1
|
Ivanich JD, Ullrich JS, Martin TKK, Marshall M, Schultz K, White E, Barlow A, Fitzgerald HE, Okamoto S, Sparrow J, Sarche M, Whitesell NR. The Indigenous Connectedness Framework for Understanding the Causes, Consequences, and Solutions to Substance Misuse in Indigenous Children's Development. ADVERSITY AND RESILIENCE SCIENCE 2023; 4:335-341. [PMID: 39421692 PMCID: PMC11485581 DOI: 10.1007/s42844-023-00119-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 10/19/2024]
Abstract
Research in Indigenous communities continues to lead innovations in the adversity and resilience sciences. These innovations highlight the strengths of Indigenous communities and are an act of resistance against prevailing stereotypes that Indigenous communities are vulnerable and wholly restrained by health deficits. The aim of this Supplemental Issue on Substance Misuse and Disorder and American Indian, Alaska Native, and Native Hawaiian Children's Development: Understanding Root Causes and Lifting up Solutions Grounded in Indigenous Community Strengths is to highlight the promising new approaches and perspectives implemented by a group of engaged researchers and their community partners, as they seek to move resilience science research forward. Case studies presented in this issue are from projects led by teams connected to the Native Children's Research Exchange (NCRE) conference, all of whom conduct health promotion and disease prevention research among American Indians, Alaska Natives, and Native Hawaiians. Sparked by several major exogenous shocks to the current landscape of the American milieu, namely, the COVID-19 pandemic, the murder of George Floyd (increased visibility of overt racism in the USA), and climate change, this article presents a model for conducting research with Indigenous Communities that acknowledges these forces while highlighting community strengths.
Collapse
Affiliation(s)
| | | | | | | | | | - Evan White
- Laureate Brain Institute, Tulsa, OK, USA
| | | | | | | | | | - Michelle Sarche
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | |
Collapse
|
2
|
Asdigian NL, Tuitt N, Mousseau AC, Ivanich JD, Schultz K, Keane EM, Zacher T, Skinner L, Richards FRW, Robe LB, Whitesell NR. Grounding evidence-based prevention within cultural context: promising effects of substance use prevention adapted for American Indian families. Subst Use Misuse 2023; 58:1004-1013. [PMID: 37125477 PMCID: PMC10259753 DOI: 10.1080/10826084.2023.2201847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Background: Effective substance use prevention strategies are needed for American Indian (AI) youth, who face disproportionate risk for early substance use and consequently bear a disproportionate burden of health and developmental disparities related to early use. With few exceptions, significant advances in prevention science have largely excluded this population, leaving gaps in the evidence of effective practice. This paper builds on emerging efforts to address this gap, reporting first outcome findings from an evidence-based early substance use prevention program culturally adapted for young adolescents on a Northern Plains reservation. Methods: Using a community-based participatory approach, the Thiwáhe Gluwáš'akapi Program (TG, sacred home in which family is made strong) was developed by embedding cultural kinship teachings within the Strengthening Families Program for Parents and Youth 10-14 and aligning other elements of program content with local culture and context. Results: Results of pre and post comparisons of proximal program outcomes showed that youth reported significant improvements in parental communication about substance use, substance use resistance skills, stress management, family cohesion, and overall well-being. Adults reported improvements in a wide array of parenting behaviors and indicators of family dynamics. Conclusions: These findings provide an initial glimpse into the potential effects of the TG program and suggest that it holds promise for helping AI families address risks for youth substance use through positive impacts on modifiable risk and protective factors documented to influence early substance use.
