth models of alcohol use and alcohol problems were specified. Effects of early onset intoxication on these trajectories, as well as lifetime alcohol abuse or dependence by the transition to young adulthood, were examined. Findings indicate that adolescents who experienced their first intoxication early (by age 14), used alcohol more heavily from the ages of 16 to 18, experienced more problems related to the alcohol's use from the ages of 16 to 18, and were more likely to have a diagnosed alcohol disorder by the final wave of data collection. Congruent with similar studies in the general population, early intoxication appears to be associated with a deleterious course of alcohol involvement during adolescence and into the transition to young adulthood among urban American Indian youth. Implications for prevention are discussed.

Hodge CE. "Starting Stories" among older Northern Plains American Indian smokers. American Indian Culture and Research Journal 33(3): 53-60, 2009. (16 refs.)

The purpose of this study was to examine smoking initiation, smoking cessation, and tobacco-control policies among Plains Indian tribes. Seven tribes located in Minnesota, Nebraska, and South Dakota participated in the multi-reservation study from 2002 to 2003. A number of focus groups were conducted. Several notable findings are presented. 1) None of the adults in the groups stated that they started smoking in adulthood. The youngest age of smoking initiation was reported at age nine; others started at the young ages of eleven and twelve. 2) Smoking was a family affair-it did not necessarily originate with peer pressure, which is often the documented route for the general population. Peer pressure and peer-influenced behaviors came later with older teen group activities and inducement. The family gatherings, with older family members telling stories, the younger members gathering at the edges of the group, were important weekly or even nightly events. These gatherings provided the opportunity for the smoking habit to be introduced and smoking behaviors to be emulated and reinforced. 3) Participants voiced a reluctance to tell others not to smoke because it was felt that �they will smoke if they want to.� Many American Indian groups value independence-or the freedom to make choices for oneself. This independence also implies noninterference, or the meddling or impediment of others. 4) All focus groups claimed the younger generation experiments with smoking at even younger ages than they did, notably ages seven or eight; this was reason for much concern. By the time a child is ten or eleven, he or she may already be addicted to smoking cigarettes. 5) Smoking initiation is viewed as an accepted, indeed an expected behavior.

Horn K; Noerachmanto N; Dino G; Manzo K; Brayboy M. Who wants to quit? Characteristics of American Indian youth who seek smoking cessation intervention. Journal of Community Health 34(2): 153-163, 2009. (41 refs.)

No group is more at-risk for tobacco-related health disparities than are American Indian youth. Little is known about their readiness to quit smoking and the extent to which cessation programs may require cultural tailoring related to recruitment, implementation, or content. This study identifies unique characteristics of American Indian teen smokers who enrolled in a school-based smoking cessation program, Not On Tobacco (called N-O-T). Using data from N-O-T intervention trials conducted in North Carolina between 2001 and 2004, the present study (a) describes the characteristics of American Indian participants (n = 91); (b) determines if basic demographics and smoking history affect intervention readiness; and (c) compares findings with non-Native participants (n = 138) enrolled in N-O-T within the same state. Upon enrollment, 80% of the sample reported that they planned to quit smoking in the next 1-6 months. We found significant differences between American Indian and non-Native youth on smoking history, with non-Natives smoking with greater intensity and frequency. Contrary to previous reports, American Indian youth in this study smoked with less intensity and were more ready to quit smoking than non-Native youth. Results reveal previously unreported characteristics of American Indian teen smokers. Study findings may advance the development of effective marketing, recruitment, and programming among American Indian teen smokers into cessation programs, particularly N-O-T, which is the only teen smoking cessation program which includes an adaptation specifically for American Indians.

Iralu J; Duran B; Pearson CR; Jiang YZ; Foley K; Harrison M. Risk factors for HIV disease progression in a rural southwest American Indian population. Public Health Reports 125(Supplement 4): 43-50, 2010. (32 refs.)

Objectives. Risk factors for human immunodeficiency virus (HIV) disease progression among American Indians (AIs) have been poorly characterized. We assessed the impact of socioeconomic factors and use of traditional healing on HIV disease progression in a rural AI community. Methods. From January 2004 through December 2006, we interviewed 36 HIV-positive AIs regarding their socioeconomic status, incarceration, and use of traditional healing. We also collected chart-abstracted adherence and substance-abuse data. Through bivariate analysis, we compared these factors with the CD4-cell counts and log HIV-1 viral loads (VLs). Using a simple regression model, we assessed interactions between the significant associations and the outcome. Results. Participant characteristics included being male (58.3%), being trans-gender (13.9%), having ever been incarcerated (63.9%), having a household income of <$1,000/month (41.7%), being unemployed (61.1%), being diagnosed with alcohol abuse (50.0%), and using traditional medicine (27.8%) in the last 12 months. Higher VLs were associated with recent incarceration (p<0.05), household income of <$1,000/month (p<0.05), and provider-assessed alcohol abuse (p<0.05). We found an interaction between incarceration and alcohol abuse, and alcohol abuse was the factor more strongly associated with higher VLs. A lower CD4 count was associated with recent incarceration (p<0.05) and use of traditional medicine (p<0.05). Conclusions. Alcohol abuse is an important contributor to HIV disease progression, and participants with lower CD4 counts were more likely to use traditional medicine. HIV care among this rural AI population should focus on addressing alcohol abuse and other socioeconomic risk factors and promote collaboration between Western medical and Navajo traditional practitioners.

Jones SE; Anderson K; Lowry R; Conner H. Risks to health among American Indian/Alaska Native high school students in the United States. Preventing Chronic Disease 8(4): A76, 2011. (29 refs.)

Introduction: According to the World Health Organization, the 10 leading risk factor causes of death in high-income countries are tobacco use, high blood pressure, overweight and obesity, physical inactivity, high blood glucose, high cholesterol, low fruit and vegetable intake, urban air pollution, alcohol use, and occupational risks. We examined the prevalence of some of the leading risks to health among nationally representative samples of American Indian/Alaska Native (AI/AN) high school students and compared rates across racial/ethnic groups. Methods: We combined data from the 2001, 2003, 2005, 2007, and 2009 national Youth Risk Behavior Survey. The survey is a biennial, self-administered, school-based survey of 9th-through 12th-grade students in the United States. Overall response rates for the surveys ranged from 63% to 72%. Of 73,183 participants, 952 were AI/AN students. Results: For 7 of the 16 variables examined in this study, the prevalence among AI/AN high school students was higher than the prevalence among white high school students. For 1 variable (ate fruit and vegetables <5 times per day), the prevalence among AI/AN students was significantly lower than that among white students. The prevalence for the remaining 8 variables was similar among AI/AN students and white students. These findings also show differences in the prevalence of some behaviors among AI/AN, black, and Hispanic students. Conclusion: These findings show the prevalence of some health risk behaviors was significantly higher among AI/AN high school students than among high school students in other racial/ethnic groups.

Keyes KM; Liu XC; Cerda M. The role of race/ethnicity in alcohol-attributable injury in the United States. Epidemiologic Reviews 34(1): 89-102, 2012. (86 refs.)

