The Role of Norms in Marijuana Use Among American Indian Adolescents

Intertribal Talking Circle for the prevention of alcohol and drug use among Native American youth

The purpose of this study was to examine the impact of a culturally based intervention, the Intertribal Talking Circle program, compared to a standard alcohol and drug abuse education, the Be A Winner program. Community-based participatory research was used to implement a two-condition, quasi-experimental study. The sample included 540 Native American youth ages 10-12 years old from three tribal areas in the United States. Data were collected at baseline, 6 and 12-months post-intervention for both the intervention and control groups using demographic, cultural identity, alcohol use, and drug use questionnaires. Regression models evaluated participants' improvement in decreasing alcohol and drug use and increasing cultural identity. Findings revealed that alcohol and drug use decreased more significantly among youth who participated in the Intertribal Talking Circle (ITC) intervention program than youth who participated in a standard alcohol and drug abuse education Be A Winner (BAW) program. Cultural identity also increased more significantly among participants who completed the Talking Circle intervention program. Native American youth ages 10-12 years old respond positively to a culturally based intervention for the reduction of alcohol and drug use. The findings highlight the importance of cultural values and identity and their significance in preventing and reducing alcohol and drug use among Native American youth.

The protective role of valuing cultural activities on cannabis use in reserve-Dwelling First Nation youth

Cannabis legalization and use across North America disproportionately negatively affects North American Indigenous (NAI) youth. Cultural activities may function as an alternative reinforcer to protect against substance use and promote engagement in substance-free activities. The present study explored the role of valuing cultural activities on positive cannabis expectancies and past-month cannabis use. This was a secondary data analysis of data from one NAI adolescent population reporting any past-month cannabis use. 106 NAI adolescents (50% female) from a Canadian reserve community completed surveys in spring 2017. The Institutional Review Board, tribal chief, and council approved this study and informed consent, assent, and parental permission were obtained from participants. Linear regression results revealed significant main effects of positive cannabis expectancies (b = 2.926, SE = 1.198, p = .017, 95%CI[0.542, 5.309]) and valuing cultural activities (b= -0.471,SE = 0.234, p=.048, 95%CI[-0.937, -0.005]) on cannabis use, but no significant interaction between cannabis expectancies and valuing cultural activities. Previous research found valuing cultural activities significantly moderates the relationship between positive alcohol expectancies and alcohol use. Divergent findings may relate to the different historical significance of alcohol versus cannabis. Alcohol was used as a method to colonize NAIs. Thus, our non-significant interaction may result from cannabis not holding the same historical significance in comparison to alcohol for First Nation people, although this is only a hypothesis and should be confirmed with a follow up study. Despite this, calls from Indigenous communities emphasize the need for strength-based approaches and our results indicate that valuing culture is still significantly related to reduced cannabis use, independent of cannabis expectancies.

The significance of information variables in polydrug use by adolescents: insights from a cross-sectional study in Tarragona (Spain)

Substance use, especially among adolescents, is a significant public health concern, with profound implications for physical and psychological development. This study aimed to evaluate the quantity and sources of information available to adolescents regarding polydrug use. A cross-sectional survey was conducted in Tarragona involving adolescents with an average age of 16.44 years. This study assessed the number of substances used (alcohol, cigarettes, and cannabis) in the past month, along with information sources related to substance use. Monitored sources (e.g., schools, parents, and mass media) and unmonitored sources (e.g., peers, siblings, internet) were distinguished. In addition, four individual and four environmental control variables were considered. Multinomial logistic regression analysis revealed that incorporating variables related to adolescents' substance use information and its sources enhanced the explanatory model, surpassing control variables. The degree of information about substance use did not significantly explain consumption patterns, but the number of information sources, both monitored and unmonitored, did. The unmonitored sources were associated with increased polydrug use. Conversely, greater reliance on supervised sources for information was linked to reduced single-substance and polydrug use. This protective effect increased with an increase in the number of substances used. In conclusion, information obtained from monitored sources acts as a deterrent to substance consumption, consistent with findings suggesting that greater health literacy among adolescents discourages substance use. Conversely, this study suggests that information from more informal sources may encourage heavier polydrug use, aligning with reports indicating that adolescents with a more comprehensive understanding of substance use consequences tend to engage in heavier drug use.