Collapse
Affiliation(s)
- Nancy L. Asdigian
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, MS F800, 13055 E. 17 Avenue, Aurora, CO, 80045
| | - Nicole Tuitt
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, MS F800, 13055 E. 17 Avenue, Aurora, CO, 80045
| | | | - Jerreed D. Ivanich
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, MS F800, 13055 E. 17 Avenue, Aurora, CO, 80045
| | - Katie Schultz
- School of Social Work, University of Michigan, 1080 S. University Ave, Ann Arbor, MI 48103
| | - Ellen M. Keane
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, MS F800, 13055 E. 17 Avenue, Aurora, CO, 80045
| | - Tracy Zacher
- Missouri Breaks Industries Research, Inc., 2309 School Road, Manderson, SD 57756, USA
| | - Leslie Skinner
- Missouri Breaks Industries Research, Inc., 2309 School Road, Manderson, SD 57756, USA
| | | | - Lisa Bear Robe
- Missouri Breaks Industries Research, Inc., 2309 School Road, Manderson, SD 57756, USA
| | - Nancy Rumbaugh Whitesell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, MS F800, 13055 E. 17 Avenue, Aurora, CO, 80045
| |
Collapse
|
3
|
Tingey L, Chambers R, Littlepage S, Slimp A, Lee A, Lee S, Melgar L, O'Keefe V, Craig M, Gaydos C, Rompalo A. 'Empowering our people' to address depression, violence, and sexual risk among Native Americans with recent binge alcohol use. ETHNICITY & HEALTH 2022; 27:733-747. [PMID: 32223325 DOI: 10.1080/13557858.2020.1740177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 03/03/2020] [Indexed: 06/10/2023]
Abstract
Background: This study was launched in response to an American Indian (AI) community's concern regarding the comorbid occurrence of substance use, poor mental health, and other risk factors on sexual health. The purpose of this manuscript was to assess the relationship between alcohol use, violence, depression and STI/HIV risk behaviors on the frequency of unprotected sex acts and number of sexual partners among AI adults.Methods: Specifically, this analysis examines sociodemographic characteristics, experience of sexual and physical violence, binge drinking, depression, and sexual risk taking among n = 281 AI adults ages 18-55. Regression models examine associations between the aforementioned risk factors, number of sex partners and number of unprotected sex acts, by depression status and sex, among participants.Results: Frequent binge drinking predicted frequency of unprotected sex for both males and females; ever experiencing physical violence was a powerful predictor of unprotected sex for females, but not males. Ever experiencing physical violence strongly predicted having multiple sexual partners for females but was related to decreased number of sexual partners for males. Females ever experiencing sexual violence had more sexual partners; this was not observed for males. Binge drinking predicted frequency of unprotected sex acts, regardless of depression status.Discussion: Interventions for AI adults seeking to reduce sexual health risk should reflect past violence victimization in sexual decision making, primarily among women. The significant role of binge alcohol use for modifying sexual decisions should be of prime focus and interventions should be personalized to address individuals' own alcohol use patterns. Additional research should explore how binge alcohol use moderates the relationship between depression and sexual risk.
Collapse
Affiliation(s)
- Lauren Tingey
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Chambers
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Shea Littlepage
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anna Slimp
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Angelita Lee
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Shauntel Lee
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Laura Melgar
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Victoria O'Keefe
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mariddie Craig
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Charlotte Gaydos
- Center for the Development of Point of Care Tests for Sexually Transmitted Diseases, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Rompalo
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
4
|
Chambers RA, Patel H, Richards J, Begay J, Littlepage S, Begay M, Sheppard L, Nelson D, Masten K, Mitchell K, Kee C, Barlow A, Tingey L. Feasibility, Acceptability, and Preliminary Impact of Asdzáán Be'eená: An Intergenerational, Strength-Based, and Culturally Grounded Program to Improve the Health of Navajo Families. FAMILY & COMMUNITY HEALTH 2021; 44:266-281. [PMID: 34145194 DOI: 10.1097/fch.0000000000000302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Native American youth endure a complex interplay of factors that portend greater risk-taking behaviors and contribute to marked health disparities experienced in adolescence. The Asdzáán Be'eená ("Female Pathways" in Navajo) program was developed as a primary prevention program to prevent substance use and teen pregnancy among Navajo girls. The Asdzáán Be'eená program consists of 11 lessons delivered to dyads of girls ages 8 to 11 years and their female caregivers. Feasibility, acceptability, and preliminary impact on risk and protective factors were assessed through a pre-/post study design. Data were collected from girls and their female caregivers at baseline, immediate, and 3 months postprogram completion. Forty-seven dyads enrolled in the study, and 36 completed the 3-month evaluation. At 3 months postprogram, girls reported significant increases in self-esteem, self-efficacy, parent-child relationship, social support, cultural, and sexual health knowledge. Caregivers reported increased family engagement in Navajo culture and parent-child communication and improved child functioning (fewer internalizing and externalizing behaviors). Findings suggest Asdzáán Be'eená has potential to break the cycle of substance use and teen pregnancy in Native communities by improving protective and reducing risk factors associated with these adverse health outcomes. Additional rigorous efficacy trials are necessary to establish program effectiveness.