A substantial proportion of injuries worldwide are attributable to alcohol consumption, and US estimates indicate that the drinking patterns of racial/ethnic groups vary considerably. The authors reviewed evidence from 19 publications regarding racial/ethnic differences in overall alcohol-attributable injury as well as percent blood alcohol content positivity for injury deaths in the United States. They found that Native Americans evidence higher rates of alcohol-attributable motor vehicle crash fatality, suicide, and falls compared with other racial/ethnic groups; conversely, Asians evidence lower rates of alcohol-attributable injury than other racial/ethnic groups. The rate of alcohol positivity and intoxication among Hispanics is disproportionately high relative to estimates of alcohol use. Black subgroups also evidence higher rates of alcohol positivity than would be expected given estimates of alcohol use, including for alcohol positivity among drivers of fatally injured black children and homicide. These findings highlight the continued need for public health focus on Native American populations with respect to alcohol consumption and injury. Further, the disparity in alcohol-attributable injury mortality among black and Hispanic groups relative to their reported rates of alcohol consumption is an overlooked area of research. The authors review potential social determinants of racial/ethnic disparities in alcohol-attributable injuries and identify directions for further research on these patterns.

Kidney CA; Alvarez J; Jason LA; Ferrari JR; Minich L. Residents of mutual help recovery homes, characteristics and outcomes: Comparison of four US ethnic subgroups. Drugs: Education, Prevention and Policy 18(1): 32-39, 2011. (40 refs.)

This study compared the characteristics and outcomes of four ethnic groups living in mutual help recovery homes. The sample consisted of 524 Caucasian, 305 African American, 31 Latino/a and 17 American Indian (AI) participants. This article includes a short review of relevant literature on AIs and substance use, provides an analysis of characteristics and outcomes of four ethnic groups and includes a discussion of the implications of the findings for knowledge of patterns of use among AIs. The AIs were more likely to report being on parole or probation and being referred for aftercare by the legal system. Additionally, AIs reported greater disharmony within their recovery residences than Caucasians, but there were no significant ethnic differences in baseline length of stay in Oxford House, length of alcohol or drug sobriety or substance use outcomes 4 months after the baseline assessment.

Kulis S; Brown EF. Preferred drug resistance strategies of urban American Indian youth of the southwest. Journal of Drug Education 41(2): 203-234, 2011. (105 refs.)

This study explored the drug resistance strategies that urban American Indian adolescents consider the best and worst ways to respond to offers of alcohol, cigarettes, and marijuana. Focus group data were collected from 11 female and 9 male American Indian adolescents attending urban middle schools in the southwest. The youth were presented with hypothetical substance offer scenarios and alternative ways of responding, based on real-life narratives of similar youth. They were asked to choose a preferred strategy, one that would work every time, and a rejected strategy, one they would never use. Using eco-developmental theory, patterns in the preferred and rejected strategies were analyzed to identify culturally specific and socially competent ways of resisting substance offers. The youth preferred strategies that included passive, non-verbal strategies like pretending to use the substance, as well as assertive strategies like destroying the substance. The strategies they rejected were mostly socially non-competent ones like accepting the substance or responding angrily. Patterns of preferred and rejected strategies varied depending on whether the offer came from a family member or non-relative. These patterns have suggestive implications for designing more effective prevention programs for the growing yet underserved urban American Indian youth population.

Kulis S; Reeves LJ; Dustman PA; O'Neill M. Strategies to resist drug offers among urban American Indian Youth of the Southwest: An enumeration, classification, and analysis by substance and offeror. Substance Use & Misuse 46(11): 1395-1409, 2011. (76 refs.)

This study explores the drug resistance strategies of urban American Indian adolescents when they encounter people offering them alcohol, cigarettes, and marijuana. Data were collected in 2005 from 11 female and 9 male adolescents who self-identified as American Indian and attended two urban middle schools in the southwestern United States. In two focus groups-one at each school site-the youth described their reactions to 25 hypothetical substance offer scenarios drawn from real-life narratives of similar youth. Qualitative analysis of their 552 responses to the scenarios generated 14 categories. Half of the responses were strategies reported most often by nonnative youth (refuse, explain, leave, and avoid). Using ecodevelopmental theory, the responses were analyzed for indications of culturally specific ways of resisting substance offers, such as variation by specific substance and relationship to the person offering. Study limitations are noted along with suggestive implications for future research on culturally appropriate prevention approaches for urban American Indian youth.

LaFromboise TD; Albright K; Harris A. Patterns of hopelessness among American Indian adolescents: Relationships by levels of acculturation and residence. Cultural Diversity & Ethnic Minority Psychology 16(1): 68-76, 2010. (86 refs.)

Poor mental health among American Indian adolescents has been a matter of significant concern for the past two decades. This study extends the literature on acculturation within this population by investigating the relationship between hopelessness, levels of acculturation, and residence among American Indian adolescents. Utilizing data drawn from 438 adolescents across 67 American Indian tribes, our analyses show that American Indian adolescents who have bicultural competence (i.e., those who are adept in both Indian and White cultures) have significantly less hopelessness than do those with adeptness in only one culture or in neither culture. Our findings also show a significant difference by residence, with American Indians who live on reservations indicating less hopelessness than those living in urban or rural/nonreservation areas. Analysis of interaction effects suggests that the beneficial effect of adeptness in White culture is particularly true for American Indians living in urban areas.

Lane DC; Simmons J. American Indian youth substance abuse: Community-driven interventions. Mount Sinai Journal of Medicine 78(3): 362-372, 2011. (57 refs.)

Substance abuse among American Indians has a long history that dates back to the colonial era. American Indian youth today continue to have one of the highest substance abuse rates when compared with other groups. Researchers have implemented American Indian youth substance abuse interventions that previously have worked in the general population, but studies have found that they are generally unprepared and poorly designed for American Indian populations. The lack of inclusion of American Indian populations in the interventional studies, poor understanding of American Indian I diversity and cultures, and lack of consideration for the unique historical and sociopolitical context of each tribe were cited as reasons the interventions failed. It has been suggested that historical trauma plays a considerable role in American Indian youth substance abuse; however, much of this theoretical framework has yet to be rigorously tested. Contemporary trauma appears to contribute significantly more to American Indian youth substance abuse. The data on American Indian substance abuse are limited, but what is currently available appears to show a vast heterogeneity in the level of substance abuse among American Indian youth that varies across different American Indian tribes and geographical distribution. In summary, this article seeks to describe the special relationship American Indian tribes have with the federal government, review historical and contemporary trauma, review American Indian youth substance abuse and interventions today, and finally describe a unique intervention strategy that tribes in the Pacific Northwest are implementing in order to combat American Indian youth substance abuse.

Latino-Martel P; Chan DSM; Druesne-Pecollo N; Barrandon E; Hercberg S; Norat T. Maternal alcohol consumption during pregnancy and risk of childhood leukemia: Systematic review and meta-analysis. (review). Cancer Epidemiology, Biomarkers & Prevention 19(5): 1238-1260, 2010. (59 refs.)