Subjective norms as a mediator between exposure to online alcohol and marijuana content and offline use among adolescents

INTRODUCTION

While adolescent substance use (SU) may be viewed as normative, SU can quickly escalate leading to consequences. Social media use may increase SU risk. Despite using social media to connect with others, adolescents also view depictions of glamorised SU by both peers and influential figures. Exposure to online alcohol and marijuana content may impact subjective norms (i.e., injunctive and descriptive) ultimately leading to increased offline SU. Data from a multi-wave project was collected to assess whether subjective norms-mediated associations between exposure to alcohol and marijuana content by peers and influential figures on Instagram and Snapchat and offline SU.

METHODS

At Wave 1, participants were 264 adolescents (Mage  = 14.91, 51% female, 86% White, 85% Hispanic/Latino/a/x).

RESULTS

Injunctive norms significantly mediated associations between exposure to alcohol content posted by peers and influential figures on Instagram and Snapchat and offline alcohol use. Injunctive norms significantly mediated associations between exposure to marijuana content posted by peers and influential figures on Instagram, and peers on Snapchat and offline marijuana use. Descriptive norms significantly mediated associations between exposure to alcohol content posted by peers on Instagram, as well as peers and influential figures on Snapchat and offline alcohol use.

DISCUSSION AND CONCLUSION

Increased exposure to online SU content was more consistently associated with injunctive norms rather than descriptive norms. Future research should examine which social media features (e.g., the like button) contribute to increased subjective norms. Overall, findings suggest that social media may strongly convey approval of SU behaviours rather than actual use.

The influence of parent and peer disapproval on youth marijuana use mediated by youth risk perception: Focusing on the state comparison

BACKGROUND

The prevention of youth marijuana use has become a national priority in the United States. This study examined the influence of parent and peer disapproval on youth marijuana use, mediated by youth risk perception. Because the legal status of marijuana use can influence individual perceptions of the drug, this study investigated differences in the mediating mechanism between youth living in states with medical marijuana legalization (MML) and those living in non-MML states.

METHODS

The 2019 National Survey of Drug Use and Health was used with a youth population aged 12-17 years (N = 2293). Structural equation modeling and bias-corrected bootstrapping were used to examine hypothesized path models and to evaluate the mediating effect of youth risk perception.

RESULT

Findings demonstrated that parent and peer disapproval significantly increased youth risk perception of marijuana and reduced youth marijuana use. Second, youth risk perception significantly mediated the association between parent and peer disapproval and youth marijuana use. Third, parent disapproval had a more significant direct effect on youth marijuana use, while peer disapproval had a more significant indirect effect on youth marijuana use via youth risk perception. Finally, the results showed a similar pattern in the mechanism between youths living in MML states compared with those in non-MML states in terms of significance and direction.

CONCLUSION

The findings suggested a need for improvements in marijuana related policies for both MML and non-MML states. Moreover, parent and peer focused strategies for education and prevention concerning marijuana use among youth are emphasized.

Talking Circle for Young Adults (TC4YA) Intervention: A Culturally Safe Research Exemplar

BACKGROUND

: As a result of the intergenerational trauma impact and experience, Native Americans continue to exhibit trauma related issues such as high rates of substance use. After leaving high school, the pressures and stress of continuing an education, finding work/employment, and the responsibilities related to family and tribal community obligations result in the Native American young adult being more vulnerable to substance use.

OBJECTIVE

The purpose of this paper is to report findings of the Talking Circle intervention impact on the outcome variables of Native-Reliance, substance use, stress, and behavioral health, depression, and cumulative trauma.

METHODS

Native-Reliance was the theoretical underpinning for the study demonstrating culturally safe research. A pre-test/post-test one-group design was utilized to examine how the Talking Circle intervention influenced the outcome variables. 75 Native American participants, ages 18-24 participated in the Talking Circle intervention sessions. Baseline pre-intervention measures were completed and were repeated at 6-month post-intervention.