Collapse
Affiliation(s)
- Rachel A Chambers
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Richards J, Chambers RS, Begay JL, Jackson K, Tingey L, Patel H, Carvajal S, Carroll SR, Teufel-Shone N, Barlow A. Diné (Navajo) female perspectives on mother-daughter communication and cultural assets around the transition to womanhood: a cross-sectional survey. BMC WOMENS HEALTH 2021; 21:341. [PMID: 34563201 PMCID: PMC8466980 DOI: 10.1186/s12905-021-01473-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
Background The inclusion of protective factors (“assets”) are increasingly supported in developing culturally grounded interventions for American Indian (AI) populations. This study sought to explore AI women’s cultural assets, perspectives, and teachings to inform the development of a culturally grounded, intergenerational intervention to prevent substance abuse and teenage pregnancy among AI females. Methods Adult self-identified AI women (N = 201) who reside on the Navajo Nation completed a cross-sectional survey between May and October 2018. The 21-question survey explored health communication around the transition to womanhood, cultural assets, perceptions of mother–daughter reproductive health communication, and intervention health topics. Univariate descriptive analyses, chi squared, and fisher’s exact tests were conducted. Results Respondents ranged in age from 18 to 82 years, with a mean age of 44 ± 15.5 years. Women self-identified as mothers (95; 48%), aunts (59; 30%), older sisters (55; 28%), grandmothers (37; 19%), and/or all of the aforementioned (50; 25%). 66% (N = 95) of women admired their mother/grandmother most during puberty; 29% (N = 58) of women were 10–11 years old when someone first spoke to them about menarche; and 86% (N=172) felt their culture was a source of strength. 70% (N = 139) would have liked to learn more about reproductive health when they were a teenager; 67% (N = 134) felt Diné mothers are able to provide reproductive health education; 51% (N = 101) reported having a rite of passage event, with younger women desiring an event significantly more than older women. Responses also indicate a disruption of cultural practices due to government assimilation policies, as well as the support of male relatives during puberty. Conclusions Results informed intervention content and delivery, including target age group, expanded caregiver eligibility criteria, lesson delivery structure and format, and protective cultural teachings. Other implications include the development of a complementary fatherhood and/or family-based intervention to prevent Native girls’ substance use and teen pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01473-4.
Collapse
Affiliation(s)
- Jennifer Richards
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Tuba City, AZ, 86045, USA.
| | - Rachel Strom Chambers
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21231, USA
| | - Jaime Lynn Begay
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Tuba City, AZ, 86045, USA
| | - Kendrea Jackson
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Chinle, AZ, 86503, USA
| | - Lauren Tingey
- Center for American Indian Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Hima Patel
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Scott Carvajal
- Health Behavior Health Promotion, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85724, USA
| | - Stephanie Russo Carroll
- Public Health Policy and Management, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85724, USA
| | | | - Allison Barlow
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| |
Collapse
|
6
|
Crabtree MA, Stanley LR, Kelly KJ, Swaim RC. Be under your own influence: Effectiveness of a Culturally-Adapted drug prevention campaign targeting Reservation-Dwelling American Indian youth. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:2316-2329. [PMID: 34273115 PMCID: PMC8380716 DOI: 10.1002/jcop.22672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/24/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
Be Under Your Own Influence (BUYOI) is a previously validated school-based intervention designed to delay adolescent substance use (SU) initiation. This study examined the effectiveness of a culturally-adapted version of BUYOI in delaying SU initiation among reservation-dwelling American Indian (AI) youth. Five reservation-based middle schools participated. Three schools were randomly assigned to receive BUYOI-AI (N = 321), and two schools served as controls (N = 176). Beginning in 7th grade, all participating students completed four assessments over the study period. Discrete time hazard models estimated the effects of BUYOI on students' risk of initiating alcohol, alcohol intoxication and marijuana before the end of 8th grade. AI students exposed to BUYOI had a lower risk of initiating alcohol use or intoxication, though sex moderated the effect on intoxication. These findings provide preliminary support for the effectiveness of a culturally-adapted version of BUYOI in delaying AI youth's first-time alcohol use and intoxication.
