"Alcohol is something that been with us like a common cold": community perceptions of American Indian drinking

Depression and alcohol use in American Indian adolescents: The influence of family factors

BACKGROUND

Rates of both depression and alcohol use are disproportionately higher among American Indian (AI) adolescents than adolescents in the general population. The co-occurrence of depression and alcohol use is common and clinically relevant given their reciprocal negative influences on outcomes. Family factors may be especially relevant because they could have a buffering effect on this relationship due to the importance of kinship and community in AI communities. The current study examines the roles of family warmth and parental monitoring in the association between depressive symptoms and alcohol use in a large, nationally representative sample of AI adolescents.

METHODS

Data were collected from 3498 AI 7th to 12th graders (47.8% female) residing on or near a reservation during the period 2009 to 2013. Participants reported on their depressive symptoms, family factors, and alcohol use.

RESULTS

There was a small, but statistically significant positive association between depressive symptoms and alcohol use (r = 0.11, p < 0.001). Greater depressive symptoms were associated with significantly less perceived family warmth (β = -0.09, 95% CI [-0.13, -0.06]), which was associated with significantly greater alcohol use (β = -0.39, 95% CI [-0.55, -0.23]). Family warmth significantly accounted for the association between depressive symptoms and alcohol use at high (β = 0.04, SE = 0.02, 95% CI [0.004, 0.09]), but not low, levels of parental monitoring (β = 0.02, SE = 0.02, 95% CI [-0.002, 0.06]).

CONCLUSIONS

Results of the present study suggest that developing culturally sensitive prevention and treatment approaches focusing on increasing both family warmth and parental monitoring are important to address the co-occurrence of depression and alcohol misuse among AI adolescents.

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.

Health Disparities Research with American Indian Communities: The Importance of Trust and Transparency

American Indian and Alaska Native (AI/AN) communities experience notable health disparities associated with substance use, including disproportionate rates of accidents/injuries, diabetes, liver disease, suicide, and substance use disorders. Effective treatments for substance use are needed to improve health equity for AI/AN communities. However, an unfortunate history of unethical and stigmatizing research has engendered distrust and reluctance to participate in research among many Native communities. In recent years, researchers have made progress toward engaging in ethical health disparities research by using a community-based participatory research (CBPR) framework to work in close partnership with community members throughout the research process. In this methodological process paper, we discuss the collaborative development of a quantitative survey aimed at understanding risk and protective factors for substance use among a sample of tribal members residing on a rural AI reservation with numerous systems-level barriers to recovery and limited access to treatment. By using a CBPR approach and prioritizing trust and transparency with community partners and participants, we were able to successfully recruit our target sample and collect quality data from nearly 200 tribal members who self-identified as having a substance use problem. Strategies for enhancing buy-in and recruiting a community sample are discussed.

Alcohol use and the interpersonal theory of suicide in American Indian young adults

Suicide is the second leading cause of death for American Indian (AI) young adults. Alcohol use is a well-established risk factor for suicide. On average, AIs ages 12 to 20 exhibit the second-highest rate of binge drinking compared to all other ethnic groups. The current study investigated the relation between alcohol use and suicide ideation in an AI sample and examined these relations in the context of the interpersonal theory of suicide (ITS). It was hypothesized that perceived burdensomeness and thwarted belongingness would each significantly moderate the relations between alcohol use and suicide ideation in an AI sample. College students who self-identified as American Indian (N = 84) completed measures of alcohol use and associated problems, perceived burdensomeness and thwarted belongingness, and suicidality. Results indicated that perceived burdensomeness significantly moderated the relation between alcohol use and suicide ideation, and this interaction was significant at high levels of perceived burdensomeness. However, thwarted belongingness was not a significant moderator of the relation between alcohol use and suicide ideation. Findings suggest that AI young adults who engage in increased alcohol use may be at increased risk for suicide, especially if they also experience stronger perceptions of being a burden on others. The current study provides support for continued examinations of the relationship between alcohol use and suicide to inform culturally appropriate interventions for AI young adults.

The Prevalence of Fetal Alcohol Spectrum Disorders in An American Indian Community

The prevalence of fetal alcohol spectrum disorders (FASD) differs among populations and is largely unknown among minority populations. Prevalence and characterization of FASD is necessary for prevention efforts and allocation of resources for treatment and support. However, prevalence data are lacking, including among many minority populations. The aim of this study was to obtain an FASD prevalence estimate in a Southern California American Indian community employing active case-ascertainment. In 2016, American Indian children aged 5–7 years and their caregivers were recruited in collaboration with Southern California Tribal Health Clinic. Children were assessed using physical examinations and neurobehavioral testing. Parent or guardian interviews assessed child behavior and prenatal exposures including alcohol. Of 488 children identified as eligible to participate, 119 families consented and 94 completed assessments to allow a classification for FASD. Participating children (n = 94) were an average of 6.61 ± 0.91 years old and half were female. Most interviews were conducted with biological mothers (85.1%). Less than one third (29.8%) of mothers reported consuming any alcohol in pregnancy and 19.1% met study criteria for risky alcohol exposure prior to pregnancy recognition. Overall 20 children met criteria for FASD, resulting in an estimated minimum prevalence of 41.0 per 1000 (4.1%). No cases of fetal alcohol syndrome (FAS) were identified; 14 (70.0%) met criteria for alcohol related neuro- developmental disorder (ARND). Minimum prevalence estimates found in this sample are consistent with those noted in the general population.