RESULTS

At 6-month post-intervention, Native-Reliance significantly revealed an increase of 40.55 (t = 22.13, p < .001), sources of stress (SS) revealed a significant decline of 3.68 (t= -18.39, p < .001), behavioral health issues (BH) showed a significant decline of 3.63 (t = -15.36, p < .001), substance related issues (SR) showed a significant decline of 3.57 (t = -15.24, p < .001), depression (PHQ-9) showed a significant decline of 4.85 (t = -17.02, p < .001), and cumulative trauma revealed a significant decline of 2.77 (t= -13.39, p < .001).

CONCLUSIONS

The use of a culturally safe Talking Circle intervention evidenced a research approach that resulted in the positive impact on reducing substance use and increasing the well-being of young Native American young adults.

IMPACT STATEMENT

Culturally safer intervention environments are conducive to results in outcomes that are positive and effective.

Marijuana use and intentions among American Indian adolescents: Perceived risks, benefits, and peer use

OBJECTIVE

The present study examines how perceptions of peer use, risks of use, and benefits to oneself and others from marijuana use are associated with past-month marijuana use and intentions to use marijuana socially among American Indian (AI) youth.

METHOD

The American Drug and Alcohol Survey (ADAS), a measure of substance use and related factors, was administered to AI youth living on or near reservations across six geographic regions (n = 3,498, 49.5% female, M age = 14.8).

RESULTS

Greater perceived peer use was significantly associated with more frequent past-month marijuana use (b = .05, p = .038) and intentions to use marijuana socially (b = .74, p < .001). Greater benefits to oneself were associated with greater marijuana use intentions (b = .35, p < .001). Greater perceived risks and benefits to others were significantly associated with less frequent past-month use (b = -.02, p = .002; b = -.01, p = .007, respectively) and intentions to use marijuana socially (b = -.05, p = .001; b = -.03, p = .002, respectively). Multilevel moderation analyses revealed that the effects of perceived peer use and benefits to oneself were related to intentions to use although stronger for those who had used; however, the effects of perceived risks and benefits to others were only significantly related to intentions to use marijuana for those who had used marijuana.

CONCLUSIONS

Results suggest that perceived benefits to others and risks are malleable factors that may be effective components of treatment programs for youth who report lifetime marijuana use, but that perceived peer use and benefits to oneself may be useful in both treatment and prevention efforts for youth who have or have not used marijuana. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Racial and Ethnic Differences in Cannabis Use and Cannabis Use Disorder: Implications for Researchers

PURPOSE

Heavy and prolonged use of cannabis is associated with several adverse health, legal and social consequences. Although cannabis use impacts all U.S. racial/ethnic groups, studies have revealed racial/ethnic disparities in the initiation, prevalence, prevention and treatment of cannabis use and Cannabis Use Disorder (CUD). This review provides an overview of recent studies on cannabis and CUD by race/ethnicity and a discussion of implications for cannabis researchers.

FINDINGS

The majority of studies focused on cannabis use and CUD among African American/Black individuals, with the smallest number of studies found among Native Hawaiians/Pacific Islanders. The limited number of studies highlight unique risk and protective factors for each racial/ethnic group, such as gender, mental health status, polysubstance use and cultural identity.

SUMMARY

Future cannabis studies should aim to provide a deeper foundational understanding of factors that promote the initiation, maintenance, prevention and treatment of cannabis use and CUD among racial/ethnic groups. Cannabis studies should be unique to each racial/ethnic group and move beyond racial comparisons.

Factors That Influence Substance Use Among American Indian/Alaskan Native Youth: A Systematic Mixed Studies Review

BACKGROUND

The American Indian/Alaskan Native (AI/AN) mortality rate from illicit drug use was 22.7%, double that of the general population between 2007 and 2009. Fifteen percent of AI/AN youth reported receiving treatment for substance use compared with 10% of non-AI/AN peers.