Collapse
Affiliation(s)
- Meghan A. Crabtree
- Tri–Ethnic Center for Prevention Research, Department of Psychology, Colorado State University, Fort Collins, CO 80523
| | - Linda R. Stanley
- Tri–Ethnic Center for Prevention Research, Department of Psychology, Colorado State University, Fort Collins, CO 80523
| | - Kathleen J. Kelly
- Department of Marketing, Colorado State University, Fort Collins, CO 80523
| | - Randall C. Swaim
- Tri–Ethnic Center for Prevention Research, Department of Psychology, Colorado State University, Fort Collins, CO 80523
| |
Collapse
|
7
|
Chambers RA, Begay J, Patel H, Richards J, Nelson D, Rosenstock S, Huskon R, Mitchell K, Begay T, Tingey L. Rigorous evaluation of a substance use and teen pregnancy prevention program for American Indian girls and their female caregivers: a study protocol for a randomized controlled trial. BMC Public Health 2021; 21:1179. [PMID: 34154552 PMCID: PMC8218410 DOI: 10.1186/s12889-021-11131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Early sexual initiation is associated with higher risk for sexually transmitted infection, teen pregnancy, domestic violence and substance use in later adolescence and early adulthood. Native American adolescents are more likely to have early sexual initiation compared to other racial/ethnic groups. Few programs designed with and for Native adolescents to delay sexual initiation and substance use have been tested through rigorous evaluations. This is the protocol for the randomized controlled trial of the Asdzáán Be’eena’ program, a teen pregnancy and substance use prevention program for young Native girls and their female caregivers. Methods N = 410 female adolescents ages 10–14 and their female caregivers will be enrolled in the study and randomized to the intervention or control arm. The intervention consists of the 11-session Asdzáán Be’eena’ program. The control arm consists of mailed non-monetary incentives. All participants will complete evaluations at baseline and 3 follow-up timepoints (immediate, 6 and 12 months post intervention). Evaluations include measures to assess protective factors associated with delayed sexual initiation and substance use. Discussion This is one of the first rigorous evaluations of a gender-specific, culturally tailored teen pregnancy and substance use primary prevention program for Native girls and their female caregivers. If proven efficacious, Native communities will have a culturally appropriate program for promoting protective factors associated with delayed substance use and sexual risk taking. Trial registration NCT04863729; April 27, 2021.
Collapse
Affiliation(s)
- Rachel A Chambers
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA.
| | - Jaime Begay
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Hima Patel
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Jennifer Richards
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Danielle Nelson
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Summer Rosenstock
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Ronni Huskon
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Kristin Mitchell
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Tiffani Begay
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| | - Lauren Tingey
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21231, USA
| |
Collapse
|
8
|
Sittner KJ, Hautala DS, Walls ML. Conjoint adolescent developmental trajectories of alcohol and marijuana use and early adult outcomes among North American Indigenous people. Addict Behav 2021; 114:106758. [PMID: 33316589 PMCID: PMC7785682 DOI: 10.1016/j.addbeh.2020.106758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The current study examined the developmental interrelationships between alcohol and marijuana use trajectories from ages 10 to 18 years in a sample of North American Indigenous adolescents. Distinct co-use groups were formed to create profiles of young adult outcomes. METHOD Dual group-based trajectory models of marijuana and alcohol frequency were estimated using data from a longitudinal community-based participatory study of Indigenous adolescents from the upper Midwest and Canada. Joint probabilities were used to create co-use groups, and profiles were created using early adult (Mean Age - 26.28 years) outcomes. RESULTS Four joint trajectory groups were identified: 1) no marijuana and no/low alcohol use (34.4%), 2) mid-onset alcohol only (14%), 3) mid-onset co-use starting at age 13 (24%), and 4) early-onset co-use starting at age 11 (22%). High probabilities existed that adolescents would use marijuana early if they began drinking alcohol at the youngest ages, and that adolescents would not use marijuana if they drank infrequently or delayed drinking until mid-adolescence. Adult outcomes were poorer for the early- and mid-onset co-use groups, but there were few differences between the no/low use and alcohol-only groups. CONCLUSION Co-use of marijuana and alcohol was associated with poorer outcomes in early adulthood, particularly for the group with an earlier age of onset. Abstaining from either substance in adolescence was associated with better outcomes.