Background: Leukemia is the most frequently occurring cancer in children. Although its etiology is largely unknown, leukemia is believed to result from an interaction between genetic and environmental factors. Among different potential risk factors, the possible role of maternal alcohol consumption during pregnancy has been questioned. Methods: To assess the association between maternal alcohol consumption during pregnancy and childhood leukemia, a systematic review and meta-analysis of published studies was done. Results: Twenty-one case-control studies were included in categorical and dose-response meta-analyses. No cohort study was identified. Analyses were conducted by type of leukemia, children's age at diagnosis, and type of alcoholic beverage and trimester of pregnancy at alcohol use. Alcohol intake during pregnancy (yes versus no) was statistically significantly associated with childhood acute myeloid leukemia (AML) [odds ratio (OR), 1.56; 95% confidence interval (CI), 1.13-2.15] but not with acute lymphoblastic leukemia (OR, 1.10; 95% CI, 0.93-1.29). Heterogeneity between studies was observed. The OR of AML for an increase of a drink per week was 1.24 (95% CI, 0.94-1.64). The association of alcohol intake during pregnancy with AML was observed for cancers diagnosed at age 0 to 4 years (OR, 2.68; 95% CI, 1.85-3.89) in five studies without heterogeneity (I-2 <= 0.1%). Conclusions: The results of case-control studies indicate that maternal alcohol consumption during pregnancy is associated with a significantly increased risk of AML in young children. Impact: Avoidance of maternal alcohol drinking during pregnancy might contribute to a decrease in the risk of childhood AML.

Lee CT; Rose JS; Engel-Rebitzer E; Selya A; Dierker L. Alcohol dependence symptoms among recent onset adolescent drinkers. Addictive Behaviors 36(12): 1160-1167, 2011. (27 refs.)

This study examined prevalence of alcohol dependence symptoms and diagnosis among a nationally representative sample of recent onset adolescent drinkers aged 12-21 years (mean 17 years) across different levels of drinking drawn from National Survey of Drug Use and Health (N = 9490). We assessed whether the relationship between level of alcohol use and alcohol dependence was similar for individuals from different socio-demographic groups (i.e., gender, age group, ethnic group, family income, and substance use in the past year). The most prevalent DSM-IV alcohol dependence criteria at low levels of alcohol use were "unsuccessful efforts to cut down", "tolerance", and "time spent" in activities necessary to obtain alcohol or recover from its effect. Logistic regression with polynomial contrasts indicated increasing rates of each criterion and an overall dependence diagnosis with increasing alcohol exposure that differed most between the lowest levels of recent drinking frequency. After controlling for drinking quantity, younger adolescents, females, Native American/Alaskans and Asian/Pacific Islanders were most likely to experience alcohol dependence symptoms and a diagnosis of dependence, suggesting that these demographic subgroups may experience dependence symptoms or develop dependence more quickly after beginning to drink. Recognizing early symptoms of alcohol dependence may assist in early identification and intervention of those at risk for heavier drinker in the future.

Legha RK; Novins D. The role of culture in substance abuse treatment programs for American Indian and Alaska Native communities. Psychiatric Services 63(7): 686-692, 2012. (45 refs.)

Objective: Culture figures prominently in discussions regarding the etiology of alcohol and substance abuse in American Indian and Alaska Native (AI/AN) communities, and a substantial body of literature suggests that it is critical to developing meaningful treatment interventions. However, no study has characterized how programs integrate culture into their services. Furthermore, reports regarding the associated challenges are limited. Methods: Twenty key informant interviews with administrators and 15 focus groups with clinicians were conducted in 18 alcohol and substance abuse treatment programs serving AI/AN communities. Transcripts were coded to identify relevant themes. Results: Substance abuse treatment programs for AI/AN communities are integrating culture into their services in two discrete ways: by implementing specific cultural practices and by adapting Western treatment models. More important, however, are the fundamental principles that shape these programs and their interactions with the people and communities they serve. These foundational beliefs and values, defined in this study as the core cultural constructs that validate and incorporate AI/AN experience and world view, include an emphasis on community and family, meaningful relationships with and respect for clients, a homelike atmosphere within the program setting, and an "open door" policy for clients. The primary challenges for integrating these cultural practices include AI/AN communities' cultural diversity and limited socioeconomic resources to design and implement these practices. Conclusions: The prominence of foundational beliefs and values is striking and suggests a broader definition of culture when designing services. This definition of foundational beliefs and values should help other diverse communities culturally adapt their substance abuse interventions in more meaningful ways.

Moghaddam JF; Momper SL. Integrating spiritual and western treatment modalities in a Native American substance user center: Provider perspectives. Substance Use & Misuse 46(11): 1431-1437, 2011. (20 refs.)

Few studies examine how traditional Native American and Western healing practices are being integrated in Native American substance user treatment centers. Data are presented from a 2008 study of providers of integrated substance user treatment for Native Americans at an urban Western US center. Nineteen semistructured interviews were conducted to examine 10 providers' views of the integration of traditional and Western healing and the impact on recovery for clients. We used a grounded theory approach to data analysis with manual and NVivo codes and themes developed. Limitations and implications for practice are discussed.

Momper SL. Implications of American Indian gambling for social work research and practice. Social Work 55(2, Special Issue): 139-146, 2010. (51 refs.)

Since the 1988 passage of the Indian Gaming and Regulatory Act (IRA), American Indian tribal communities have rapidly opened up casinos. American Indian participation in recreational gambling has increased, resulting in an increase in problem and pathological gambling. However, increased revenues from gaming have significantly benefited tribes. Background information on the Supreme Court case that led to passage of the IGRA and subsequently the opening of casinos on Indian reservations is provided. Data are presented on American Indian gambling studies that explore the impact of gambling on the development of problem or pathological gambling among American Indians. Reports and data are presented on the effects of gambling on the socioeconomic development of tribal communities. The implications of American Indian gaming for social work research and practice are discussed.

Momper SL; Delva J; Reed BG. OxyContin misuse on a reservation: Qualitative reports by American Indians in Talking Circles. Substance Use & Misuse 46(11): 1372-1379, 2011. (28 refs.)

Few studies have addressed OxyContin use among American Indians (AIs) on reservations. Eight focus groups were conducted as "talking circles" (2006 and 2007) with 49 AI adults and youth. An emergent design was utilized in which the initial two circles were planned, but the subsequent six circles evolved from tribal members' input. Participants reported an increase in OxyContin use; negative effects on individuals, families, and the tribe; a lack of treatment options; and a growing problem on other reservations. Results indicate the need to further research prevalence and patterns of use to design interventions to curtail OxyContin abuse on reservations.

Mota N; Elias B; Tefft B; Medved M; Munro G; Sareen J. Correlates of suicidality: Investigation of a representative sample of Manitoba First Nations adolescents. American Journal of Public Health 102(7): 1353-1361, 2012. (71 refs.)

Objectives. We examined individual, friend or family, and community or tribe correlates of suicidality in a representative on-reserve sample of First Nations adolescents. Methods. Data came from the 2002-2003 Manitoba First Nations Regional Longitudinal Health Survey of Youth. Interviews were conducted with adolescents aged 12 to 17 years (n=1125) from 23 First Nations communities in Manitoba. We used bivariate logistic regression analyses to examine the relationships between a range of factors and lifetime suicidality. We conducted sex-by-correlate interactions for each significant correlate at the bivariate level. A multivariate logistic regression analysis identified those correlates most strongly related to suicidality. Results. We found several variables to be associated with an increased likelihood of suicidality in the multivariate model, including being female, depressed mood, abuse or fear of abuse, a hospital stay, and substance use (adjusted odds ratio range=2.43-11.73). Perceived community caring was protective against suicidality (adjusted odds ratio=0.93; 95% confidence interval=0.88, 0.97) in the same model. Conclusions. Results of this study may be important in informing First Nations and government policy related to the implementation of suicide prevention strategies in First Nations communities.