OBJECTIVE

The purpose was to explore the factors that influence substance use among AI/AN youth.

METHOD

We performed a systematic review using a results-based convergent synthesis design. Eight electronic databases were searched for articles published between 2014 and 2019 using the search terms "Native American youth," "Native American adolescent," "Native Youth," "substance use," "substance misuse," and "substance abuse." The Mixed Methods Appraisal Tool was used to appraise the studies.

RESULTS

Forty-seven studies met the inclusion criteria (44 quantitative, one qualitative, and two mixed-methods studies). The results were organized using the ecological systems model and included evaluation of both protective and risk factors related to AI/AN youth substance use. Three system levels were found to influence substance use: individual, micro- and macrosystems. The individual systems-level coping mechanisms played a key role in whether AI/AN youth initiated substance use. Family, school, and peer factors influence the microsystem level. At the macrosystem level, community environmental factors were influential.

CONCLUSION

The major factor linking all the systems was the influence of a connected relationship with a prosocial adult who instilled future aspirations and a positive cultural identity. Findings of this systematic mixed studies review will assist in intervention development for AI/AN youth to prevent substance misuse.

Does parental permissiveness toward cigarette smoking and alcohol use influence illicit drug use among adolescents? A longitudinal study in seven European countries

PURPOSE

Adolescents' perceptions of parental norms may influence their substance use. The relationship between parental norms toward cigarette and alcohol use, and the use of illicit substances among their adolescent children is not sufficiently investigated. The purpose of this study was to analyze this relationship, including gender differences, using longitudinal data from a large population-based study.

METHODS

The present study analyzed longitudinal data from 3171 12- to 14-year-old students in 7 European countries allocated to the control arm of the European Drug Addiction Prevention trial. The impact of parental permissiveness toward cigarettes and alcohol use reported by the students at baseline on illicit drug use at 6-month follow-up was analyzed through multilevel logistic regression models, stratified by gender. Whether adolescents' own use of cigarette and alcohol mediated the association between parental norms and illicit drug use was tested through mediation models.

RESULTS

Parental permissive norms toward cigarette smoking and alcohol use at baseline predicted adolescents' illicit drug use at follow-up. The association was stronger among boys than among girls and was mediated by adolescents' own cigarette and alcohol use.

CONCLUSION

Perceived parental permissiveness toward the use of legal drugs predicted adolescents' use of illicit drugs, especially among boys. Parents should be made aware of the importance of norm setting, and supported in conveying clear messages of disapproval of all substances.

Latent Class Analysis and Predictors of Marijuana Use among Reservation-based American Indian High School Students

American Indian (AI) youth residing on reservations report higher rates of marijuana use compared to national youth. Latent class analysis (LCA) was used to identify unique types of marijuana use among 2,884 AI high school students surveyed from 26 schools across six indigenous geographic regions. Predictors of class membership were then assessed using social, cultural, and individual measures relevant to adolescent substance use. Classes and predictors were examined separately for males and females. Four-class models fit the data best for both male and female AI students. Classes differed by sex, as did predictors. Overall, social predictors related to family and peers and the individual predictor, using marijuana to cope, were the best predictors of class membership. Based on these results, prevention and intervention efforts should provide alternative coping methods for these adolescents who often live in difficult situations, and should focus on encouraging parents to effectively monitor their adolescent children and communicate clear sanctions against marijuana use.

Variations in risk and promotive factors on substance use among urban American Indian youth