Collapse
Affiliation(s)
- Kelley J Sittner
- Department of Sociology, Oklahoma State University, 431 Murray Hall Stillwater, OK 74078, United States.
| | - Dane S Hautala
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 1915 South Street Duluth, MN 55812, United States.
| | - Melissa L Walls
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 1915 South Street Duluth, MN 55812, United States.
| |
Collapse
|
9
|
Hautala D, Sittner K, Walls M. Latent Trajectories and Profiles of Commercial Cigarette Smoking Frequency From Adolescence to Young Adulthood Among North American Indigenous People. Nicotine Tob Res 2020; 22:2066-2074. [PMID: 32270190 DOI: 10.1093/ntr/ntaa063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 04/06/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION North American Indigenous people (ie, American Indian/Alaska Native and Canadian First Nations) have the highest rates of commercial cigarette smoking, yet little is known about long-term trajectories of use among this population. The purpose of this study is to examine heterogeneous trajectories and profiles of Indigenous cigarette use frequency from early adolescence (mean age: 11.1 years) to young adulthood (mean age: 26.3 years). AIMS AND METHODS Data come from a nine-wave prospective longitudinal study spanning early adolescence through young adulthood among Indigenous people in the Upper Midwest of the United States and Canada (N = 706). Smoking frequency was examined at each wave, and latent class growth analysis was used to examine heterogeneous patterns. Early adolescent and young adult demographics and smoking-related characteristics were examined across these latent trajectory groups. RESULTS In young adulthood, 52% of participants smoked daily/near-daily, and an additional 10% smoked weekly or monthly. Four latent trajectory groups emerged: low/non-smokers (35.2%) who had low probabilities of smoking across the study; occasional smokers (17.2%) who had moderate probabilities of smoking throughout adolescence and declining probabilities of smoking into young adulthood; mid-adolescent onset smokers (21.6%) who showed patterns of smoking onset around mid-adolescence and escalated to daily use in young adulthood; and early-adolescent onset smokers (25.9%) who showed patterns of onset in early adolescence and escalated to stable daily use by late adolescence. CONCLUSIONS The findings suggest multiple critical periods of smoking risk, as well as a general profile of diverse smoking frequency patterns, which can inform targeted intervention and treatment programming. IMPLICATIONS Nearly two-thirds (62%) of this sample of Indigenous people were current smokers by early adulthood (mean age = 26.3 years), which is substantially higher than national rates in the United States and Canada. Moreover, in all but one trajectory group, smoking prevalence consistently increased over time, suggesting these rates may continue to rise into adulthood. The longitudinal mixture modeling approach used in this study shows that smoking patterns are heterogeneous, and implications for public health policy likely vary across these diverse patterns characterized by timing of onset of use, escalation in frequency of use, and stability/change over time.
Collapse
Affiliation(s)
- Dane Hautala
- Department of Psychiatry, University of Minnesota Medical School, Duluth, MN
| | - Kelley Sittner
- Department of Sociology, Oklahoma State University, Stillwater, OK
| | - Melissa Walls
- Department of International Health, Johns Hopkins Center for American Indian Health and Johns Hopkins Bloomberg School of Public Health, Duluth, MN
| |
Collapse
|
10
|
Onset, Comorbidity, and Predictors of Nicotine, Alcohol, and Marijuana Use Disorders Among North American Indigenous Adolescents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1025-1038. [PMID: 30515623 DOI: 10.1007/s10802-018-0500-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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 SUDs 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 SUDs, 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.
Collapse
|
11
|
Heris CL, Chamberlain C, Gubhaju L, Thomas DP, Eades SJ. Factors Influencing Smoking Among Indigenous Adolescents Aged 10–24 Years Living in Australia, New Zealand, Canada, and the United States: A Systematic Review. Nicotine Tob Res 2019; 22:1946-1956. [DOI: 10.1093/ntr/ntz219] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/26/2019] [Indexed: 11/13/2022]
Abstract
AbstractIntroductionSmoking rates are higher among Indigenous populations in most high-income countries with initiation primarily occurring in adolescence for all population groups. This review aims to identify protective and risk factors for smoking behavior among Indigenous adolescents and young adults.Aims and MethodsWe searched Medline, Embase, and Psychinfo for all original research published between January 2006 and December 2016 that reported influences on smoking for Indigenous adolescents or young adults aged 10–24 living in Australia, New Zealand, Canada, and the United States (US). Extracted data were coded to individual, social, and environmental level categories using a modified Theory of Triadic Influence framework.ResultsA total of 55 studies were included, 41 were descriptive quantitative and 14 qualitative, and 26 included Indigenous participants only. The majority were from the US (32). Frequently reported influences were at the individual and social levels such as increasing age; attitudes and knowledge; substance use; peer and family relationships; smoking norms; mental health; physical activity. At the environmental level, smoke-free spaces; second-hand smoke exposure; high community level prevalence; and social marketing campaigns were also frequently reported. Some studies referenced price, access, and traditional tobacco use. Few reported historical and cultural factors.ConclusionsYoung Indigenous people experience similar influences to other populations such as smoking among family and friends. Greater youth smoking is related to broader community level prevalence, but few studies explore the distal or historical contributing factors such as traditional tobacco use, colonization, experiences of intergenerational trauma and discrimination, or the role of cultural connection.ImplicationsThis review identified a range of factors that influence Indigenous youth smoking and contributes to an understanding of what prevention measures may be effective. Youth tobacco use occurs alongside other substance use and may also serve as an indicator of mental health. Comprehensive community-based programs that work more broadly to address the risk factors related to tobacco, including improving youth mental health, will be important for other behaviors as well. This research highlights the importance of social influence and need for ongoing denormalization of smoking. Future Indigenous led and community owned research is needed to identify likely protective cultural factors.