Myhra LL. "It runs in the family": Intergenerational transmission of historical trauma among urban American Indians and Alaska Natives in culturally specific sobriety maintenance programs. American Indian and Alaska Native Mental Health Research 18(2): 17-40, 2011. (49 refs.)

The aim of this exploratory study, which was informed by ethnographic principles, was to better understand the intergenerational transmission of historical trauma among urban American Indians/Alaska Natives (AI/ANs) in culturally specific sobriety maintenance programs. The results of the study were organized into 3 overarching categories, which included 10 themes that emerged contextually in relation to participants' lived experience of historical and associated traumas, substance abuse, and current involvement in a culturally specific sobriety maintenance program.

Nalls AM; Mullis RL; Mullis AK. American Indian youths' perceptions of their environment and their reports of depressive symptoms and alcohol/marijuana use. Adolescence 44(176): 965-978, 2009. (33 refs.)

The role of neighborhood and school environments in adolescent development has been explored over the years, yet few have examined these relationships with an American Indian sample. The purpose of this study was to explore the role of American Indian adolescents' sense of safety in their neighborhood and school environments and how this relates to their experience of depressive symptoms and alcohol/marijuana use. The data were drawn from a southwestern state's dataset containing survey results of adolescent well-being. Responses from a total of 148 American Indian 8th, 10th, and 12th grade students were analyzed. The findings indicated that neighborhood safety, especially the presence of crime and drug sales, was the strongest predictor of depressive symptoms and alcohol/marijuana use. Implications for future research and work with this population are discussed.

Nelson KM; Simoni JM; Pearson CR; Walters KL. 'I've Had Unsafe Sex So Many Times Why Bother Being Safe Now?': The role of cognitions in sexual risk among American Indian/Alaska Native men who have sex with men. Annals of Behavioral Medicine 42(3): 370-380, 2011. (54 refs.)

American Indian/Alaska Native (AI/AN) men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition and transmission. This study aimed to investigate a potential area of focus for HIV prevention interventions by assessing the impact of sexual risk cognitions on sexual risk-taking among AI/AN MSM. AI/AN MSM (N = 173) from a national cross-sectional survey were analyzed. Reporting more frequent sexual risk cognitions overall (high sexual risk cognitions) was associated with multiple HIV risk factors including unprotected anal intercourse and serodiscordant unprotected anal intercourse. Participants: with high sexual risk cognitions had a 2.3 (95% Confidence Interval: 1.1, 4.7) times greater odds of engaging in unprotected anal intercourse regardless of childhood sexual abuse, depression, and alcohol dependence. Most individual sexual risk cognitions were associated with unprotected anal intercourse, serodiscordant unprotected anal intercourse, or both. Results suggest that sexual risk cognitions may be a productive area for further work on HIV prevention among AI/AN MSM.

Novins DK; Boyd ML; Brotherton DT; Fickenscher A; Moore L; Spicer P. Walking on: Celebrating the journeys of Native American adolescents with substance use problems on the winding road to healing. Journal of Psychoactive Drugs 44(2): 153-159, 2012. (17 refs.)

High rates of substance use and related problems have been long recognized as critical health issues for Native American adolescents. Unfortunately, no manualized interventions address the specific needs of Native American adolescents in a culturally appropriate manner. In 2006, the Cherokee Nation partnered with the University of Colorado to employ a community-based participatory research process to develop an intervention for Native American adolescents with substance use problems. The resulting intervention, Walking On, is an explicit blend of traditional Cherokee healing and spirituality with science-based practices such as cognitive behavioral therapy and contingency management and is designed to address the specific needs and worldviews of Native American adolescents with substance use problems and their families. Each individual and family session includes a brief assessment, a skill-building component, and a ceremony. A Weekly Circle (multifamily group) promotes sobriety and builds a community of healing. Early pilot study results suggest that Walking On is feasible for use in tribal substance abuse treatment programs. While Walking On shows early promise, the intervention will require further study to examine its efficacy.

Novins DK; Spicer P; Fickenscher A; Pescosolido B. Pathways to care: Narratives of American Indian adolescents entering substance abuse treatment. Social Science & Medicine 74(12): 2037-2045, 2012. (46 refs.)

Using data from 89 American Indian adolescents and guided by the Network Episode Model, this paper analyses pathways to residential substance abuse treatment and their correlates. These adolescents were recruited at admission to a tribally-operated substance abuse treatment program in the southern United States from October 1998 to May 2001. Results from the qualitative analyses of these adolescent's pathways to care narratives indicated that 35% ultimately agreed with the decision for their entry into treatment; 41% were compelled to enter treatment by others, usually by their parents, parole officers, and judges; and 24% did not describe a clear pathway to care. In the multinomial logistic regression model examining correlates of these pathways to care classifications, adolescents who described pathways indicative of agreement also reported greater readiness for treatment than the adolescents who described compelled or no clear pathways to care. Adolescents who described a Compelled pathway were less likely to meet diagnostic criteria for Conduct Disorder and described fewer social network ties. We were unable to find a relationship between pathways classifications and referral source, suggesting these narratives were subjective constructions of pathways to care rather than a factual representation of this process. In the final logistic regression model examining correlates of treatment completion, articulating a pathway to care, whether it was one of agreement or of being compelled into treatment, predicted a greater likelihood of completing treatment. Overall, these narratives and their correlates are highly consistent with the Network-Episode Model's emphasis on the interaction of self, situation, and social network in shaping the treatment seeking process, demonstrating the applicability of this model to understanding the treatment seeking process in this special population and suggests important considerations for understanding the dynamics of service utilization across diverse communities.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The TEDS Report: Gender Differences among American Indian Treatment Admissions Aged 18 to 25. (June 24, 2010). Rockville MD: Substance Abuse and Mental Health Administration, 2010

Substance abuse disorders disproportionately affect minority populations, making it important to understand the specific characteristics and substance use behaviors of these groups. Among American Indian communities, substance abuse is a serious health and social problem, especially among youth and young adults. Of the approximately 1.8 million substance abuse treatment admissions in 2007, 2.2 percent or about 40,000 were American Indian. Of these, 21.5 percent were young adults between the ages of 18 and 25. Data from the Treatment Episode Data Set (TEDS) for 2007 is used to examine American Indian substance abuse treatment admissions aged 18 to 25 (hereafter referred to as "young adult American Indian admissions"). This report focuses on gender differences among this population. Of the approximately 8,600 young adult American Indian admissions in 2007, about 59.1 percent or 5,100 were male, and 40.9 percent or 3,500 were female. Among American Indian substance abuse treatment admissions aged 18 to 25 in 2007, males were more likely than females to report alcohol (61.1 vs. 44.7 percent) or marijuana (22.4 vs. 16.0 percent) as the primary substance of abuse; however, young adult female American Indian admissions were almost three times more likely than their male counterparts to report primary methamphetamine abuse (17.5 vs. 5.9%). Over half of young adult American Indian male and female admissions (54.7% each) had been in treatment at least once before. Among young adult American Indian admissions, only about one third (34.1%) of males and less than one fifth (19.3%) of females were employed.

