Studies of Substance Abuse with Interventions for the Youth of Native American Indian Communities #6

Definitions #1

Tobacco is one of the most frequently used drugs by Native youth. According to data for 12–17-year-olds from the last available NHSDA, 27.5% of American Indians/Alaskan Natives were current smokers, compared with 16.0% of Whites, 10.2% of Latinos, 8.4% of Asian Americans, and 6.1% of African Americans (SAMHSA, Office of Applied Studies, 2002). A study using MTF data (Wallace et al., 2002) reported that among 12th graders, the 30-day prevalence of cigarette smoking for American Indians is 46.1%, as compared to 34.3% for the overall population. Native American 12th graders also have the highest rate of smoking half a pack or more of cigarettes a day, at 17.1% versus an overall total rate of 12.7% (Wallace et al., 2002). LeMaster, Connell, Mitchell, and Manson (2002) used data from the Voices of Indian Teens Project to determine the prevalence of cigarette and smokeless tobacco use among Native communities. Their sample consisted of 2,390 youth ages 13 to 20 attending high schools in five Indian communities west of the Mississippi. Approximately 50% of the youth reported having smoked cigarettes, with 30% smoking “once in a while.” Slightly less than 3% (2.8%) reported smoking 11 or more cigarettes a week, and only 1.2% said that they smoked a pack or more a day. The lifetime prevalence of smokeless tobacco use was 21%, with 3.6% reporting use 4–6 days a week and 6.7% reporting use every day.

Inhalants are commonly among the first substances used by Indian youth, often preceding the use of alcohol (Beauvais et al., 1989). Beauvais (1992a) reported that Indian youth living on reservations had higher lifetime inhalant use rates than did Indian youth not living on reservations or White youth. Among 8th graders, 34% of reservation Indians reported lifetime inhalant use, compared with 20% for nonreservation Indians and 13% for Whites. The 12th graders surveyed reported lifetime use rates of 20% for reservation Indians, 15% for nonreservation Indians, and 10% for Whites. Reservation Indians in the 8th grade also had the highest rates of 30-day inhalant use (15%), followed by nonreservation Indians (8%), and Whites (5%). Among 12th graders, nonreservation Indians had the highest rate (3%), with reservation Indian and White students using at the same rate (2%). Native youth living apart from their families in boarding schools were also found to have extremely high prevalence rates, with 44% of students reporting that they had used inhalants (Okwumabua & Duryea, 1987). In contrast, a study conducted with urban American Indian communities found that 12.3% of the youth surveyed reported some lifetime inhalant use (Howard, Walker, Silk Walker, Cottler, & Compton, 1999). MTF survey data reviewed by Wallace et al. (2002) revealed that American Indian 12th graders had the highest past-year prevalence rate for inhalant use at 9.4%, as compared with 12th graders of all other ethnic groups combined at 6.6%. The 30-day prevalence rate was also higher than all but one other ethnic group at 4.3%, in contrast to an all-ethnic groups rate of 2.4% (Cuban Americans were the only group with a higher 30-day prevalence, at 6.6%).

Estimates of the prevalence of alcohol use among American Indian youth vary significantly. On the basis of national data of American Indian students collected from 1975 to 1994, Beauvais (1996) reported that 15% of Native youth had consumed alcohol or used drugs at least once by the age of 12, 62% had been intoxicated at least once by age 15, and 71% of 7th through 12th graders had used alcohol during their lifetime. May (1986) reported that approximately one third of Native Americans had tried alcohol by 11 years of age. This latter rate is substantiated by another study, which found that 44% of 4th and 5th graders surveyed in the Pacific Northwest and Oklahoma (mean age _ 10.3 years) had tried alcohol (Moncher, Holden, & Trimble, 1990).

Among American Indian boarding school students, the lifetime prevalence rate of alcohol use was found to be 93%, with 53% of these considered to be at risk for serious alcohol abuse (Dinges & Duong-Tran, 1993). A longitudinal study following urban American Indian youth in Seattle showed that at Year 5 (mean age 15.8 years) 41.5% of the youth reported having drunk alcohol to the point of intoxication (Walker et al., 1996). Beauvais (1992a) compared drinking rates for reservation Indians, nonreservation Indians, and White students in the 8th and 12th grades. Nonreservation Indian 8th graders were more likely to report lifetime alcohol use (80%) than reservation Indian (70%) or White (73%) 8th graders. However, lifetime prevalence rates for 12th graders were highly comparable among these three groups. Reservation Indians in both the 8th and 12th grades were most likely to report having been drunk in their lifetime (49% of 8th graders, 87% of 12th graders), followed by nonreservation Indians (42% and 76%) and Whites (27% and 73%). A similar pattern was found for the 30-day prevalence of having been drunk, with 8th and 12th graders on reservations having the highest rate, followed by nonreservation Indians, and then Whites.