Collapse
Affiliation(s)
- Christina L Heris
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Lina Gubhaju
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David P Thomas
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sandra J Eades
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
12
|
Ren M, Lotfipour S. Nicotine Gateway Effects on Adolescent Substance Use. West J Emerg Med 2019; 20:696-709. [PMID: 31539325 PMCID: PMC6754186 DOI: 10.5811/westjem.2019.7.41661] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 04/15/2019] [Accepted: 07/01/2019] [Indexed: 11/11/2022] Open
Abstract
Given the rise in teenage use of electronic nicotine delivery systems ("vaping") in congruence with the increasing numbers of drug-related emergencies, it is critical to expand the knowledge of the physical and behavioral risks associated with developmental nicotine exposure. A further understanding of the molecular and neurochemical underpinnings of nicotine's gateway effects allows emergency clinicians to advise patients and families and adjust treatment accordingly, which may minimize the use of tobacco, nicotine, and future substances. Currently, the growing use of tobacco products and electronic cigarettes among teenagers represents a major public health concern. Adolescent exposure to tobacco or nicotine can lead to subsequent abuse of nicotine and other substances, which is known as the gateway hypothesis. Adolescence is a developmentally sensitive time period when risk-taking behaviors, such as sensation seeking and drug experimentation, often begin. These hallmark behaviors of adolescence are largely due to maturational changes in the brain. The developing brain is particularly vulnerable to the harmful effects of drugs of abuse, including tobacco and nicotine products, which activate nicotinic acetylcholine receptors (nAChRs). Disruption of nAChR development with early nicotine use may influence the function and pharmacology of the receptor subunits and alter the release of reward-related neurotransmitters, including acetylcholine, dopamine, GABA, serotonin, and glutamate. In this review, we emphasize that the effects of nicotine are highly dependent on timing of exposure, with a dynamic interaction of nAChRs with dopaminergic, endocannabinoid, and opioidergic systems to enhance general drug reward and reinforcement. We analyzed available literature regarding adolescent substance use and nicotine's impact on the developing brain and behavior using the electronic databases of PubMed and Google Scholar for articles published in English between January 1968 and November 2018. We present a large collection of clinical and preclinical evidence that adolescent nicotine exposure influences long-term molecular, biochemical, and functional changes in the brain that encourage subsequent drug abuse.
Collapse
Affiliation(s)
- Michelle Ren
- University of California, Irvine, Department of Pharmaceutical Sciences, Irvine, California
| | - Shahrdad Lotfipour
- University of California, Irvine, Department of Emergency Medicine and Pharmaceutical Sciences, Irvine, California
| |
Collapse
|
13
|
Karki S, Laukkanen E, Länsimies H, Tuomainen TP, Pietilä AM. Substance use and associated emotional and behavioral problems in Nepalese adolescents. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2018.1562576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Suyen Karki
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Eila Laukkanen
- Department of Adolescent Psychiatry, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Helena Länsimies
- Administrative Centre, Kuopio University Hospital, Kuopio, Finland
| | - Tomi-Pekka Tuomainen
- Department of Public Health, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
14
|
Sittner KJ. Factors associated with Indigenous youths' abstinence from drinking. J Adolesc 2017; 59:8-18. [PMID: 28551200 DOI: 10.1016/j.adolescence.2017.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 05/09/2017] [Accepted: 05/12/2017] [Indexed: 10/19/2022]
Abstract
The proportion of youth who abstain from alcohol use decreases during adolescence but little attention has focused on factors associated with abstinence. No research has examined this question for Indigenous youth, many of whom live in communities experiencing high rates of alcohol-related health problems. Using data from a longitudinal study of Indigenous youth (n = 649, ages 10-17 years) in the U.S. and Canada, the current study investigates factors associated promoting or decreasing abstaining from alcohol use. Results from generalized linear growth models demonstrate that abstinence declines significantly during adolescence. In concurrent models, caretaker monitoring and school adjustment increased the odds of abstaining, and frequency of smoking cigarettes and number of best friends who drink decreased the odds. In lagged analysis, only school adjustment, smoking, and peer drinking remained significant. Time-stable characteristics moderated several time-varying associations. This study has important implications for programs aimed at encouraging alcohol abstinence.
