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

Abstract

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

Association between experience of racial discrimination and hazardous alcohol use among Māori in Aotearoa New Zealand

“…Our findings highlight the pervasive nature of discrimination in Aotearoa New Zealand and demonstrate that discrimination may play a role in the higher levels of hazardous drinking observed among Indigenous populations , extending work conducted with African Americans in the United States . Although our findings support the indirect pathway between discrimination and alcohol use (i.e.…”

Smoking behaviours and other substance use among Indigenous and non‐Indigenous Australian secondary students, 2017

“…Many studies have identified a cluster of risk behaviours for adolescent smoking, including alcohol and illicit drug use [11,14–17]. These associations have been found among Indigenous adolescents of North America [22,32] and in qualitative work in Australia [23,24] with researchers noting the importance of social settings that promote sharing and experimentation with illicit substances. Our results suggest other substance use is an important risk factor for smoking for all young people.…”

“…The strong association between smoking, drinking and cannabis use clearly suggests common determinants as explained by PBT. Adolescent smoking can also serve as an indicator of risk, with those who experiment or establish smoking in early high school more likely to adopt other problem behaviours, including substance use, later in high school and adolescence [32,34]. The call for coordinated health promotion programs to address multiple risk behaviours through common determinants has been made for both Indigenous adolescents [21,32,35] and adolescents in general [15,34].…”

“…Adolescent smoking can also serve as an indicator of risk, with those who experiment or establish smoking in early high school more likely to adopt other problem behaviours, including substance use, later in high school and adolescence [32,34]. The call for coordinated health promotion programs to address multiple risk behaviours through common determinants has been made for both Indigenous adolescents [21,32,35] and adolescents in general [15,34]. These determinants may include self‐efficacy and other coping and refusal skills that can be applied to multiple behaviours, as well as important protective factors such as self‐esteem, family relationships and peer attitudes [15,32].…”

“…The call for coordinated health promotion programs to address multiple risk behaviours through common determinants has been made for both Indigenous adolescents [21,32,35] and adolescents in general [15,34]. These determinants may include self‐efficacy and other coping and refusal skills that can be applied to multiple behaviours, as well as important protective factors such as self‐esteem, family relationships and peer attitudes [15,32]. Additional protective factors identified specifically for Indigenous adolescents include cultural connectedness [21,35].…”