Association of belief in the "firewater myth" with strategies to avoid alcohol consequences among American Indian and Alaska Native college students who drink

Belief in an American Indian/Alaska Native (AI/AN) specific biological vulnerability (BV) to alcohol problems (aka the "firewater myth") is associated with worse alcohol outcomes among AI/AN college students who drink, despite also being associated with greater attempts to reduce drinking. The current study examined how belief in a BV may have affected how 157 AI/AN college students who drink (a) attempted to moderate their alcohol use and avoid alcohol-related problems using abstinence-based and harm reduction strategies, and (b) attitudes toward these strategies as a means of addressing alcohol problems. Contrary to our hypotheses, belief in a BV was not found to be associated with use of harm reduction strategies or with how effective students believed these strategies to be. However, greater belief in a BV was associated with lower self-efficacy for the use of harm reduction strategies among more frequent heavy episodic drinkers. This is concerning, as the use of harm reduction strategies was associated with less frequent heavy episodic drinking in this sample. In contrast, belief in a BV was positively associated with the use of abstinence-based strategies and with how effective these strategies were perceived to be. However, for individuals with average or greater belief in a BV, abstinence-based strategies were associated with greater alcohol consequences. The results suggest that for AI/AN students who drink, belief in a BV may be influencing the strategies used to moderate alcohol use and avoid alcohol-related harm, as well as attitudes toward these strategies, in ways that do not appear helpful. (PsycINFO Database Record

The role of alcohol in identity construction among LGBT people: a qualitative study

Research suggests that alcohol use and misuse are higher among lesbian, gay and bisexual than heterosexual populations, yet the social context of drinking in sexual minority communities has rarely been examined. To explore lesbian, gay, bisexual and transgender (LGBT) people's relationship with alcohol, we conducted seven focus groups (N = 33) with pre-existing groups of friends and work colleagues (18 to 52 years) in Scotland, UK. We identified and analysed patterns in our data using thematic analysis. Respondents perceived heavy drinking as central to the commercial gay scene. Choice of drink and drinking vessel was an important part of identity construction. Respondents discussed the perception that gay men would drink alcopops and cocktails while lesbians would drink pints of beer. Even when stereotypes were dismissed as inaccurate, they were still thought to pressure people to drink 'appropriately'. Respondents who did not identify as male or female, and those who used drag, were particularly aware of their choice of drink as a means to express identity or to challenge people's preconceptions about gender. Researchers developing interventions to reduce alcohol-related harm in sexual minority populations need to take account of the central role of identity construction in LGBT drinking practices.

Descriptive drinking norms in Native American and non-Hispanic White college students

OBJECTIVE

College students tend to overestimate how much their peers drink, which is associated with higher personal alcohol use. However, research has not yet examined if this phenomenon holds true among Native American (NA) college students. This study examined associations between descriptive norms and alcohol use/consequences in a sample of NA and non-Hispanic White (NHW) college students.

METHOD

NA (n=147, 78.6% female) and NHW (n=246, 67.8% female) undergraduates completed an online survey.

RESULTS

NAs NHWs showed similar descriptive norms such that the "typical college student," "typical NA student," and "typical NHW student" were perceived to drink more than "best friends." "Best friends" descriptive norms (i.e., estimations of how many drinks per week were consumed by participants' best friends) were the most robust predictors of alcohol use/consequences. Effect size estimates of the associations between drinking norms and participants' alcohol use were consistently positive and ranged from r=0.25 to r=0.51 across the four reference groups. Negative binomial hurdle models revealed that all descriptive norms tended to predict drinking, and "best friends" drinking norms predicted alcohol consequences. Apart from one interaction effect, likely due to familywise error rate, these associations were not qualified by interactions with racial/ethnic group.

CONCLUSIONS

We found similar patterns between NAs and NHWs both in the pattern of descriptive norms across reference groups and in the strength of associations between descriptive norms and alcohol use/consequences. Although these results suggest that descriptive norms operate similarly among NAs as other college students, additional research is needed to identify whether other norms (e.g., injunctive norms) operate similarly across NA and NHW students.