Although roughly 70% of the American Indian and Alaska Native (AI) population live in urban areas, research is scarce regarding this population. As a consequence, there is limited understanding about the salient socioenvironmental factors that aid in preventing substance use among urban AI communities. This study utilized a statewide, cross-sectional, school-based survey of urban AI adolescents (N = 2,375) to (a) examine the associations between substance use and risk and promotive factors within the family and peer group, and (b) explore how these associations vary by subgroups (gender, racial/ethnic background, and grade level). Results suggest that risk factors-familial substance use and antisocial peer affiliation-were associated with higher alcohol, cigarette, and marijuana use. However, these findings varied by subgroup. For males, involvement with antisocial peers was associated with greater marijuana use. Involvement with antisocial peers was also positively associated with alcohol and marijuana use for multiracial/multiethnic AI adolescents and those adolescents in 10th and 12th grades. The promotive factors-supportive family environment and prosocial peer affiliation-were not universally associated with lowered substance use by subgroup. This study advances understandings of the risk and promotive factors important in reducing and preventing substance use among urban AI adolescents. Experiencing familial substance use and affiliating with antisocial peers were the salient factors associated with increased substance use, particularly for urban AI adolescents who are older, male, and with multiracial/multiethnic AI backgrounds.

Three As of American Indian adolescent marijuana use: Availability, acceptability, and approval

BACKGROUND

American Indian (AI) adolescents report high rates of marijuana use and related consequences and availability of marijuana has a robust relationship with marijuana use. The purpose of the present study was to examine the role of perceptions of approval (i.e., injunctive norms), and acceptability (i.e., descriptive norms and perceived harm) in the relationship between marijuana availability and marijuana use.

METHODS

Data collected from 2009 to 2013 included 3498 AI 7th-12th graders residing on or near a reservation (47.8 % female). Multilevel mediation analyses were conducted using the MLmed macro in IBM SPSS v26.0 to account for the nesting of data within schools.

RESULTS

The associations between marijuana availability and perceived risks (b=-.38, p < .001), descriptive norms (b = .80, p < .001), and injunctive norms related to marijuana use (b=-.24, p < .001), were significant. The associations between perceived risks (b=-.27, p < .001), descriptive norms (b = .14, p < .001), and injunctive norms (b=-.18, p < .001) and marijuana use were also significant. The indirect effects of marijuana availability on marijuana use through the pathways of perceived risks (b = .10, p < .001, 95 %CI[.08, .12]), descriptive norms (b = .11, p < .001, 95 %CI[.09, .14]), and injunctive norms related to marijuana use (b = .04, p < .001, 95 %CI[.03, .06]) were significant. The direct effect linking marijuana availability to marijuana use remained significant (b = .28, p < .001) but decreased by 37.8 %. when controlling for perceived risks, descriptive norms, and injunctive norms related to marijuana use.

CONCLUSIONS

Interventions aiming to reduce AI adolescent marijuana use should focus on availability and may also be well served by targeting descriptive and injunctive norms, as well as perceived risks of marijuana use.

Predictors of Substance Use Latent Classes Among American Indian Youth Attending Schools On or Near Reservations

BACKGROUND AND OBJECTIVES

Identical latent classes of substance use for 7 to 8 grade and 9 to 12 grade American Indian (AI) youth living on or near reservations suggest that patterns of substance use are established early among these youth. This study examines relationships of substance-related factors to latent class membership and whether these relationships differ by grade group.

METHODS

In-school surveys were administered to 1503 7 to 8 grade and 1995 9 to 12 grade students from 46 schools on or near reservations during the 2009/2010 to 2012/2013 school years. Four-class latent class models of substance use were specified and five classes of substance-related factors (peers, substance availability, perceived harm, family, early initiation), plus grade level and gender, were evaluated as predictors.

RESULTS

For 7 to 8 grade students, substance-related factors differentiated nonusers from users, while for 9 to 12 graders, these factors also differentiated types of users. Early initiation and peer factors were strongly related to class membership, while other factors were less strongly related.

DISCUSSION AND CONCLUSIONS

Early initiation of alcohol or marijuana is strongly related to being in a substance-using class for AI youth. Because these youth tend to initiate use earlier that other US youth, prevention resources should be targeted to reaching them and their families before age 12.

SCIENTIFIC SIGNIFICANCE

Predictors of latent classes of substance use were identified for reservation-based AI youth. While the classes were identical for 7 to 8 grade and 9 to 12 grade youth, predictors varied across grade group, which may inform how best to develop prevention efforts unique to middle and high school AI youth.

