Substance Use Among American Indian Youth: Epidemiology and Etiology

Colorado State University, Fort Collins CO

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Abstract

Project Summary This ongoing integrated epidemiologic and etiologic research study (Our Youth, Our Future) is the only source of nationally-representative substance use data for reservation-area American Indian (AI) adolescents, a population that is at-risk and experiences large health disparities. Substance use rates among AI adolescents have been greater than national rates for decades, and our current findings point to complex changes since the onset of COVID-19. Each year, 3,000 or more 6th - 12th grade reservation-area AI students will be surveyed to provide nationally-representative rates of substance use for this population. In collaboration with Monitoring the Future researchers, these rates will be compared with national rates to identify areas of special concern for reservation-area AI youth. In addition, age, period, and cohort effects will be distinguished by combining our past data with data gathered in the upcoming cycle, emphasizing substance use before, during, and after the onset of COVID-19, to identify changes in substance use and related constructs due to historical (e.g., COVID- 19), regulatory, and normative factors. Finally, we will examine heterogeneity in SU disparities among reservation-area American Indian youth across intersections of sociodemographic identities and contextual variables using intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy. Collecting data from multiple reservations across the country yields a unique opportunity to conduct the first systematic assessment of Social Determinants of Health (SDOH) impacts on substance use and related constructs for this population. A wide range of SDOH factors specific to reservation communities will be compiled in order to identify how SDOH factors either contribute to or shield against use, providing a comprehensive perspective on the interplay of vulnerabilities and strengths within AI communities. Building etiologic evidence for substance use prevention efforts is also a key part of this project. Although AI youth are influenced by broader society, unique individual, cultural, and contextual factors influence substance use. An Ecosystemic Resilience Framework (ERF) will guide examination of the ecosystemic resilience processes involved in the relationships of adversity to substance use and its comorbidities in reservation-area AI youth, with particular emphasis on unique cultural and community factors. This will provide actionable insights for prevention efforts. Additionally, we will expand the ERF to incorporate an intersectional analytic approach to examine how ecosystemic risk and resilience processes impact SU among AI youth occupying different socio-demographic intersections and social contexts. Project findings will be disseminated to key stakeholders, with special emphasis on tribal and non-tribal entities involved in policy and resource-related decisions that affect AI youth substance use.