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report: Substance Use among American Indian or Alaska Native Adults. (June 24, 2010). Rockville MD: Substance Abuse and Mental Health Administration, 2010. (9 refs.)

Over the past several decades, the population of the United States has become increasingly diverse. Gaining a better understanding of the behavioral health needs of particular racial/ethnic groups can help inform public health policy, build prevention and treatment programs that target the different needs of these populations, and expand access to services for individuals who need them. This report uses data from the National Survey on Drug Use and Health (NSDUH) to examine substance use and treatment need among single-race American Indian or Alaska Native adults aged 18 or older. [Other reports in this series will examine similar issues among other racial/ethnic groups.] According to the U.S. Census Bureau, 2 million people-1.0 percent of the total population in 2008-identify themselves as non-Hispanic American Indian or Alaska Native adults of one race. This report is based on NSDUH data from 2004 to 2008. In brief, the rate of past month alcohol use was lower among American Indian or Alaska Native adults than the national average for adults (43.9 vs. 55.2%); the rates of past month binge alcohol use and illicit drug use, however, were higher among American Indian or Alaska Native adults than the national averages (30.6 vs. 24.5% and 11.2 vs. 7.9%, respectively). The percentage of American Indian or Alaska Native adults who needed treatment for an alcohol or illicit drug use problem in the past year was higher than the national average for adults (18.0 vs. 9.6%). One in eight (12.6%) American Indian or Alaska Native adults in need of alcohol or illicit drug use treatment in the past year received treatment at a specialty facility; this rate did not differ significantly from the national average of 10.4 percent

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report: Substance Use among American Indian or Alaska Native Adults. (June 24, 2010). Rockville MD: Substance Abuse and Mental Health Administration, 2010. (9 refs.)

The rate of past month alcohol use was lower among American Indian or Alaska Native adults than the national average for adults (43.9 vs. 55.2 percent); the rates of past month binge alcohol use and illicit drug use, however, were higher among American Indian or Alaska Native adults than the national averages (30.6 vs. 24.5 percent and 11.2 vs. 7.9 percent, respectively). The percentage of American Indian or Alaska Native adults who needed treatment for an alcohol or illicit drug use problem in the past year was higher than the national average for adults (18.0 vs. 9.6 percent). One in eight (12.6 percent) American Indian or Alaska Native adults in need of alcohol or illicit drug use treatment in the past year received treatment at a specialty facility; this rate did not differ significantly from the national average of 10.4 percent.

Public Domain

Parker T; Maviglia MA; Lewis PT; Gossage JP; May PA. Psychological distress among Plains Indian mothers with children referred to screening for Fetal Alcohol Spectrum Disorders. Substance Abuse Treatment, Prevention, and Policy 5(e-article 22), 2010

Background: Psychological distress (PD) includes symptoms of depression and anxiety and is associated with considerable emotional suffering, social dysfunction and, often, with problematic alcohol use. The rate of current PD among American Indian women is approximately 2.5 times higher than that of U.S. women in general. Our study aims to fill the current knowledge gap about the prevalence and characteristics of PD and its association with self-reported current drinking problems among American Indian mothers whose children were referred to screening for fetal alcohol spectrum disorders (FASD). Methods: Secondary analysis of cross-sectional data was conducted from maternal interviews of referred American Indian mothers (n = 152) and a comparison group of mothers (n = 33) from the same Plains culture tribes who participated in an NIAAA-funded epidemiology study of FASD. Referred women were from one of six Plains Indian reservation communities and one urban area who bore children suspected of having an FASD. A 6-item PD scale (PD-6, Cronbach's alpha = .86) was constructed with a summed score range of 0-12 and a cut-point of 7 indicating serious PD. Multiple statistical tests were used to examine the characteristics of PD and its association with self-reported current drinking problems. Results: Referred and comparison mothers had an average age of 31.3 years but differed (respectively) on: education (Copyright 2010, BioMed Central

Redwood D; Lanier AP; Renner C; Smith J; Tom-Orme L; Slattery ML. Differences in cigarette and smokeless tobacco use among American Indian and Alaska Native people living in Alaska and the Southwest United States. Nicotine & Tobacco Research 12(7): 791-796, 2010. (20 refs.)

Introduction: This study analyzed self-reported tobacco use among American Indian and Alaska Native (AI/AN) people enrolled in the Education and Research Towards Health Study in Alaska (n = 3,821) and the Southwest United States (n = 7,505) from 2004 to 2006. Methods: Participants (7,060 women and 4,266 men) completed a computer-assisted self-administered questionnaire on cigarette and smokeless tobacco (ST) use. Results: Current use of cigarettes was considerably higher in Alaska than in the Southwest United States (32% vs. 8%). Current ST use was also more common in Alaska than in the Southwest United States (18% vs. 8%). Additionally, smoking was more common among men, younger age, those who were not married, and who only spoke English at home, while ST use was more common among men, those with lower educational attainment and those who spoke an AI/AN language at home (p<.01). Compared with the U. S. general population, AI/AN people living in Alaska were more likely and those living in the Southwest United States were less likely to be current smokers. Rates of ST use, including homemade ST, in both regions were much higher than the U.S. general population. Discussion: Tobacco use among AI/AN people in the Southwest United States, who have a tradition of ceremonial tobacco use, was far lower than among Alaska Native people, who do not have a tribal tradition. Tobacco use is a key risk factor for multiple diseases. Reduction of tobacco use is a critical prevention measure to improve the health of AI/AN people.

Richards J; Mousseau A. Community-based participatory research to improve preconception health among Northern Plains American Indian adolescent women. American Indian and Alaska Native Mental Health Research 19(1, special issue): 154-185, 2012. (31 refs.)

Background: Sacred Beginnings is a community-based participatory research project that examines the effectiveness of a culturally appropriate preconception health educational intervention developed by tribal community members and elders. The primary goal is to increase knowledge of preconception health and its benefits among adolescent females and tribal communities. Preconception health is an area of considerable concern among American Indians (AIs) in the Northern Plains region, as there are high rates of birth, infant mortality, unintended pregnancy, teen pregnancy, and sexually transmitted diseases in this area. We examined the effectiveness of implementing this intervention during a residential summer program for AI high school students. Materials and Methods: The educational intervention consisted of 15 preconception health education sessions and was piloted during a summer high school residential academic program. The intervention (N = 39) and non-intervention (N = 38) groups were comprised of incoming AI female freshmen representing comparable demographics. A pre- and post-intervention survey was administered to both groups. Results: Results indicated a significant difference in Time 2 (T2; post-intervention) scores, with the intervention group scoring higher than the non-intervention group in overall preconception health knowledge and obesity knowledge. In terms of intra-group score analysis between Time 1 (T1; pre-intervention) and T2, there were significant changes within the intervention group in knowledge of obesity and diabetes. Knowledge changes in smoking were approaching significance. Within the non-intervention group, there was a significant change from T1 to T2 in scores for diabetes knowledge only. Discussion: The key finding was that the intervention group had higher overall preconception health knowledge at T2 compared to the non-intervention group. Intervention participants demonstrated an understanding of how preconception behaviors may affect birth outcomes and maternal health. Another key finding was that, among participants in the intervention group, the change in knowledge regarding smoking beliefs between T1 and T2 were approaching significance. Because smoking during pregnancy is a risk factor for poor birth outcomes, this finding emphasizes that future curriculum modification should address the effects of smoking, and the benefits of smoking cessation, prior to or during pregnancy. Study limitations such as small sample size, high baseline health knowledge, the need to add traditional knowledge variables, and shortened implementation timeframe reveal key areas for improvement. Possible future intervention modifications include expanding on areas that reached or approached significance, implementing the intervention over a longer period of time, identifying ways to translate traditional knowledge into quantifiable survey measures, and implementing the intervention with high-risk, reservation-based populations of AI youth.