Collapse
Affiliation(s)
- Kelley J Sittner
- Department of Sociology, Oklahoma State University, 431 Murray Hall, Stillwater, OK, 74078, United States.
| |
Collapse
|
15
|
Borloti E, García MVH, Jiménez VS, Sudbrack MFO. Drug use prevention projects in schools in Vitória, Brazil: quality analysis and improvement proposals. PSICOLOGIA-REFLEXAO E CRITICA 2017; 30:1. [PMID: 32026023 PMCID: PMC6967332 DOI: 10.1186/s41155-016-0056-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/14/2016] [Indexed: 11/17/2022] Open
Abstract
Adolescents living in vulnerable regions are more exposed to risk
factors for drug use. The prevention of such use in school is a public policy that
needs evaluation. Based on technical criteria and derived from a mixed research,
this article analyses the quality of school-based prevention of drug use in Vitória,
state of Espírito Santo, Brazil, and proposes improvements. A checklist of quality
elements was completed with data from 16 projects proposed by 99 teachers from
public schools. In 10 projects (62.5%), the approximate quality index was above
0.50. The majority of projects fulfilled the requirement of theoretical foundation
(81.25%) and some of the methodological (93.75%), design (75%) and implementation
(62%) requirements. Other requirements were absent: the majority were not designed
by the whole school community (87.5%), and the participation of the family (62.5%)
or the students as mediators (62.5%) was not considered. In general, contents of
life skills (87.5%), positive relationships and alternative activities to drug use
(56.25%) were not included. Activities for reinforcing the content were not
described in any of the projects, and evaluation activities were described in only a
few (31.25%). Many projects did not describe the inclusion of the project in the
school curriculum (62.5%). Although, considering all items of effectiveness,
regardless of their weight, more than half of the projects had an above average
quality. The present items provide quality to the projects, whereas absent items
indicate shortcomings to be improved using some of the measures described in this
study.
Collapse
Affiliation(s)
- Elizeu Borloti
- Universidade Federal do Espírito Santo - UFES, Av. Fernando Ferrari, 514 - Goiabeiras, Vitória, ES, CEP 29.075-910, Brazil.
| | | | | | | |
Collapse
|
16
|
Tomczyk S, Pedersen A, Hanewinkel R, Isensee B, Morgenstern M. Polysubstance use patterns and trajectories in vocational students--a latent transition analysis. Addict Behav 2016; 58:136-41. [PMID: 26943488 DOI: 10.1016/j.addbeh.2016.02.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/22/2015] [Accepted: 02/14/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The transition from late adolescence to early adulthood (16-20 years) represents a time of exploration and self-discovery for many young people. As such, it is often associated with experimentation in substance use. Vocational students in particular report high substance use. Thus, the aim of this study is to examine patterns and trajectories of their substance use behavior. METHODS On two occasions (interval 18 months), we investigated 5214 students (M=19.39 years; 54% male) from 49 vocational schools in seven German federal states. We identified classes of substance use and trajectories via latent transition analysis, controlling for gender, age, and socio-economic status. Additionally, we investigated work-related (job demands/stress/satisfaction) and psychopathological (depressive symptoms) predictors of substance use via multinomial regressions. RESULTS We found three latent stages of substance use: low use (baseline: 43%/follow-up: 44%), mainly alcohol use (50%/45%), and polysubstance use (7%/11%). Over time, 10% of alcohol users at baseline transitioned to polysubstance use at follow-up, while there were smaller transition rates (2-9%) between the other stages. Compared to low use, polysubstance use at follow-up was predicted by high job stress (aOR=1.45, 1.07-1.96) at baseline. CONCLUSIONS High alcohol use is associated with bidirectional transitions in young adults. Hence, future research needs to identify mechanisms of change to identify protective factors. Regarding vocational practice, early stress management seems to be a viable path to prevent polysubstance use in vocational students.