Association of the firewater myth with drinking behavior among American Indian and Alaska Native college students

The firewater myth (FM) is the notion that American Indians and Alaska Natives (AI/ANs) are more susceptible to the effects of alcohol and vulnerable to alcohol problems due to biological or genetic differences. Believing that one is vulnerable to problems with alcohol may have negative effects on expectancies and drinking behavior among AI/ANs who drink; however, the association of belief in the FM with alcohol outcomes has not previously been examined. In this study we examined the factor structure of a revised version of the Firewater Myth Scale (FMS; LaMarr, 2003) and the association of belief in the FM with alcohol use, consequences, attitudes, and expectancies with 159 AI/AN college students who drink. On average, participants "slightly agreed" with the FM and scores were normally distributed. There were significant small to moderate positive associations between believing that AI/ANs have a biological vulnerability to problems with alcohol (i.e., the FM) and drinks consumed per week, frequency of heavy episodic drinking, and alcohol consequences, as well as belief in a disease model of "alcoholism," attempts to control drinking, guilt over drinking small amounts of alcohol, both positive and negative alcohol expectancies, temptation to drink heavily, and lack of self-efficacy to drink moderately. Although this is only an initial examination of potential consequences of belief in the FM for AI/AN students who drink, the results suggest that this belief may be harmful and have negative effects on attempts to moderate drinking. (PsycINFO Database Record

Association of contextual factors with drug use and binge drinking among White, Native American, and Mixed-Race adolescents in the general population

Large-scale surveys have shown elevated risk for many indicators of substance abuse among Native American and Mixed-Race adolescents compared to other minority groups in the United States. This study examined underlying contextual factors associated with substance abuse among a nationally representative sample of White, Native American, and Mixed-Race adolescents 12-17 years of age, using combined datasets from the National Survey on Drug Use and Health (NSDUH 2006-2009, N = 46,675, 48.77 % female). Native American adolescents displayed the highest rate of past-month binge drinking and past-year illicit drug use (14.06 and 30.91 %, respectively). Results of a logistic regression that included seven predictors of social bonding, individual views of substance use, and delinquent peer affiliations showed that friendships with delinquent peers and negative views of substance use were associated significantly with both substance abuse outcomes among White and Mixed-Race adolescents and, to a lesser extent, Native American adolescents. The association of parental disapproval with binge drinking was stronger for White than for Native American adolescents. Greater attention to specific measures reflecting racial groups' contextual and historical differences may be needed to delineate mechanisms that discourage substance abuse among at-risk minority adolescent populations.

Incorporating traditional healing into an urban American Indian health organization: a case study of community member perspectives

Facing severe mental health disparities rooted in a complex history of cultural oppression, members of many urban American Indian (AI) communities are reaching out for indigenous traditional healing to augment their use of standard Western mental health services. Because detailed descriptions of approaches for making traditional healing available for urban AI communities do not exist in the literature, this community-based project convened 4 focus groups consisting of 26 members of a midwestern urban AI community to better understand traditional healing practices of interest and how they might be integrated into the mental health and substance abuse treatment services in an Urban Indian Health Organization (UIHO). Qualitative content analysis of focus group transcripts revealed that ceremonial participation, traditional education, culture keepers, and community cohesion were thought to be key components of a successful traditional healing program. Potential incorporation of these components into an urban environment, however, yielded 4 marked tensions: traditional healing protocols versus the realities of impoverished urban living, multitribal representation in traditional healing services versus relational consistency with the culture keepers who would provide them, enthusiasm for traditional healing versus uncertainty about who is trustworthy, and the integrity of traditional healing versus the appeal of alternative medicine. Although these tensions would likely arise in most urban AI clinical contexts, the way in which each is resolved will likely depend on tailored community needs, conditions, and mental health objectives.

Substance use patterns among high-risk American Indians/Alaska Natives in Los Angeles County

BACKGROUND

Substance abuse among American Indians/Alaska Natives (AI/ANs) is a significant and long-standing health problem in the U.S. Two-thirds of American AIs/ANs reside in the urban setting. However, studies analyzing substance use characteristics among urban AI/ANs are very limited.

METHODS

Substance use patterns among a sample of AI/ANs (n = 77) and other ethnic/racial groups in Los Angeles County at high risk of substance abuse were analyzed utilizing three datasets from programs targeting individuals at high risk for substance abuse and risky sexual behaviors.

RESULTS

Compared to all other ethnic/racial groups, AI/ANs demonstrated significantly younger age of onset of alcohol, marijuana, methamphetamine, and "other" drug use, higher correlations of age of first use of amphetamine with a measure of the drug's reinforcement, and higher mean number of illicit drug injections in the 30 days before being interviewed.

CONCLUSIONS

Results from this study highlight a critical need for furthering our understanding of substance abuse problems among urban AI/ANs.

Taking humor seriously: talking about drinking in Native American focus groups

Focus groups provide a source of data that highlight community ideas on a topic of interest. How interview data will be utilized varies by project. With this in mind, we identify ways that focus group data from a particular population (Native American) articulate a health issue of individual tribal concern (alcohol consumption). Taking our analytic framework from linguistics, one of the four fields of inquiry in anthropology, we examine format ties and the performance of humor as stylistic features of tribal focus groups and illustrate how linguistic devices can be used in analyzing aspects of adolescent and adult drinking. Focus group data require systematic review and analysis to identify useful findings that can lead to inquiry points to initiate collaborative work with local experts before the data can be developed and configured into effective program initiatives.