In 1998 the National Institute on Drug Abuse reported slightly higher rates of alcohol use for American Indian youth as compared with youth from other ethnic groups. They reported that 93% of American Indian and 87% of non-American Indian high school seniors had tried alcohol during their lifetime. The rates for past month use were 56% and 51%, respectively. More recently, Wallace et al. (2002) reported a past-year alcohol use prevalence of 76.5% and a 30-day prevalence of 55.1% for Native American Indian 12th graders, rates similar to other ethnic groups. In comparison to all other ethnic groups combined, however, Native American Indian students had the highest rate of daily alcohol use (6.1% vs. 3.5%) and were the group most likely to have consumed five drinks or more in a row in the previous 2 weeks (37.0% vs. 30.8%).

Marijuana use is also significantly higher among American Indian and Alaskan Native youth than other groups. Beauvais (1996) found that nearly 50% of Indian students in the 7th through 12th grades reported having used marijuana on at least one occasion. In another study (Beauvais, 1992a) found that of the 8th graders surveyed, 47% of reservation Indians, 26% of nonreservation Indians, and 13% of Whites reported lifetime marijuana use. For 8th graders, 30-day prevalence was also highest for reservation youth (23%), followed by nonreservation (10%) and White youth (5%). Twelfth-grade youth living on reservations had higher lifetime (77%) and 30-day (33%) rates of use than did nonreservation Indian (58% and 21%) and White students (38% and 13%). Data from the MTF surveys (Wallace et al., 2002) also show that American Indian teens had the highest annual (45.3%) and 30-day (29.6%) marijuana prevalence rates as compared with teens of other ethnic groups. In addition, they were more likely than teens of other ethnic groups to use on a regular basis. Almost 10% of Indian 12th graders said that they use marijuana daily, compared with 5.4% of the total 12th grade population.

A study using data from the Voices of Indian Teens Project sampled 9th to 12th graders in seven predominantly American Indian schools in four western communities. Using a total sample size of 1,464 youth, Novins and Mitchell (1998) found that 55.7% of Native teens reported using marijuana at least once during their lifetime, and 40.0% had used marijuana in the past month. Among those youth who had used marijuana in the past month, 42.5% reported using 1 to 3 times, 27.5% reported using 4 to 10 times, and 30.0% said that they had used 11 or more times.

Epidemiological research indicates a high level of normative adolescent substance use. However, it suggests that much of this use is experimental or episodic in nature, with only a small minority of youth qualifying as heavy users. Within the Native American population, youth tend to initiate substance use at a younger age, continue use after initial experimentation, and have higher rates of polysubstance use (Beauvais, 1992a; U.S. Congress, Office of Technology Assessment [OTA], 1990). Substance initiation in Indian communities typically occurs between the ages of 10 and 13, with the onset for some individuals beginning as early as 5 or 6 years of age (Beauvais, 1996; Okwumabua & Duryea, 1987).

The stage, or gateway, theory has been proposed to explain the progression of adolescent drug involvement (Golub & Johnson, 1994; Kandel & Faust, 1975; Kandel & Yamaguchi, 1993; Kandel, Yamaguchi, & Chen, 1992; Weinberg, Radhert, Colliver, & Glantz, 1998). This theory postulates that for most individuals, initiation of drug use follows a specific sequence: (a) legal substances, such as tobacco and alcohol; (b) marijuana; (c) other illicit drugs; (d) cocaine; and (e) crack. However, an adolescent’s use of substances at one stage does not necessarily mean that he or she will move on to the next stage. The applicability of stage theory to American Indian and Alaskan Native youth has been questioned. One study found that among American Indian youth (ages 9–15) living in South Carolina, the use of alcohol predicted subsequent use of tobacco and illicit drugs, similar to what might be expected given the stage theory (Federman, Costello, Angold, Farmer, & Erkanli, 1997). However, Novins et al. (2001) found that among users of both alcohol and marijuana, approximately 35% reported using alcohol first, whereas 35% reported using marijuana first.

Further, these researchers found that 75% of youth using substances from three or more classes reported patterns of use inconsistent with stage theory. They recommend that a modification which categorizes substances as initiating (tobacco, alcohol, inhalants, marijuana) or heavy (other illicit drugs) more accurately and appropriately captures the drug use trends of Native American Indian youth.