Self-esteem, cultural identification, and substance use among American Indian youth

OBJECTIVES

Determine potential mediating and moderating effects of self-esteem on the relationship between cultural identification and substance use among American Indian (AI) youth.

METHODS

Anonymous surveys were administered to middle and high school AI students assessing levels of last month alcohol and marijuana use, cultural identification, and self-esteem. Structural equation modeling assessed potential mediating and moderating effects of self-esteem on the relationship between AI and white identification on alcohol and marijuana use.

RESULTS

No mediating effects were found for middle school students. Among high school students, no mediating effects were found for alcohol. Among female high school students, a small mediating effect was found between AI identification and marijuana use, with AI identification protecting against use. Across all students, no moderating effects of self-esteem were found.

CONCLUSIONS

The literature on cultural identification and substance use among minority youth is unclear. It was anticipated that consideration of self-esteem as a potential mediator or moderator might help clarify some of the confusion. However, no moderating effects were found and mediating effects were limited to female high school students for marijuana. Consideration should be given to assessing other measures of cultural identification and subscales of self-esteem to confirm that these findings are robust.

Perceptions of Community Norms and Youths' Reactive and Proactive Dating and Sexual Violence Bystander Action

There is enthusiasm for programs that promote bystander intervention to prevent dating and sexual violence (DSV). However, more information about what facilitates or inhibits bystander behavior in DSV situations is needed. The present cross-sectional survey study investigated whether youth perceptions of adults' behavior and community norms were associated with how frequently youth took action and intervened in DSV situations or to prevent DSV. Specifically, study hypotheses were that youths' perceptions of community-level variables, such as adults' willingness to help victims of DSV or prevent DSV, perceptions of community collective efficacy, and perceptions of community descriptive and injunctive norms disapproving of DSV and supporting DSV prevention, would be associated with how frequently youths took reactive and proactive bystander action. Participants were 2172 students from four high schools in one New England state. ANOVA analyses found that descriptive norms were associated with all actionist behaviors, and perceptions of community cohesion were also consistently associated with them. Injunctive norms were associated, but less consistently, with actionist behaviors. Findings suggest that DSV-related social norms, and descriptive norms and community cohesion in particular, might be relevant to youth DSV bystander behavior.

Young, American Indian or Alaskan Native, and born in the USA: at excess risk of starting extra-medical prescription pain reliever use?

BACKGROUND

Prescription pain reliever (PPR) overdoses differentially affect 'American Indian/Alaskan Natives' in the United States (US). Here, studying onset of extra-medical PPR use in 12-24-year-olds, we examine subgroup variations in rates of starting to use prescription pain relievers extra-medically (i.e., to get 'high' or for other reasons outside boundaries of prescriber's intent). Risk differences (RD) are estimated for US-born versus non-US-born young people, stratified by American Indian/Alaskan Natives versus other ethnic self-identities.

METHODS

Between 2002-2009, nationally representative cross-sectional samples of 12-24-year-old non-institutionalized civilians completed interviews for the US National Surveys of Drug Use and Health. Analysis-weighted annual incidence estimates, RD, and confidence intervals (CI) are from the Restricted-use Data Analysis System, an online software tool for US National Surveys of Drug Use and Health.

RESULTS

Each year, an estimated 2.5% of 12-24-year-olds in the US start using PPR extra-medically (95% CI [2.1%-3.0%]). Estimates for the US-born (3.8%; 95% CI [3.7%-3.9%]) are larger (non-US-born: 1.8%; 95% CI [1.5%-2.0%]; RD = 2.0; p < 0.05). US-born American Indian/Alaskan Natives youths have the largest incidence rate (4.8%). Robust RD for US-born can be seen for 'non-Hispanic White' subgroups, and for others (e.g., 'Cuban', 'Dominican').

DISCUSSION

Each year, one in 20 of US-born American Indian/Alaskan Natives starts using PPR extra-medically. Overdose prevention is important, but is no substitute for primary prevention initiatives for all young people. The observed epidemiological patterns can guide targeted prevention initiatives for the identified higher risk subgroups in complement with more universal prevention efforts intended to reduce incidence of first extra-medical PPR use, a crucial rate-limiting step on the path toward more serious drug involvement (i.e., progressing past initial use).