Samuel KA; Ribisl KM; Williams RS. Internet cigarette sales and Native American sovereignty: Political and public health contexts. Journal of Public Health Policy 33(2): 173-187, 2012. (67 refs.)

Internet cigarette vendors (ICVs) advertise low prices for tobacco products, subverting public health policy efforts to curtail smoking by raising prices. Many online retailers in the United States claim affiliation with Native American tribes and share in tribal tax-free status. Sales of discounted cigarettes from both online vendors and brick-and-mortar stores have angered non-Native retailers and triggered enforcement actions by state and federal governments in the United States concerned over lost cigarette excise tax revenue. Examination of the history and politics of cigarette sales on reservations and attempts to regulate Internet cigarette sales highlights the potential role for greater use of negotiated intergovernmental agreements to address reservation-based tobacco sales. Our review notes global parallels and explicates history and politics of such regulation in the United States, and offers background for collaborative efforts to regulate tobacco sales and decrease tobacco use.

Sarche MC; Whitesell NR. Child development research in North American native communities-looking back and moving forward: Introduction. Child Development Perspectives 6(1): 42, 2012. (65 refs.)

The study of Native children's development in the United States and Canada has lagged behind that of other populations. As a result, there is limited research literature to inform efforts to address the challenges faced by Native children and their families, including disparities in mental health problems such as substance abuse, suicide, mental disorders, and academic achievement. This article provides a brief overview of the historical context of children's development in Native communities and introduces the Native Children's Research Exchange (NCRE), formed in 2008 to facilitate child development research with tribal communities. The following collection of articles, written by NCRE scholars, reviews existing research, highlights challenges encountered in this work, and points to an agenda for furthering developmental research within Native cultures.

Spillane NS; Smith GT. Individual differences in problem drinking among tribal members from One First Nation community. Alcoholism: Clinical and Experimental Research 34(11): 1985-1992, 2010. (63 refs.)

Background: Health disparities related to drinking in native communities are of concern. Although individuals living in native communities have high rates of problem drinking, there is also variability in their drinking levels. The authors conducted a test of a model of First Nation drinking risk that incorporates personality and psychosocial learning to examine its cross-cultural applicability. That model identifies a risk process thought to explain aspects of individual differences in both native problem drinking and non-native problem drinking. One implication of the theory is that positive alcohol expectancies mediate the influence of negative urgency (the tendency to act rashly when distressed) on problem drinking similarly for both cultures. Methods: We administered questionnaires to a total of 211 First Nation people and 236 Caucasians. Results: A structural modeling analysis of 211 First Nation people and 236 Caucasian people found that (i) personality, alcohol expectancy, and problem drinking measures were invariant across the 2 cultures and (ii) results consistent with the hypothesis that positive alcohol expectancies mediated the influence of negative urgency on problem drinking were also invariant across culture. Conclusions: The findings support the theory that personality traits and psychosocial learning are important determinants of problem drinking in First Nation people and Caucasians.

Thomas JL; Renner CC; Patten CA; Decker PA; Utermohle CJ; Ebbert JO. Prevalence and correlates of tobacco use among middle and high school students in western Alaska. International Journal of Circumpolar Health 69(2): 168-180, 2010. (38 refs.)

Objectives. Tobacco use is the leading cause of preventable death in the United States and contributes to increased incidence, morbidity and mortality from cancer, heart disease, stroke, complications of pregnancy and respiratory illness. Tobacco use rates are highest among American Indians and Alaska Natives. This study examined the prevalence and correlates of tobacco use among youth residing in rural western Alaska. Study design. Data were analysed from the 2003 Youth Risk Behavior Survey (YRBS) administered to a regional sample of adolescents attending school in western Alaska. Methods. Data were analysed from 260 middle school (52% female, 87% Alaska Native) and 258 high school (48% female, 93% Alaska Native) students. Results. Among middle school students, 39% reported current use of ST, 24% reported cigarette smoking and 50% reported current use of any tobacco product. On multivariate analysis, independent correlates of current use of any tobacco were Alaska Native ethnicity (p=0.002) and ever use of marijuana (p<0.001). Among high school students, 38% reported current ST use, 43% reported cigarette smoking and 60% reported current use of any tobacco product. Independent correlates of current use of any tobacco were increasing age (p=0.007), ever use of marijuana (p<0.001), current use of marijuana (p=0.005) and reporting a suicide attempt within the past 12 months (p=0.003). No significant gender differences on tobacco use emerged for middle or high school students. Conclusions. This study documents the high tobacco use rates among youth residing in western Alaska, with over half of the adolescents reporting tobacco use. Developing interventions to promote tobacco use prevention and cessation is an essential step towards reducing tobacco-related health disparities in this rural population. Expanded efforts are needed to address tobacco use among youth residing in this region of Alaska.

Thomas LR; Rosa C; Forcehimes A; Donovan DM. Research partnerships between academic institutions and American Indian and Alaska Native tribes and organizations: Effective strategies and lessons learned in a multisite CTN study. American Journal of Drug and Alcohol Abuse 37(5): 333-338, 2011. (14 refs.)

Background: Community Based and Tribally Based Participatory Research (CBPR/TPR) are approaches that can be successful for developing ethical and effective research partnerships between academic institutions and Tribes and Native organizations. Objectives: The National Institute on Drug Abuse Clinical Trials Network funded a multi-site, exploratory study using CBPR/TPR to begin to better understand substance abuse issues of concern to some Tribes and Native organizations as well as strengths and resources that exist in these communities to address these concerns. Attention was paid to the development and maintenance of research partnerships in each of the sites. Methods: Each of the five partnerships is briefly described and common as well as unique challenges and successes are identified. Results: A summary of the common themes for developing these collaborative research efforts is provided. Conclusion: True, collaborative research partnerships require a great deal of time and effort in order to develop mutual trust, understanding, knowledge, and collaboration that will guide research that is rigorous as well as ethical, effective, and culturally appropriate. Scientific Significance: As AIAN communities become increasingly sophisticated partners in, and consumers of, research, CBPR and TPR are emerging as effective, ethical, culturally appropriate, and acceptable approaches. This can serve to improve the science we engage in with AIAN communities, add to the scarce literature regarding AIAN communities, and better serve AIAN communities in addressing health disparities and improving health.

Tragesser SL; Beauvais F; Burnside M; Jumper-Thurman P. Differences in illicit drug-use rates among Oklahoma and non-Oklahoma Indian Youth. Substance Use & Misuse 45(13): 2323-2339, 2010. (42 refs.)