Collapse
Affiliation(s)
- Samuel Tomczyk
- Institute for Therapy and Health Research, Harmsstraße 2, 24114 Kiel, Germany.
| | - Anya Pedersen
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Kiel, Olshausenstraße 62, 24118 Kiel, Germany
| | - Reiner Hanewinkel
- Institute for Therapy and Health Research, Harmsstraße 2, 24114 Kiel, Germany; Department of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Barbara Isensee
- Institute for Therapy and Health Research, Harmsstraße 2, 24114 Kiel, Germany
| | - Matthis Morgenstern
- Institute for Therapy and Health Research, Harmsstraße 2, 24114 Kiel, Germany; Department of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| |
Collapse
|
17
|
Armenta BE, Sittner KJ, Whitbeck LB. Predicting the Onset of Alcohol Use and the Development of Alcohol Use Disorder Among Indigenous Adolescents. Child Dev 2016; 87:870-82. [PMID: 27028364 DOI: 10.1111/cdev.12506] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Empirical efforts to identify the predictors of drinking behavior among North American Indigenous adolescents are relatively limited. Using longitudinal data, this study considers perceived discrimination, positive drinker prototypes, and peer drinking behavior as risk factors for the onset of alcohol use and development of an alcohol use disorder among 674 Indigenous adolescents as they progressed from early to late adolescence (M age at baseline = 11.11, SD = 0.83). Results showed that positive drinker prototypes and associations with peers who drink increased the risk for the onset of drinking, while perceived discrimination and associations with peers who drink increased the risk for the development of an alcohol use disorder. The theoretical and practical implications of our results are discussed.
Collapse
|
18
|
Tomczyk S, Hanewinkel R, Isensee B. Multiple substance use patterns in adolescents-A multilevel latent class analysis. Drug Alcohol Depend 2015; 155:208-14. [PMID: 26233485 DOI: 10.1016/j.drugalcdep.2015.07.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Multiple substance use among adolescents is associated with a number of negative consequences. Therefore, we aim to investigate multiple substance use patterns among young adolescents and identify possible multilevel predictors. METHODS We analyzed a longitudinal sample of 2490 German students (51% male; Mage=13.32, SD=0.57) at 45 schools in four German states (Bremen, Hesse, North Rhine-Westphalia, Schleswig-Holstein), who completed two assessments in fall, 2010 and fall, 2013. We conducted multilevel latent class analysis for follow-up data on a variety of outcomes, and tested our final 3-class-model for possible baseline predictors. Follow-up substance use measures included lifetime use, current use, and amount of substance for cigarettes and alcohol. Baseline covariates comprised age, gender, socio-economic status, bullying, victimization, peer and parental use, type of school, and health certification of school. RESULTS We identified three latent classes: non-users (n=1541; 61.9%), experimenters (n=722; 29.0%), and multiusers (n=227; 9.1%). Experimental consumption was predicted by higher baseline age (OR=1.71; 1.31-2.24), paternal drinking (OR=2.89; 1.23-6.79), and school type (OR=2.57; 1.83-3.61), while multiuse was predicted by peer smoking (OR=2.94; 1.80-4.80) and drinking (OR=2.13; 1.32-3.44), maternal drinking (OR=6.26; 2.02-19.43), bullying (OR=1.69; 1.15-2.48), higher age (OR=1.92; 1.40-2.62), and school type (OR=4.76; 2.75-8.24) compared to the non-users class. CONCLUSIONS Prevention and further research on multiple substance use need to concentrate on social influence models and behavior-related interventions, especially at schools without a college-preparatory track.
Collapse
Affiliation(s)
- Samuel Tomczyk
- Institute for Therapy and Health Research (IFT-Nord), Harmsstraße 2, Kiel 24114, Germany.
| | - Reiner Hanewinkel
- Institute for Therapy and Health Research (IFT-Nord), Harmsstraße 2, Kiel 24114, Germany
| | - Barbara Isensee
- Institute for Therapy and Health Research (IFT-Nord), Harmsstraße 2, Kiel 24114, Germany
| |
Collapse
|