Substance Use Among American Indian Youths on Reservations Compared With a National Sample of US Adolescents

IMPORTANCE

American Indian adolescents attending schools on or near reservations are historically at high risk for substance use.

OBJECTIVE

To compare rates of substance use among reservation-based American Indian adolescents vs rates among national US youths.

DESIGN, SETTING, AND PARTICIPANTS

Population-based survey study of 8th-, 10th-, and 12th-grade students attending participating schools on or near reservations, stratified by region, during the 2016-2017 school year. Substance use rates were compared with those of a national sample of comparably aged students from the Monitoring the Future study.

MAIN OUTCOMES AND MEASURES

Lifetime and last-30-day self-reported use of alcohol, marijuana, and other drugs, using relative risk (RR) ratios with 95% confidence intervals to compare American Indian student rates with Monitoring the Future student rates.

RESULTS

Participants included 570 students in eighth grade (49.6% girls; mean age, 13.5 years), 582 in 10th grade (50.0% girls; mean age, 15.4 years), and 508 in 12th grade (53.5% girls; mean age, 17.4 years). American Indian students reported substantially higher lifetime and last-30-day substance use rates compared with the Monitoring the Future students, with greatest disparity at eighth grade: last-30-day substance use RRs for grade 8 were 2.1 (95% CI, 1.4-3.0) for alcohol, 4.2 (95% CI, 3.1-5.8) for marijuana, and 2.4 (95% CI, 1.7-3.3) for other illicit drugs. Compared with 2009 to 2012 data, the RRs between American Indian and Monitoring the Future students for lifetime alcohol and marijuana use did not change substantially from the 2016-2017 school year (alcohol: RR, 1.5 [95% CI, 1.4-1.6] vs RR, 1.3 [95% CI, 1.2-1.4], respectively; marijuana: RR, 2.0 [95% CI, 1.8-2.1] vs RR, 2.1 [95% CI, 1.9-2.3], respectively), but increased substantially for other drugs (RR, 1.8 [95% CI, 1.7-1.9] vs RR, 3.0 [95% CI, 2.9-3.2], respectively).

CONCLUSIONS AND RELEVANCE

Reservation-based American Indian students are at high risk for substance use compared with US youths in general, making prevention efforts critical. Cultural and value-based characteristics unique to American Indian populations may provide beneficial targets for prevention, but there is limited evidence on how cultural factors work to prevent risky behaviors. Without increased attention to these disparities, the costs to American Indian youths and their communities will remain high.

Perceived harm as a mediator of the relationship between social norms and marijuana use and related consequences among American Indian youth

BACKGROUND

American Indian (AI) youth are at increased risk for marijuana use with marijuana use rates on or near reservations 1.6-4.8 times higher compared to non-AI youth in the same regions (Stanley et al., 2014). One outcome of the changing social and legal acceptance of marijuana is a decrease in perceived risk among adolescents. It is unknown whether these changes in perceptions of marijuana-related harm will presage higher rates of use among AI youth. Perceptions of others use (i.e., descriptive norms) and approval (i.e., injunctive norms) are consistent predictors of marijuana use and consequences. Moreover, large scale surveys have shown that gender is an important moderator of the relationship between norms and marijuana use in AI samples.

METHOD

The current study is a large epidemiologic study of 7th-12th grade self-identified American Indian students (N=3050). We examined the direct relations between descriptive and injunctive norms and marijuana use/consequences among AI youth, as well as the mediating role of perceived harm and the moderating role of gender.

RESULTS

Results of a multi-group path analysis revealed a similar pattern of findings for males and females. In addition, there were direct effects for descriptive but not injunctive norms on marijuana use/consequences, and the sequential pathway from norms to use/consequences via perceived harm held.

DISCUSSION

Findings suggest that normative perceptions and perceived harm are antecedents of marijuana use/consequences and are prime targets for large scale interventions on AI reservations.