Demographic factors may serve as risk or protective factors for drug use in American Indian communities. The purpose of the present study was to compare drug-use rates among Oklahoma and Non-Oklahoma Indian youth, and test corresponding rates of preventative and protective community, family, and social-demographic factors. Participants' data included 1,928 Indian 7th-12th graders from non-Oklahoma schools and 1,938 Indian students from schools in Oklahoma, aggregated across 2-3 years from an ongoing survey study of substance use and prevention among Indian youth. As predicted, one-way analysis of variance tests indicated that Oklahoma youth showed lower rates of drug use, later ages of initiation of drug use, and greater levels of perceived harm from using drugs. These differences were reflected in the predicted protective factor differences, including higher levels of exposure to anti-drug campaigns in the community and schools, greater family involvement in drug-use prevention, and lower levels of peer drug associations. The strength of these protective factors is illustrated by the fact that drug-use rates were lower among Oklahoma youth despite the perception among Oklahoma youth that drugs were more available, compared with non-Oklahoma youth. Limitations and suggestions for future research are noted.

Ubina EC; Van Sell SL; Arnold C; Woods S. Best practices guidelines for nurse practitioners regarding smoking cessation in American Indian and Alaskan Native Youth. Family & Community Health 34(3): 266-274, 2011. (38 refs.)

The greatest prevalence of tobacco use in the United States occurs with the American Indian and Alaskan Native (AI/AN). A critical need exists for a culturally specific tobacco cessation option for AI/AN youth. The nurse practitioner is positioned to provide a culturally specific commercial tobacco cessation option by incorporating the transcultural nursing theory into the development of a decision tree to expand understanding of culturally appropriate best practices regarding screening and management of tobacco smoking cessation in AI/AN youth. Presented is the Nurse Practitioner Culturally Specific American Indian and Alaskan Native Youth Decision Tree for Smoking Cessation with supporting evidence-based best practices.

Wallace JM; Vaughn MG; Bachman JG; O'Malley PM; Johnston LD; Schulenberg JE. Race/ethnicity, socioeconomic factors, and smoking among early adolescent girls in the United States. Drug and Alcohol Dependence 104(Supplement 1): S42-S49, 2009. (32 refs.)

Background: This study uses large nationally representative samples of White, Black, Mexican American, Puerto Rican, Other Latina, Asian American, and American Indian 8th-grade girls to examine racial/ethnic differences and similarities in patterns, trends, and socioeconomic correlates of cigarette use. Methods: The data are drawn from the University of Michigan's Monitoring the Future study. Prevalence and trend data (from 1991 to 2007) in girls' cigarette use were examined by racial/ethnic subgroup. Logistic regression analyses were conducted to determine the extent to which socioeconomic factors predict girls' cigarette use, and whether the relationships between socioeconomic status (SES) and smoking differed across racial/ethnic Subgroup. Results: Cigarette use was highest among American Indian girls; at an intermediate level among Mexican American, Puerto Rican, Other Latinas, and White girls; and lowest among Black and Asian American girls, Trend data show that cigarette use has declined for all racial/ethnic subgroups, and that small but consistent racial/ethnic differences in girls' cigarette use have persisted. Generally, girls who did not live in two-parent households, whose parents had lower levels of educational attainment, who attended lower SES schools, and who had more disposable income were more likely than their peers to smoke. That said, however, the relationships between smoking and parental education and school SES were, on average, stronger for White girls than for Black or Hispanic (Mexican American, Other Latina, Puerto Rican) girls. Conclusions: Future research should seek to understand the mechanisms by which low SES impacts smoking.

Walters KL; Beltran R; Evans-Campbell T; Simoni JM. Keeping our hearts from touching the ground: HIV/AIDS in American Indian and Alaska Native women. Women's Health Issues 21(6(supplement)): S261-S265, 2011. (32 refs.)

HIV/AIDS is a critical and growing challenge to American Indian and Alaska Native (AIAN) women's health. Conceptually guided by the Indigenist Stress-Coping Model, this paper explores the historical and contemporary factors implicated in the HIV epidemic among AIAN women and the co-occurring epidemics of sexual violence and substance abuse. The authors also outline multiple indicators of resiliency in AIAN communities and stress the need for HIV prevention interventions for AIAN women to capitalize on cultural and community strengths.

Ward BW; Ridolfo H. Alcohol, tobacco, and illicit drug use among Native American college students: An exploratory quantitative analysis. Substance Use & Misuse 46(11): 1410-1419, 2011. (64 refs.)

We examine alcohol, tobacco, and illicit drug use among US Native American college students by using 4 years of College Alcohol Study data (1993, 1997, 1999, and 2001; n = 267). To the authors' knowledge, this is the first study to quantitatively examine this population using advanced statistical analyses and a nationally representative sample of US college students. Descriptive and logistic regression analyses show that Native American college students have unique rates and patterns of substance use that must be addressed accordingly. It is suggested that specialized future research and policy are needed to properly address alcohol and drug use among this population. Limitations of the study are noted.

Westermeyer J; Canive J; Thuras P; Thompson J; Crosby R; Garrard J. A comparison of substance use disorder severity and course in American Indian male and female veterans. American Journal on Addictions 18(1): 87-92, 2009. (24 refs.)

The purpose of this analysis was to compare substance use disorder (SUD) diagnoses, severity, comorbidity, and course in 362 American Indian veterans. The sample was drawn from communities in the north central and southwestern areas of the United States, structured to over-sample women and to include half-rural/half-urban residents. Instruments used in the study included current demography, military history, the Diagnostic Interview Schedule/Quick Version, Michigan Alcoholism Screening Test modified to include alcohol and drugs (MAST/AD), Brief Symptom Inventory, Posttraumatic Checklist, and a treatment algorithm. Univariate analyses showed that women had lower scores on the MAST/AD, reported lower symptom levels on the Posttraumatic Checklist, and were less apt to use VA mental health services, but were more willing to seek mental health treatment if needed (with probabilities of .01 to .001). At borderline probabilities (.02 to .05), women were younger and had more education, whereas men had more drug-related diagnoses and more combat exposure. On binary logistic regression, women were less apt to have a drug diagnosis and had lower MAST/AD scores; the other differences were not significant. Female American Indian veterans with SUD manifested many of the same gender-related differences as women in the population at large, but with some exceptions (eg, comorbidity). Trauma, PTSD, and continuing posttraumatic symptoms occurred frequently in both male and female veterans of American Indian heritage. VA facilities should out-reach to American Indian women, who report a willingness to seek mental health services but may avoid VA care.

Wexler LM; Gone JP. Culturally responsive suicide prevention in indigenous communities: Unexamined assumptions and new possibilities. American Journal of Public Health 102(5): 800-806, 2012. (93 refs.)

Indigenous communities have significantly higher rates of suicide than non-Native communities in North America. Prevention and intervention efforts have failed to redress this disparity. One explanation is that these efforts are culturally incongruent for Native communities. Four prevalent assumptions that underpin professional suicide prevention may conflict with local indigenous understandings about suicide. Our experiences in indigenous communities led us to question assumptions that are routinely endorsed and promoted in suicide prevention programs and interventions. By raising questions about the universal relevance of these assumptions, we hope to stimulate exchange and inquiry into the character of this devastating public health challenge and to aid the development of culturally appropriate interventions in cross-cultural contexts.

Whitbeck LB; Yu M; McChargue DE; Crawford DM. Depressive symptoms, gender, and growth in cigarette smoking among indigenous adolescents. Addictive Behaviors 34(5): 421-426, 2009. (51 refs.)

This study reports findings from two-level growth curve modeling of cigarette smoking and depressive symptoms based on the first three waves of data from a longitudinal study of Indigenous adolescents and their parents/caretakers in the northern Midwest and Canada. The 743 adolescents were aged 10-13 years at Wave 1 and 12-15 years at Wave 3. Over the three years of the study the overall retention rate was 93%. By Wave 3, 39% of the adolescent girls and 25% of the boys had smoked cigarettes in the past 12 months. The growth curve results indicated that smoking increased for both adolescent boys and girls across time. Depressive symptoms were associated with an increase in cigarette smoking for girls but not boys.

Whitton M; Weatherly JN. The effect of near-miss rate and card control when American Indians and non-indians gamble in a laboratory situation: The influence of alcohol. American Indian And Alaska Native Mental Health Research 16(2): 28-42, 2009. (25 refs.)

Twelve American Indian (AI) and 12 non-AI participants gambled on a slot-machine simulation and on video poker. Prior to the gambling sessions, half of the participants consumed alcohol while the other half consumed a placebo beverage. They then played the slot-machine simulation three times, with the percentage of programmed "near misses" varying across sessions. They also played video poker three times, with the control the players had over holding and discarding cards varying across sessions. Results showed that AI participants played significantly fewer poker hands than did non-AIs and that participants played most when they had the least control over what cards were played. No significant effect of alcohol consumption was observed. Likewise, results failed to show a significant effect of the percentage of near misses when participants played the slot-machine simulation. The present results lend support for the idea that the differences in gambling problems between AI and non-AI reported in the literature are not a function of ethnicity per se. They may also suggest that providing video poker players with accurate information may have the unintended effect of increasing the rate at which they gamble.

Wiechelt SA; Gryczynski J; Johnson JL. Designing HIV prevention interventions for urban American Indians: Evolution of the Don't Forget Us Program (editorial). Health and Social Work 34(4, Special Issue): 301-304, 2009. (16 refs.)

Wiechelt SA; Gryczynski J; Johnson JL; Caldwell D. Historical trauma among urban American Indians: Impact on substance abuse and family cohesion. Journal of Loss & Trauma 17(4): 319-336, 2012. (48 refs.)

Historical trauma theory suggests that many American Indians are still affected by the cultural losses and injustices endured by previous generations. The current study examines historical trauma in an urban American Indian sample using validated measures of historical loss and associated symptoms (N = 120). Urban American Indians reported high degrees of historical trauma compared to reservation samples in past research. Generalized linear models showed that historical trauma symptoms were significantly associated with past month alcohol use, lifetime use of non-marijuana illicit drugs, and lower family cohesion. However, frequent thoughts about historical losses were positively associated with family cohesion. Implications are discussed.

Xu J; Kochanek KD; Murphy SL; Tejada-Vera B. QuickStats: Rates of Drug-Induced Deaths, by Race/Ethnicity --- United States, 1999--2007. MMWR. Morbidity and Mortality Weekly Review 59(42): 1376, 2010. (1 refs.)

Drug-induced deaths include deaths from poisoning, drug dependence, and conditions resulting from acute or chronic exposure to drugs. Drug-induced deaths exclude deaths from adverse events caused by drugs in therapeutic use (ICD-10 codes Y40--59), deaths indirectly related to drug use (e.g., motor vehicle crashes), and newborn deaths associated with the mother's drug use. During 1999--2007, age-adjusted rates for drug-induced deaths generally increased for each race group. The rate increased by 80.0% for the total population, 97.1% for the white population, 15.8% for the black population, 65.8% for American Indians/Alaska Natives, and 42.9% for Asians/Pacific Islanders. However, for the Hispanic population the rate was more stable, with a decline of 5.8%. During this period, Asians/Pacific Islanders had substantially lower rates than all other groups.

Public Domain

Yu M; Stiffman AR. Positive family relationships and religious affiliation as mediators between negative environment and illicit drug symptoms in American Indian adolescents. Addictive Behaviors 35(7): 694-699, 2010. (38 refs.)

The present study tests how positive family relationships and religious affiliation mediate between negative familial and social environments, and adolescent illicit drug abuse/dependence symptoms. The theoretical framework is based on an integration of two theories: the ecological model of human development (Bronfenbrenner, 1979) and the social development model (Hawkins & Weis, 1985). We used a stratified random sample of 401 American Indian adolescents. A path analysis tested the integrative theoretical model. Findings showed that positive family relationships mediated the negative impact of addicted family members, violence victimization, and negative school environment on illicit drug abuse/dependence symptoms. Religious affiliation mediated the negative effect of deviant peers on positive family relationships. Intervention and prevention efforts may benefit from promoting positive family relationships and religious affiliation to reduce the impact of complex familial and social problems on illicit drug symptoms.

Yu MS. Tobacco use among American Indian or Alaska Native middle- and high-school students in the United States. Nicotine & Tobacco Research 13(3): 173-181, 2011. (33 refs.)

An estimated 0.5 million American Indian or Alaska Native (AI/AN) adolescents under the age of 18 years smoked cigarettes during their entire lifetime. Using a national sample of AI/AN middle- and high-school students, this study examines prevalence rates and relative impacts of individual, familial, and social predictors of different types of tobacco use. A national sample of 305 (weighted N = 142,989) AI/AN middle- and high-school students in Grades 6 through 12 were selected from the 2006 National Youth Tobacco Survey. During their entire life, most of the respondents used cigarettes (54%), followed by cigars (24%), smokeless tobacco (16%), pipes (13%), and menthol cigarettes (12%). One in 3 (32%) used 2 or more forms of tobacco. High-school students reported significantly higher for all types of tobacco use than middle-school students, while the rates did not differ by gender. Multivariate analyses showed that age, family members' smoking, and refusal to smoke predicted tobacco users with one product. Family members' smoking and refusal to smoke remained significant in predicting more than 2 forms of tobacco use (polytobacco users), while age was no longer significant. School truancy and receptivity to tobacco marketing uniquely predicted polytobacco users. Findings underscore that tobacco control programs for AI/AN students need to address the multiple predictors of different types of tobacco use. Implications of the findings are discussed.

Yuan NP; Eaves ER; Koss MP; Polacca M; Bletzer K; Goldman D. "Alcohol is something that been with us like a common cold": Community perceptions of American Indian drinking. Substance Use & Misuse 45(12): 1909-1929, 2010. (29 refs.)

This study examined tribal members' perspectives on alcohol, risk factors, consequences, and community responses. Focus groups were conducted with five American Indian tribes between 1997 and 2001. Participants were knowledgeable of the cultural lives of their reservation communities. Although there was agreement regarding the pervasiveness of heavy drinking, participants reported different opinions about the meaning of alcohol and appropriate intervention strategies. Three dilemmas were identified, suggesting that community ambivalence may serve as a barrier to reducing problem drinking. Implications, limitations, and future research directions are discussed. The study was funded by the National Institute on Alcohol Abuse and Alcoholism.